Author: Eliška Hosnedlová, IHP (Certified Integrative Health Practitioner and Femvie Expert)
PCOS (Polycystic ovary syndrome) is one of the most common women's health issues, yet we know so little about it! Why and how does it develop? How do hormones get out of balance, and what role does metabolism play? And what type of PCOS do you actually have?
What is PCOS?
Polycystic Ovary Syndrome, referred to as PCOS from its English original, is a metabolic and hormonal condition in which the female body overproduces androgens, or male hormones. It is one of the most common endocrine disorders affecting women of reproductive age and, according to statistics, affects 6-12% of women worldwide. (1)
Symptoms of PCOS
Symptoms are very diverse; not every woman necessarily experiences all of them, and some symptoms may indicate a problem other than PCOS.
The most common manifestations include:
- Irregular cycles, missed periods, or very light bleeding
- Hair growth on the face, chest, arms, or abdomen – in areas typically associated with 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 tags on the neck or in the armpits
- Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts
PCOS – Polycystic ovaries?
Despite the name, what we can see on ultrasound are not actually cysts at all. (2) These are an increased number of follicles that did not complete their development, and thus ovulation did not occur. In a normal, healthy cycle, one dominant follicle among many would 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, for ovulation to occur, we need to have the correct hormone levels.
However, anovulatory cycles and underdeveloped follicles on the ovaries are not only known to women with PCOS. It is a common phenomenon in irregular cycles, during adolescence when the body is still learning to work with hormones, but it is natural from time to time even for those of you who have exemplary cycles, for example, due to illness or current stress.
This is the first and very crucial reason why PCOS should not be diagnosed based solely on ultrasound. But more on how to get the correct diagnosis next time.
Why are androgens out of balance?
Androgens belong to a group of hormones that primarily influence the growth and development of the male reproductive system. In women, androgens are precursors to estrogens, meaning they are necessary for their formation and function. Androgens also contribute to bone and muscle growth and female libido. In the female body, they are produced in the ovaries and adrenal glands from a common base – cholesterol.
Although we cannot neglect the importance of androgens in the female body, their excessive production reflects on a woman's overall hormonal health. Interestingly, it is estimated that over 80% of women exhibiting signs of hyperandrogenism (i.e., excessive production of androgens), 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 originating from the adrenal glands. Their levels can be increased by high prolactin values, due to excessive stress, or the main cause is a congenital adrenal cortex disease called Congenital Adrenal Hyperplasia (CAH) (5)
- Insulin resistance, which, due to high insulin levels, leads to overproduction of androgens from the ovaries and is one of the most common causes of PCOS development (6)
The role of metabolism and its impact on hormones
Although PCOS is often addressed 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 related to metabolic disorders such as insulin resistance. Insulin resistance is a condition where cells in the muscles, fat, and liver do not respond well to insulin and cannot easily absorb glucose, blood sugar. In addition to PCOS, insulin resistance also promotes the development of other metabolic problems, such as Type II diabetes, hypertension, and cardiovascular disease. (7)
As a result of impaired insulin action, the pancreas continues to produce and release insulin, which is not utilized. (8) This leads to 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 thus disrupt follicle maturation and halt ovulation (10)
- Insulin promotes LH, whose high levels 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 originate from another source: the adrenal glands. In stressful situations, the brain, specifically the hypothalamus along with the pituitary gland, stimulates the adrenal glands to produce cortisol, adrenaline, and noradrenaline, the main stress hormones, through hormonal signals. If the stress does not subside (referred to as chronic stress), the body must intervene with other protective measures. This is where adrenal androgens originating from the adrenal glands, DHEAS and androstenedione, come into play; their task is to protect the brain from the negative effects of cortisol and other stress hormones. (12) However, they also cause the typically known symptoms of PCOS.
What types do we distinguish, or what drives PCOS?
Insulin resistance affects up to 70% of women diagnosed with PCOS. (13) High insulin drives androgen production. This condition can be alleviated or completely reversed by lifestyle changes, proper exercise, and diet.
Tips for improving insulin sensitivity
- Regular exercise, prioritizing strength training over cardio
- Combine proteins, fats, and carbohydrates with every meal
- Focus on whole, natural foods that are minimally processed
This type does not necessarily need to be categorized as a distinct type of PCOS, as it often refers to a temporary state related to discontinuing birth control. Problems and symptoms similar to PCOS often appear 3-6 months after discontinuation. Firstly, some pills can contain a significant amount of androgens, which can disrupt our natural hormone levels. At the same time, endogenous (body's natural) hormones were suppressed while on birth control, so the body tries to compensate for all imbalances, and it may take some time for hormones to stabilize. Until the body is in optimal condition, ovulation does not occur, so underdeveloped follicles remain on the ovaries.
Tips to support the body after stopping hormonal contraception
- Ensure a high-quality, varied diet
- Focus on nourishing the body instead of dieting
- Consider certain supplements, such as magnesium or B vitamins
- Be patient; hormones will eventually balance out with a proper lifestyle
In this case, chronic inflammation in the body plays a crucial role in the development of PCOS. As a result of inflammation, the ovaries produce higher amounts of testosterone, and in addition to the typical symptoms of androgen overproduction, you may also 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
- Regularly consume quality meat and bone broth
- Add anti-inflammatory herbs and spices to every meal, such as cinnamon, turmeric, ginger, holy basil, oregano, or rosemary
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 play a role, but rather the strain on the adrenal glands, so focus on calming the body and mental state.
Tips for Adrenal PCOS
- Prioritize quality and sufficient sleep
- Work with stress; reflect on what you can and cannot influence in your life
- Consider certain supplements for stress management and calming the nervous system, such as magnesium or B vitamins; in addition, some adaptogens may also help
Polycystic ovary syndrome is a very complex topic, and for each woman, it must be approached in a slightly different way, based on the type of PCOS. If you have any questions about women's health, do not hesitate to contact our experts at Femvie Counselling. They will gladly answer all your questions for free.*
Do you feel you need a comprehensive setup of correct habits to kickstart your health? Our experts will lovingly advise you during online consultations and help optimize your health and hormones through diet, healthy habits, and the right mindset. We offer three support packages.
*Consultation does not serve as a substitute for gynecological support and assistance. If you are experiencing any health problems, we recommend contacting your doctor as soon as possible.
Sources used:
- https://www.frontiersin.org/articles/10.3389/fendo.2022.825528/full
- https://www.drlauranicholas.com/blog/2020/10/22/whatisthedifferencebetweenovariancystsandpcosscysts
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115104/#bib15
- https://helloclue.com/articles/cycle-a-z/androgens-101
- https://chriskresser.com/adrenal-pcos-surprising-ways-stress-affects-your-hormones/
- https://academic.oup.com/edrv/article/33/6/981/2354926
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115104/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115104/#bib9
- https://academic.oup.com/jcem/article/99/12/E2780/2833758
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8107978/
- https://med.virginia.edu/research-in-reproduction/patient-information/causes-of-pcos/
- https://www.pnas.org/doi/10.1073/pnas.95.4.1852
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277302/
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Frequently Asked Questions
How to support fertility naturally?
A healthy diet, sufficient exercise, sleep, stress management, and targeted dietary supplements such as folic acid or a fertility complex can naturally support female fertility.
When should I start taking folic acid?
We recommend starting to take folic acid ideally 3 months before planned conception. It is crucial for the proper development of the fetal neural tube.
What affects female fertility?
Age, hormonal balance, diet, body weight, stress, and conditions such as PCOS or endometriosis can affect fertility. Tracking ovulation will help you identify fertile days.
