Insulin resistance

What are the causes and symptoms of PCOS?

by Marcelle Pick, OB/GYN NP and Marcy Holmes, Women’s Health NP

• Hormonal causes of PCOS
• Symptoms of PCOS

We’ve found that 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. It’s so common in the women who come to the clinic that we take the approach that our patients with PCOS have insulin issues until proven otherwise.

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! We’ve found that 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

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 about 80% of the women we see 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 other 20%, 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”].

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 us 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. (To learn more, read our article on PCOS and fertility.)
• 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: 11/10/2011
Principal Authors: Marcelle Pick, OB/GYN NP
& Marcy Holmes, NP, Certified Menopause Clinician