The Root Causes of Polycystic Ovarian Syndrome (PCOS)

The good thing about Polycystic Ovarian Syndrome (PCOS) (yes there are some positives!) is that when you identify and address the root causes, symptoms can often be reversed!

It may take you a little time to figure out what your personal causative factors are, however once you do, you can absolutely live a life with balanced hormones.

I believe nutrition and naturopathic medicine works wonders for women with Polycystic Ovarian Syndrome (PCOS), however it often takes than conventional medicine to see changes, because changes are being made at a cellular level.


What actually is PCOS?

PCOS is a syndrome, meaning that a constellation of symptoms such as acne, hair loss, hirsutism, weight gain and irregular cycles are commonly experienced.

It is the leading cause of infertility in women of reproductive age and it is believed that 1 in 10 (some say up to 1 in 5!) women suffer with this condition.

The main problem with PCOS is that women have higher than normal androgen (male hormone) levels, which can prevent ovulation from occurring and cause the symptoms I listed above.

All women should have 'male hormones' present, just as men have 'female hormones' like oestrogen, however they should be in much smaller amounts.

A common misconception is that the cystic appearance of the ovaries, which are often present on an ultrasound, are the cause of anovulation (not releasing an egg) and androgenic symptoms. However these 'cysts' are actually undeveloped follicles, which can occur as a result of PCOS, but they aren't the cause.

You could perform an ovarian ultrasound on 'normal' women without hormone imbalances, and around 1 in 4 will have ovaries with a 'polycystic appearance'!

Instead of asking which diet to follow or supplements to take for your PCOS symptoms, you need to be asking WHY!

Here are the common root causes and triggers of Polycystic Ovarian Syndrome...

- Genetics

PCOS can run in families, and you are much more likely to develop it if you have a mother, sister or aunt with this condition. However we now know that epigenetic (environmental) factors can actually decide whether our genes for conditions like PCOS get 'switched on' or not.

This means that if you are living a similar lifestyle to your family members who have PCOS, then you will probably develop it too. However if you eat healthily, exercise and avoid some of the other factors in this post, then you can actually reduce the likelihood that this will develop.

If your mother was obese, stressed, a smoker or exposed to certain environmental toxins during pregnancy, this can increase your chances in developing PCOS. It also goes back to your grandmother too! When your mother was developing in her mothers womb, you were in there too, as a teeny egg in your mothers ovary. This is because females are born with all the eggs they will ever have!

- Inflammation

Inflammation is the driver of all chronic disease, including diabetes, bowel disease, Alzheimer's and cancer. It is finding the source of the inflammation that can be difficult.

Eating foods you are sensitive to, having a chronic gut infection, consuming refined sugar or poor quality fats and high stress levels can all promote inflammation within the body. Inflammation, along with insulin resistance, are the two biggest drivers of PCOS symptoms.

Inflammation can up-regulate the 5-alpha reductase enzyme that converts testosterone into the super potent metabolite dihydrotestosterone (DHT). It can also trigger our adrenal glands to produce more androgenic hormones and can both cause and exacerbate insulin resistance.

Things such as omega 3 fats, turmeric, ginger and dark leafy green vegetables can help to reduce inflammation, however it is important to understand WHY it is occurring. Your body may be chronically inflamed as a protective mechanism so that you can heal or fight hidden infections for example.

Weight gain / Weight loss

A dramatic increase in weight or weight loss can both trigger the start of PCOS symptoms for many women. An increase of fat tissue can actually promote inflammation, oestrogen dominance and insulin resistance, a common trio of factors present in women with PCOS. Fat tissue isn't just inert, it is a metabolically active endocrine organ, meaning that it has the ability to release it's own hormones.

The good thing is though that for many women who are overweight, losing just 5-10% of their body weight can result in reduced androgens and restored ovulation. This is often easier said than done however, for women with PCOS.

When we lose too much weight or at a rapid rate, this is a huge stressor to the body and can signal 'famine' to our brain. The hypothalamus in the brain can then down regulate the production of thyroid hormone and sex hormone production like oestrogen and progesterone, throwing our hormonal balance out of whack.

At the same time, our adrenal glands may start to function on overdrive and can pump out a ton of cortisol, adrenaline and androgens such as DHEA-S. This can lead to reduced levels of female hormones and therefore a relative increase of adrenal produced male hormones.

Side note: If you lose your period and develop PCOS like symptoms due to over exercising and under eating this could actually be a condition known as Hypothalamic Amennorhea (HA) Check out this article, to determine if you are dealing with true PCOS, H.A or both!

- Insulin resistance

Around 70% of women with PCOS have some degree of insulin resistance. When our blood glucose levels rise after eating, our pancreas releases the hormone insulin to help to transport glucose from the bloodstream, into our cells for energy. You can think of insulin as a key to 'unlock' the cells.

When we use this 'key' too frequently (pumping out insulin due to excessive intake of refined carbs/sugar) or the lock becomes damaged (due to inflammation, nutrient deficiencies, poor cell membrane function) this can prevent glucose entering the cells, and therefore leads to elevated levels in the bloodstream, which the body hates! The body then stores the excess glucose in the liver as glycogen, and when the liver's stores are full, the rest is stored as fat. The pancreas continues to pump out insulin in attempt to fuel the cells.

Elevated insulin levels can stimulate the ovaries to produce testosterone and other androgens. This is often the 'classic' type of PCOS and is typically the only cause that conventional doctors are familiar with.

Although excessive carbohydrate consumption can lead to insulin resistance, so can frequent eating, lack of sleep, chronic stress, poor gut health, lack of exercise, nutrient deficiencies, inflammation and environmental toxins. Some indicators of insulin resistance include elevated fasting insulin on a blood test, weight gain around the mid-section, sugar cravings, fatigue after eating carbohydrates, excessive thirst and urination.

