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Your guide to Polycystic Ovary Syndrome (PCOS)

Updated: Oct 14, 2023

Irregular menstrual cycles? Weird hair growth? Acne? Perhaps polycystic ovary syndrome is the cause.

PCOS affects 8 to 10% of reproductive age women. Decades ago, PCOS was rarely seen by healthcare providers, now it is one of the most common female endocrine disorders.

It often leads to many complications, including weight loss resistance and obesity, osteoporosis, heart disease, type 2 diabetes, and infertility.

Most treatment options for PCOS simply mask the condition with pharmaceuticals. However, addressing the root cause is vital to prevent complications and further ill health. Here I dive into the 4 major causes of PCOS, so you can actually address it for good.

paper design image of a women's reproductive organs

Firstly, let’s clarify, what is PCOS?

PCOS is a group of symptoms related to ovarian dysfunction (anovulation) and high levels of androgens or male hormones (testosterone, DHEAS and androstenedione).

Some of the signs and symptoms include:

  • Irregular periods (main symptom)

  • Dysfunctional bleeding (usually prolonged and heavy)

  • Excessive facial and body hair (hirsutism) – especially if on chin, cheeks, belly and around nipples.

  • Acne (Especially around the chin and jaw line. Not a reliable indicator if you’re a teenager though).

  • Hair loss from the head

  • Weight gain is common with a tendency toward apple shaped obesity in Insulin Resistant PCOS. (Ideally your waist should be less than half your height)

  • Infertility

How is PCOS diagnosed?

Despite the name, visualization of multiple cysts or follicles on the ovaries by ultrasound is not a reliable indicator of PCOS. For a true diagnosis, the woman must have indications of a failure to ovulate regularly, combined with signs of androgen or “male” hormone excess. Other reasons for high androgens should also have been ruled out.

Blood tests will often show high levels of free testosterone or other androgens such as androstenedione and DHEAS. Luteinising hormone (LH) is also often elevated. Progesterone is commonly low.

High oestrogen levels are also common but may not occur in those with very poor liver function and low cholesterol levels.

The high testosterone and androgen levels are what cause the androgenic or "male" symptoms of excessive hair and acne.

What are the root causes of PCOS?

woman drinking a sugary drink

Insulin Resistant PCOS

Insulin Resistance is thought to be the primary driver for 70% of PCOS sufferers.

Normally after eating, blood sugars (glucose) will briefly rise and the hormone insulin is released from the pancreas to take up the glucose and convert it to energy or to store it in the liver in the form of glycogen. This causes your blood sugar to fall and then your insulin levels to fall.

When you are insulin sensitive, both your sugar and insulin levels are low on a fasting blood test.

With insulin resistance, your body fails to respond to the insulin hormone, so the pancreas produces more and more insulin to try and get its message through. Fasting blood sugars can be normal, but your insulin is high. This situation is highly inflammatory to the body and the precursor to type 2 diabetes.

Too much insulin can also impair ovulation and stimulate your ovaries to produce testosterone, which is why it is a primary driver for PCOS.

What causes Insulin resistance?

  • Excessive sugar and processed carbohydrate consumption (especially products containing High fructose corn syrup)

  • Low muscle mass (usually due to lack of physical activity)

  • Too much adipose (fat) tissue

  • Consuming too many trans fats

  • Nutrient deficiencies such as low chromium, zinc, selenium, and magnesium levels

  • Stress and cortisol dysregulation

  • Lack of sleep

  • Exposure to inflammatory foods and environmental toxins

Fasting insulin should be less than 8mIU/L (55pmol/L). However if very low, the liver could have given up. To detect milder insulin resistance an Insulin Glucose Challenge test is needed where several blood samples are taken during the two hours following a sweet drink and insulin and glucose levels are measured.

Oral contraceptive pill

Post-pill PCOS

Another potential cause of PCOS symptoms is hormonal birth control as it can worsen insulin resistance, suppress ovulation, and certain types can cause a temporary surge in androgens when stopped. Fortunately, post-pill PCOS is usually temporary.

One of the only findings for post-pill PCOS is high lutenising hormone (LH) compared to follicle stimulating hormone (FSH). LH stimulates the ovarian follicles to make androgens leading to symptoms.

Going back on the pill is not the solution to PCOS, instead, it’s important to give it time and eat plenty of nutritious real food.

young woman in despair

Inflammatory PCOS

Inflammation is behind all types of PCOS and pretty much all other health challenges, but the term inflammatory PCOS is used if irregular periods and high androgens are present, yet there is no insulin resistance or stopping of hormonal birth control. There also needs to be signs of chronic inflammation like:

  • Digestive issues such as irritable bowel syndrome (IBS)

  • Food allergies or sensitivities

  • Headaches

  • Joint pain

  • Skin conditions such as eczema and psoriasis

  • Unexplained fatigue

Improving gut health is vital to address inflammatory PCOS and many other health challenges. Going low-tox and reducing exposure to environmental toxins is also a must. Smoking is a big inflammatory toxin to be aware of.

Adrenal PCOS

If coming off the pill wasn’t the cause, if there is no insulin-resistance, and no signs of inflammation then adrenal PCOS is a possibility.

The adrenals are a set of glands that sit on top of the kidneys and produce a variety of hormones including adrenaline, the steroids aldosterone, cortisol, and DHEAS androgens.

With adrenal PCOS, the ovarian androgens (testosterone and androstenedione) are normal but the adrenal androgens, DHEAS are elevated.

Other reasons for high DHEAS should be ruled out before diagnosing adrenal PCOS, which accounts for around 10% of PCOS cases.

An abnormal stress response, genetics, and endocrine-disrupting chemicals are thought to be behind adrenal PCOS. Reducing stress, and improving diet and lifestyle are therefore essential for an improvement in symptoms.

Polycystic ovary syndrome is essentially a problem with ovulation, which results in an overproduction of androgens (male hormones). There are 4 main types, many with common root causes like poor diet and gut health, excessive stress, lack of exercise, and exposure to environmental toxins. Addressing the root causes is absolutely necessary not just to improve periods, fertility, weight issues, and acne, but to prevent a host of other potential health issues.

For more information on PCOS and a number of other period-related issues I’d highly recommend reading Lara Briden’s book, The Period Repair Manual. Most of the info for this article came from this book and lectures through The Functional Medicine University.

Need help identifying and addressing the root cause of PCOS, acne or fertility issues then check out how you can work with me here. Or book a free discovery call first.

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