What is polycystic ovary syndrome (PCOS)? Symptoms, causes, and what drives PCOS

August 15, 2022

Author: Eliška Hosnedlová, IHP (Certified Integrative Health Practitioner and Femvie specialist )

PCOS ( Polycystic ovary syndrome) is one of the most common problems in women's health, and yet we know so little about it! Why and how does it occur? How do hormones become imbalanced and what role does metabolism play? And what type of PCOS do you actually have?

What is PCOS?

Polycystic ovary syndrome, also known as PCOS, is a metabolic and hormonal condition in which a woman's body produces excess androgens, male hormones. It is one of the most common endocrine disorders in women of reproductive age, affecting 6-12% of women worldwide.( 1 )

Symptoms of PCOS

Symptoms vary widely; not every woman necessarily experiences every one of them, and some symptoms may indicate a problem other than PCOS.

The most common manifestations include:

Irregular cycle, missed period, or very light bleeding
Hair growth on the face, chest, arms or abdomen – in places where we know it mainly in men
Acne or oily skin
Infertility or difficulty conceiving due to irregular cycles and anovulation
Polycystic ovaries on ultrasound
Increased weight, especially in the abdominal area
Excessive hair loss
Small skin growths on the neck or armpits
Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts

PCOS

PCOS – polycystic ovaries?

Regardless of the name, what we can see on the ultrasound are not actually cysts at all. ( 2 ) They are an increased number of follicles that have not completed their development and therefore have not ovulated. In a normal, healthy cycle, one of the many follicles would dominate, which would eventually complete development with an egg inside, and at the time of ovulation, the mature egg would be released from the ovary and wait in the uterus for fertilization. However, in order to ovulate, we need to have the right hormone levels.

However, anovulatory cycles and underdeveloped follicles on the ovaries are not only known to women with PCOS. This is a common phenomenon in irregular cycles, in adolescence , when the body is just learning to work with hormones, but from time to time it is also natural for those of you who have an exemplary cycle, for example due to illness or current stress.

This is the first and most important reason why PCOS should not be diagnosed based on ultrasound alone. But more on how to get the right diagnosis next time.

Why are androgens imbalanced?

Androgens belong to a group of hormones that primarily influence the growth and development of the male reproductive system . In women, androgens are the so-called precursors of estrogens, which means that they are necessary for their formation and function. At the same time, androgens participate in the growth of bones and muscles, or in female libido. In the female organism, they are formed in the ovaries and adrenal glands from a common basis - cholesterol.

While we cannot ignore the importance of androgens in the female body, their excessive production affects a woman’s overall hormonal health. Interestingly, it is estimated that more than 80% of women who show signs of hyperandrogenism (i.e. excessive androgen production), including acne or excessive hair loss, suffer from PCOS.( 3 )

What are the main causes of increased androgen production?

Hormonal contraception – some types of hormonal contraception contain progestin along with androgens, which cause side effects such as hair loss or acne ( 4 )
Adrenal androgens , which are androgens derived from the adrenal glands. Their levels can be increased by high levels of prolactin, due to excessive stress, or the main cause is a congenital disease of the adrenal cortex called Congenital Adrenal Hyperplasia (CAH) ( 5 )
Insulin resistance , which results from high insulin levels leading to overproduction of androgens from the ovaries, is one of the most common causes of PCOS ( 6 )

The role of metabolism and the effect on hormones

Although PCOS is often treated primarily from the perspective of hormonal health and androgen production, it is a very complex problem. We must not forget the role of metabolism , which plays an important, sometimes primary, role in the development of PCOS.

Polycystic ovary syndrome is closely linked to metabolic disorders such as insulin resistance. Insulin resistance is a condition in which cells in muscle, fat, and liver do not respond well to insulin and cannot easily take up glucose , the blood sugar. In addition to PCOS, insulin resistance also promotes the development of other metabolic disorders such as type 2 diabetes, hypertension, and cardiovascular disease. ( 7 )

PCOS

As a result of insulin resistance, the pancreas continues to produce and release insulin, but it is not used. ( 8 ) This results in high insulin levels in the body.