- High stress

Androgens are not just produced in the ovaries. It is believed that 50% of women with PCOS have elevated adrenal androgens.

Our adrenals are two walnut shaped glands that sit on top of our kidneys and control our stress response. One marker that is often elevated when stress is driving PCOS symptoms would be DHEA-S, as this androgen is uniquely made in the adrenal glands. That being said, stress can elevate other androgens produced by both the ovaries and adrenals, such as androstenedione, etiocholanalone, tesosterone and DHEA.

Chronic stress also increases blood sugar levels therefore contributing to insulin resistance, up-regulates the 5-alpha reductase enzyme that produces DHT (which is 3x as potent as testosterone) and can hinder progesterone production (which is a natural anti-androgen).

Stress isn't just phycological. Our body can be stressed out due to physical stressors such as dehydration, a poor diet or over-exercising and/or biochemically stressed due to things like blood sugar imbalances and nutrient deficiencies.

It is very important that we do pay attention to our mental stress and mindset. Our body doesn't know the difference between a thought and an actual life-threatening event. Whether we are sat on the sofa worrying about an unpaid bill or almost get into a car accident, our body can react in the exact same way (heart pounding, sweaty palms, burst of adrenaline).

If you can learn to stop being so reactive to small, every day stressors such as traffic, deadlines, misbehaving children and dirty dishes) then this is going to reduce your inputs to the 'stress bucket'. We should all be adding in stress relieving activities into our daily routine, especially if you are dealing with PCOS. Check out some of my favourite recommendations here.

- Environmental toxins

There's almost no escaping environmental toxins in our modern world. Women with PCOS tend to be more sensitive to exposure and have been found to bio-accumulate substances, such as BPA in plastic. I believe that women with PCOS are like canaries in the coal mine, in the fact that they tend to respond more obviously to chemicals and toxins, than the rest of the population.

A lot of these environmental toxins are known endocrine disrupters, meaning that they have the ability to interfere with or 'mimic' our own natural hormones. Certain pesticides, plastics and chemicals like phthalates found in personal care products, are common examples.

The most crucial time to avoid exposure is the time between early foetal development and puberty, as this is the time that our hormone programming develops. Your mothers lifestyle and environmental exposures may have influenced the development of this hormone imbalance, however we cannot blame, as this information isn't common knowledge.

That being said, we do have control of what we expose ourselves to in our homes. Going organic, ditching plastic and buying non-toxic personal care products can greatly reduce our toxic load and stores of these endocrine disrupters. One study found that going organic, reduced levels of pesticides, in one families bloodstream, to almost zero, in just 2 weeks!

- Thyroid issues

PCOS and thyroid issues often go hand in hand and it is believed that 25% of women with PCOS have a thyroid condition. This is because the thyroid, ovaries and the adrenal glands are what I like to call the holy trinity! You can think of them as a 3 legged stool, when one goes out of whack, the others are going to follow. Thyroid issues are often a 'hidden cause' of PCOS symptoms.

It's a chicken and egg situation. We aren't sure which hormone imbalance develops first, but they are intimately connected. The inflammation and metabolic chaos that often comes along with PCOS can impair thyroid production, however an under-active thyroid can also drive insulin resistance and a sluggish metabolism.

Some women can actually be misdiagnosed as having PCOS when they are dealing with hypothyroidism, because they can both share similar symptoms like anovulation, long menstrual cycles (35+ days), hair loss, acne and weight loss resistance.

Women with hypothyroidism can have elevated androgens and often display the 'cystic appearance' on an ovarian ultrasound, because the ovulation process can be disrupted or halted. One study found that the polycystic ovary appearance completely disappeared when thyroid function was restored.

- Birth control pill use

Many women take the pill to 'manage' their PCOS symptoms, however some women only seem to develop issues like cystic acne, hair loss, irregular periods and hirsutism once they stop taking the oral contraceptive pill! This is often at a time when they are struggling to conceive and therefore undergo investigation from their Doctor, who subsequently diagnoses them with PCOS. Even if they have no family history and had zero hormonal symptoms beforehand!

The majority of these women are dealing with 'post-pill PCOS', also known as post birth control pill syndrome (PBCS). The pill works by shutting down the communication between your brain and ovaries for the entire time you are taking it, meaning that our natural hormone production is suppressed and we are instead pumped with synthetic hormones. They can also raise sex hormone binding globulin (SHBG) which acts as a sponge, soaking up excess androgens in the bloodstream.

When we stop taking the pill, our brain and ovaries begin communicating again and our body has to re-learn how to produce hormones again, especially androgens! This can result in overproduction of male hormones in the 3-6 months after we discontinue this medication, resulting in oily skin, acne breakouts, hair loss and missing periods. This is known as an androgen rebound, and it is one of the main reasons that women are scared to stop taking the pill.

Thankfully, this is often a temporary state, and as long as we restore the multiple nutrient deficiencies caused by the pill, manage stress, control inflammation and live a healthy lifestyle, we can expect these symptoms to eventually rebalance.

The frustrating thing is that women are told they have PCOS and may be put back on the pill or unnecessary medication to 'treat' their symptoms. Plus they may start to 'self treat' after researching about PCOS and possibly embark on a low carb diet and intense exercise, thinking this will help. However this will likely make things a whole lot worse. These women may also believe that they need IVF, because they have 'fertility issues'.


Next steps...

The best way to determine the causes of your PCOS is to create a symptom timeline and assess if you've been exposed to any of the factors discussed in this post.

Lab testing is also recommended to see if factors such as insulin resistance, chronic gut infections or stress-related adrenal hormones are present. Your GP may be happy to run certain blood markers, however for the more specific tests, you may need to order functional lab tests through a more holistic health practitioner.