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

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 big difference.

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 to PCOS.

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 baldness).

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” = “many”].

Common signs and symptoms of PCOS
  • Irregular or absent periods
  • Infrequent or lack of ovulation
  • Infertility
  • Hair growth in unwanted places
  • Hair loss
  • Acne and darkened skin patches
  • Central-body weight gain
  • Cravings
  • Anxiety
  • Depression
  • Fatigue

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!


Moran, L., & Teede, H. 2009.

2 Legro, R., et al. 2004. Detecting insulin resistance in polycystic ovary syndrome: Purposes and pitfalls. Obstet. Gynecol. Surv., 59 (2), 141-154. URL (abstract): (accessed 04.29.2011).

3WebMD. 2011. Polycystic ovary syndrome (PCOS) — symptoms. URL: (accessed 05.18.2011).

4Halperin, I., et al. 2010. The association between the combined oral contraceptive pill and insulin resistance, dysglycemia and dyslipidemia in women with polycystic ovary syndrome: A systematic review and meta-analysis of observational studies. Hum. Reprod., 26 (1), 91-201. URL (abstract): (accessed 04.29.2011).

5 March, W., et al. 2010. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum. Reprod., 25 (2), 544-551. URL: (accessed 04.29.2011).

Lukaczer, D. 2005. The epidemic of insulin insensitivity. In Textbook of Functional Medicine, ed. D. Jones & S. Quinn, 247. Gig Harbor, WA: Institute for Functional Medicine.

Azziz, et al. 2004. The prevalence and features of the polycystic ovary syndrome in an unselected population. J. Clin. Endocrinol. Metab., 89 (6), 2745-2749. URL: (accessed 05.18.2011).

Sheehan, M. 2004. Polycystic ovarian syndrome: Diagnosis and management. Clin. Med. Res., 2 (1), 13-27. URL: (accessed 04.29.2011).

Asunción, M., et al. 2000. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J. Clin. Endocrinol. Metab., 85 (7), 2434-2438. URL: (accessed 05.18.2011).

Nestler, J. 1999. Chapter 19. Insulin resistance effects on sex hormones and ovulation in the polycystic ovarian syndrome. In Insulin Resistance: The Metabolic Syndrome X (Contemporary Endocrinology), 347. G. Reaven & A. Laws, eds. Totawa NJ: Humana Press, Inc.

Diamanti-Kandarakis, E., et al. 1999. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: Hormonal and metabolic profile. J. Clin. Endocrinol. Metab., 84 (11), 4006-4011. URL: (accessed 05.18.2011).

Knochenhauer, E., et al. 1998. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: A prospective study. J. Clin. Endocrinol. Metab., 83, 3078-3082. URL: (accessed 05.18.2011).

6 García-Romero, G., & Escobar-Morreale, H. 2006. Hyperandrogenism, insulin resistance and hyperinsulinemia as cardiovascular risk factors in diabetes mellitus. Curr. Diabetes Rev., 2 (1), 39-49. URL (abstract): (accessed 05.17.2011).

7 García-Romero, G., & Escobar-Morreale, H. 2006.

8 Koiou, E., et al. 2011.

Li, X., & Lin, J. 2005. [Clinical features, hormonal profile, and metabolic abnormalities of obese women with obese polycystic ovary syndrome]. Zhonghua Yi Xue Za Zhi, 85 (46), 3266–3271. URL (abstract): (accessed 05.18.2011).