How does insulin affect androgen production?

Insulin reduces the release of SHBG from the liver, which increases the bioavailability of free testosterone in the blood, and promotes increased androgenic activity (9 )
Insulin stimulates the hormone LH, which is involved in the menstrual cycle, and can disrupt follicle maturation and stop ovulation ( 10 ).
Insulin promotes LH, high levels of which contribute to higher androgen production ( 11 )

Adrenal glands and adrenal androgens

While insulin resistance and elevated insulin often drive testosterone production in the ovaries, androgens can also come from another source, the adrenal glands . In a stressful situation, the brain, or rather the hypothalamus, together with the pituitary gland, use hormones to stimulate the adrenal glands to produce cortisol , adrenaline, and noradrenaline, the main stress hormones. If the stress does not go away (this is called chronic stress ), the body must intervene with other protective measures. This is where the adrenal androgens from the adrenal glands, DHEAS and androstenedione, come in, which are responsible for protecting the brain from the negative effects of cortisol and other stress hormones. ( 12 ) In addition, they also cause the typical symptoms of PCOS.

What are the different types or what drives PCOS?

Insulin resistance

Insulin resistance affects up to 70% of women diagnosed with PCOS. ( 13 ) High insulin drives androgen production. This condition can be reduced or completely reversed through lifestyle, exercise, and diet.

Tips for improving insulin sensitivity

Regular exercise, preferring strength training over cardio
Combine proteins, fats and carbohydrates at every meal
Focus on basic, natural foods that are minimally processed

After HAK withdrawal

We do not necessarily classify this type as a type of PCOS, because in many cases it is only a temporary condition related to the discontinuation of contraception. Problems and symptoms similar to those of PCOS often occur 3-6 months after discontinuation. First of all, some pills may contain a load of androgens, which messes with the level of our own hormones a little. At the same time, endogenous (natural to the body) hormones have been turned off while taking contraception, so the body tries to compensate for any imbalance, and it may take a while for the hormones to balance out. Until the body is in an optimal state, ovulation does not occur, so undeveloped follicles remain on the ovaries.

Tips for supporting the body after stopping hormonal contraception

Pay attention to a high-quality, varied diet
Instead of dieting, try to nourish the body
Consider some dietary supplements, such as magnesium or B vitamins
Be patient, hormones will balance themselves over time thanks to the right lifestyle

Inflammation

In this case, chronic inflammation in the body plays a crucial role in the development of PCOS. As a result of the inflammation, the ovaries produce higher amounts of testosterone, and in addition to the typical symptoms of androgen overproduction, you may experience intestinal and digestive problems, joint pain, or migraines.

Tips for reducing inflammation in the body

Include plenty of anti-inflammatory foods, such as salmon, extra virgin olive oil, berries, or dark green leafy vegetables
Consume quality meat and bone broth regularly
Add anti-inflammatory herbs and spices to every meal, such as cinnamon, turmeric, ginger, holy basil, oregano, or rosemary.

Adrenal PCOS

Stress, whether emotional or physical, causes the adrenal glands to release more cortisol, which also increases adrenal androgen levels. In this type of PCOS, insulin resistance may not be the cause, but rather adrenal stress, so focus on calming your body and your mental state.

Tips for Adrenal PCOS

Prioritize quality and sufficient sleep
Work with stress, think about what you can influence in your life and what you cannot.
Consider some supplements to manage stress and calm the nervous system, such as magnesium or B vitamins, and some adaptogens may also help.

Polycystic ovary syndrome is a very complex topic, and every woman must approach it in a slightly different way. Based on the type of PCOS that arises. If you have any questions about women's health, do not hesitate to contact our experts at the Femvie consultation . They will be happy to answer everything for free.*

Do you feel that you need to comprehensively set the right habits and kick-start your health? Our experts will give you loving advice and help you optimize your health and hormones through online consultations with diet, healthy habits, and the right mindset. We offer three support packages.

*The consultation does not serve as a substitute for gynecological support and assistance. If you are experiencing any health problems, we recommend that you contact your doctor as soon as possible.

Sources used:

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