What Is PCOS?

Family history:

If you have a female relative with PCOS, there is a likelihood that you may have it too. You may be born with a susceptibility for PCOS, but our environment and what we experience may trigger the expression of these genes.

High levels of insulin (hyperinsulinaemia):

High androgen levels can be the result of high levels of insulin. Excess insulin causes the liver to make less sex hormone binding globulin (SHBG), the main protein that binds testosterone and clears it away. This creates more free testosterone and potentially more PCOS symptoms. Plus, high insulin can also cause the ovaries to produce more androgens, in particular testosterone. High insulin also stimulates your pituitary gland (in your brain) to produce luteinising hormone (LH), which is supposed to help ovulation, but when it’s at high level it unfortunately stimulates even more androgens to be produced by the ovaries. And what causes high insulin? Largely, it’s triggered by high levels of sugar or refined carbohydrates. And, over time, if these insulin levels stay high on a regular basis, it can lead to insulin resistance, a condition where the body doesn't respond properly to insulin (see below). Plus, smoking, stress, some hormonal birth control, sleep deprivation, alcohol, trans fats, unhealthy gut bacteria, magnesium deficiency and environmental toxins can all play a part too.

Inflammation:

Inflammation can directly stimulate the ovaries to produce more androgens. Inflammation can disrupt the normal development and function of ovarian follicles, impacting ovulation and contributing to irregular menstrual cycles.  Chronic inflammation in PCOS is linked to insulin resistance, a condition where the body doesn't respond properly to insulin. This can lead to increased insulin levels, which further stimulate androgen production in the ovaries and worsen PCOS symptoms. In a vicious cycle, insulin resistance can also cause inflammation – so the symptoms continue. PCOS can often lead to unwanted weight gain – particularly around the middle, known as ‘visceral fat’. In turn, visceral fat works as an ‘endocrine organ’ or tissue which can create signalling molecules, often secreting pro-inflammatory signalling molecules. This can cause inflammation, which in turn leads to more weight gain – so the symptoms continue. Eating an inflammatory diet of ultra processed foods, sugary drinks, or fried foods, or drinking excessive alcohol and smoking can add to our inflammatory load. Any other reasons that may be causing systemic inflammation: infections, gut issues, like IBS; autoimmune conditions; food sensitivities or intolerances; environmental allergens, even chronic stress!

Adrenal androgens and stress:

The adrenal glands, which sit on top of the kidney, are involved in the production of certain hormones and the regulation of stress hormones in the blood and may be affected in women with PCOS. The adrenal glands are responsible for at least 20-30% of the elevated androgens seen in PCOS. Chronic stress is therefore a major contributor to the development of PCOS symptoms, especially in normal or underweight women with non-cystic ovaries and normal insulin sensitivity. Elevated androgens, while causing PCOS symptoms, may be the body’s way of protecting the brain from the harmful effects of chronic stress. Research has suggested that cortisol is dysregulated in PCOS, primarily through increased hypothalamic-pituitary-adrenal (HPA) axis activity and enhanced cortisol secretion, which can also potentially lead to elevated adrenal androgen production in PCOS, such as dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS), androstenedione, and androstenediol. And, even without the androgens being involved, higher levels of cortisol are not optimal for either overall health or for fertility. Cortisol can disrupt our menstrual cycle, increase appetite (particularly for sugary foods), promote weight gain, especially around our middle where it is more harmful to our health and impair our immune function.

Exposure to endocrine-disrupting chemicals:

Xenoestrogens can mimic or interfere with how normal hormones work, like oestrogen and androgens, leading to an imbalance in the endocrine system. This imbalance can contribute to the development and progression of PCOS. Some xenoestrogens, like BPA found in plastic water bottles, have been linked to increased insulin resistance. Xenoestrogens may increase inflammation in the body. They may also contribute to fat accumulation, especially visceral fat, which is linked to insulin resistance and other PCOS-related issues. Xenoestrogens can interfere with normal ovarian function, potentially disrupting follicular development and ovulation, which are essential for healthy menstrual cycles. Exposure to xenoestrogens, even during prenatal development, may contribute to altered foetal programming and the development of PCOS later in life. Continued exposure throughout the lifespan can further disrupt hormonal balance and exacerbate PCOS symptoms. 

Post-pill surge in androgens:

Stopping the contraceptive pill can sometimes lead to a temporary surge of hormones, which can mimic or worsen symptoms of PCOS, but it doesn't cause PCOS itself. This is sometimes referred to as "post-pill PCOS" or post-birth control syndrome. While the symptoms may seem to worsen after stopping the pill, it's important to distinguish this from a true PCOS diagnosis, as PCOS is a chronic condition.