What are the causes and symptoms of PCOS?
by Marcelle Pick, OB/GYN NP and Marcy Holmes, Women’s Health NP
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
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 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
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 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!
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements,
our exclusive endocrine support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at
1-800-798-7902. We're here to listen and help.
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