What are the causes and symptoms of PCOS?
By Dr. Sharon Stills, NMD
In general, no two women with PCOS have the exact same collection of symptoms or
the same sequence of events leading to a PCOS diagnosis — but nearly all of them
are insulin resistant to some extent. But as important as insulin resistance is,
it’s just one player in a complex mix of hormonal imbalances — and how these imbalances
show up is as varied as women themselves! Knowing just what’s going on can help
clarify to women how they need to change their diet and lifestyle to reduce the
symptoms that make PCOS so bothersome. So let’s talk a little about how these imbalances
cause PCOS symptoms.
PCOS causes and solutions
This is a simplified diagram of the chain of events often leading to PCOS. The good
news is that limiting your carbs and taking other lifestyle measures can make a
Women with PCOS are typically dealing with the following hormonal scenario:
- High amounts of androgens (including testosterone), in combination with...
- Insulin resistance (impaired sugar tolerance)...
- Interacting in a positive feedback loop (meaning the one amplifies the other).
Some of the factors that can influence these different hormonal scenarios are genetics,
environment and lifestyle. Let’s take a closer look at the hormonal imbalances connected
Increased insulin. In the majority of women with PCOS,
the imbalance that most immediately needs to be addressed is the overproduction
of insulin (called hyperinsulinemia). This situation, over time, eventually
leads to insulin resistance, but it also stimulates the production of androgens,
which are sex hormones like testosterone that we usually consider to be “male” hormones.
It seems as though circulating insulin may also be one of the factors that confuses
the ovaries and when it’s reduced, the ovaries often function better. In the rest
of women with PCOS, research suggests that they are not insulin resistant, but they
are still producing excess androgens for some reason — and it’s not clear why.
Increased androgens. Excess androgens disrupt hormonal
balance and produce some of the characteristic signs of PCOS. It’s normal for women
to have some androgens, but when a woman produces excessive androgens, she can start
to have hair growth or hair loss in “male” patterns (facial hair and/or male pattern
Increased estrogen. Excess androgens can also be converted
into estrogen, and this excess estrogen in turn suppresses the surge in follicle-stimulating
hormones (FSH) that triggers ovulation. When this happens, ovulation generally
doesn’t occur, elevating luteinizing hormone (LH) and leading to low progesterone.
Without enough progesterone, the body can’t fully support normal ovulation and pregnancy.
Irregular/absent periods and cyst formation. Many women
with PCOS have irregular periods or stop menstruating altogether. At the same time,
when eggs aren’t released, cysts form. If ovaries produce an abundance of egg follicles
each month, but do not release any egg, a series of small cysts form that often
look like a pearl necklace — hence the name “polycystic” ovarian syndrome [“poly”
Common signs and symptoms of PCOS
- Irregular or absent periods
- Infrequent or lack of ovulation
- Hair growth in unwanted places
- Hair loss
- Acne and darkened skin patches
- Central-body weight gain
Signs and symptoms of PCOS and insulin resistance
Like most “syndrome” conditions, PCOS shows up differently in each woman, and each
woman’s PCOS symptom picture will change during the course of her lifetime, too.
Some women experience very few symptoms, while others have many. High androgens
may cause acne, male-pattern hair growth or hair loss, or other visible changes.
Of all the health concerns that women with PCOS and insulin resistance face, women
most often ask for help with irregular periods and unwanted weight gain.
- Irregular or absent periods. With PCOS, you may go for
months without a period. Or you may have difficult periods, bleeding heavily for
days or weeks. This occurs when the uterine lining has gotten too thick and the
body must naturally shed it. With a period — even regular periods — the ovary may
or may not have released an egg. This unpredictability can be very disturbing for
women, especially if they are trying to become pregnant. PCOS is one of the major
causes of infertility in women, affecting somewhere between 4% and 18% of women
of childbearing age.
- Unwanted weight gain. Extra fat cells fuel production
of extra estrogen, which further disrupts ovulation. What’s more, this extra padding
usually accumulates around the waist — where it can be more difficult to lose, even
with diet and exercise, and more likely to have adverse long-term effects on your
health, such as increased risk of cardiovascular disease.
Other, less obvious clues are often missed. Polycystic ovaries (PCO) can,
for example, occur with normal periods and normal androgen levels, or may come and
go. Some women with PCOS do not have cysts at all.
Hormonal imbalance is variable and dynamic, so its signs and symptoms are, too.
This is why diagnostic criteria for PCOS are open to interpretation — and why appropriate
diagnosis and treatment are too often delayed. Fortunately, there are a lot of natural solutions
for PCOS – like changing your diet and lifestyle factors — so the sooner
you recognize your symptoms for what they are, the better!
Related to this article:
References & further reading on the symptoms
and hormonal features of PCOS
Last Modified Date: 11/10/2013