There are some women on here who have been successful with diet and exercise alone, but it depends entirely on the nature and degree of your symptoms. Unfortunately, PCOS is one of those issues where we're all different and any given course of treatment is going to need tweaked for the individual.

That said, there seem to be a few different commonalities I've seen while observing the responses in the forums:

1. The "nearly normal" ladies, who are fortunate enough to be able to lose weight the same way everyone else does -- a moderate calorie deficit and exercise a few days a week.

2. The "extreme 'normal'" ladies, who can do it entirely with diet and exercise, but need to go to one extreme or another -- create a 2lb/week deficit to lose 1lb/week, exercise an hour a day, every single day, etc. Depending on your point of view, the women who use the LCHF/ketogenic ways of eating would also fall into this. (I don't consider such ways of eating to be "extreme," really, but a lot of people who have only ever eating the SAD/Western way of eating see it as extreme.)

3. The "Metformin miracle" ladies, who become basically "normal" solely by taking some Metformin. The amount varies, but their amount of Metformin is enough to make everything else "click" back into place and become "normal."

4. The "Metformin plus" ladies, who need something in addition to Metformin, usually Spiro, or if the doctor knows what they're doing and the woman doesn't want kids right now, it may be a birth control like Yaz. These are the ones who the Metformin works for weight loss (kind of), but the acne, hair, and skin issues are still a problem (that's where the "plus" comes in).

5. The "alternative medicine" ladies, who use supplements instead of prescription medications. Usually, this includes at least Myo-Inositol or D-Chiro Inositol, sometimes both, and possibly other supplements, including magnesium, folate, and/or choline.

Given your acne issues, I would highly recommend looking into at least supplementing Myo or D-Chiro Inositol. It's been fairly well-studied to have positive effects on a number of the problem areas women have with PCOS, including acne. Inositol is a "pseudo-vitamin" that we usually make in our own bodies, but there's evidence that women with PCOS don't make enough or can't adequately convert the ones we do make enough of.

Aside from that, it is possible, though can be a slow and difficult road. Hold on to whatever progress you make and remember it when you start feeling down.

Hi, I have been on Spiro & BC for years. Every time that I try to go off the BC, my hormones get really messed up. I always end up going back on it. With the spiro, I get acne, facial hair, bloated once I stop taking it. I am concerned about the side effects, but have found, at least for me, that the benefits outweigh side effects. I do plan to go back to doctor to see if there is anything else that I can do. I would like to be able to stop taking meds, especially since there is risk of blood clots as you get older with taking hormones.

It is a battle, but I try to maintain my weight in the normal BMI range. I have had trouble with insulin resistance in the past, but maintaining my weight & cutting down on carbs/sugar really helps ALOT! I have to constantly count calories. I have pretty severe carb cravings, and it seems like once I start eating high carb foods, it is hard to stop! Keeping track helps keep me accountable.

It is possible to lose weight with PCOS & control symptoms. I think everyone is different in regards to medication, etc. The key is to find out what works for you.

I've lost and maintained successfully on low carb but the rest of my symptoms certainly didn't go away (just as I had symptoms before I was ever fat)

I'm currently seeing an ND (Naturopathic Doctor) and am opting for a natural treatment approach. I'm taking Inositol as well as Testoquench for Woman.

I've seen drastic results in regards to my Insulin Resistance, I still eat low carb but even when I don't I'm still loosing (OMG!) The rest of my hormonal symptoms have yet to be determined if they are improving (it's too soon to tell as it's only been a month). I'll certainly keep you posted.

I have recently (within the last month) come of hormonal BC and do not take Metformin. Since I have come off the BC, I have seen some of my symptoms return (my hair is shedding/falling out more often and bits of acne have popped back up). But, I did not like the BC I was on (my cycle still wasn't regular on the BC) and decided to come off of it and see if I could control thing through diet and exercise. I recently also started taking the supplement vitex chasteberry, but haven't been taking it long enough to know yet if it will help regulating things. Time will tell, I suppose.
According to blood work, it doesn't look as if I have insulin resistance and finding any information on PCOS without insulin resistance is pretty tough. I'm not sure if it even makes a difference in how to approach treating the PCOS.