What Causes PCOS?

PCOS (polycystic ovary syndrome) is primarily a metabolic issue that affects your hormones and reproductive health. Are you at risk?
Woman lying on a couch clunching her stomach in pain
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Pretty Crummy Overload of Symptoms is what I used to call my PCOS. Irregular periods, the appearance of acne in my 20s, stubborn weight gain, thick hairs along my jawline, a growing thyroid problem, and a general feeling of lousiness plagued my university days.

But it didn’t have to be that way. Once I confirmed the diagnosis with my doctor, I began making dietary and lifestyle changes, including supplementation that led me to better health, and a better quality of life.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a bit of a misnomer since it doesn’t always mean that you have cysts in your ovaries. Actually, most of my patients with this diagnosis don’t have cysts at all! It is primarily a metabolic issue that affects your hormones and reproductive health. In fact, it could even be called Pretty Common Ovulation Struggles since ovulation isn’t really occurring in those suffering from PCOS and it’s a lot more common than you might think.

While there’s no official cause of PCOS, genetics might be partly to blame as it tends to run in families. So if you have a blood relative with PCOS, type 2 diabetes, non-alcoholic fatty liver disease, or a thyroid disorder, you may be at a higher risk of developing PCOS.

What causes PCOS?

The following issues are commonly seen in those diagnosed with PCOS. They’re interconnected, and can appear differently in different people. 

Adrenal dysfunction, which can be genetic or due to chronic stress, is often seen in PCOS. Cortisol, our stress hormone, can be high or low and will feed into thyroid issues, inflammation, insulin resistance, and changes in sex hormones.

Anovulation (no ovulation) due to hormonal shifts can also affect follicular maturity in your ovaries, causing the follicles to look like a string of pearls (which is where the “polycystic” component of PCOS comes from). The follicles fail to mature due to hormonal imbalance, which can also lead to anovulation.

Elevated androgen levels like testosterone can lead to oily skin, adult acne, hair loss on the head, and hair growth on the face.

Family history of PCOS, infertility, and diabetes can increase risk of a PCOS diagnosis.

Infertility due to both the lack of ovulation as well as poor egg quality.
Insulin resistance, or blood sugar dysregulation (often a signifier of diabetes), can also develop with PCOS. If cells can’t adequately access sugars from the bloodstream, the amount of sugar increases in the blood, increasing inflammation and androgen production.

Irregular periods are often the result of the interaction of the issues listed. This is just one reason why it's important to track ovulation and menstruation.

Low-grade inflammation can both contribute to, and be created by, PCOS conditions.

Non-alcoholic fatty liver disease (NAFLD) occurs when the body can’t metabolize fat effectively, causing a build-up of fat in liver tissue, exacerbating blood sugar issues and inflammation. Insulin resistance can also aggravate NAFLD (and vice versa).

Obesity, weight gain, or difficulty losing weight can happen both as a result of PCOS and can also contribute to it! (The vagaries of the human body can be so capricious!)

Thyroid issues can also lead to anovulation and decreased egg quality. Low progesterone and early miscarriage can sometimes arise from simple factors like low iron, vitamin D, or vitamin B12, but there can also be a cascading effect from other sources. Testing is key!

Vitamin D deficiency, rampant in Canada, is commonly experienced in conjunction with the above-mentioned inflammatory conditions. (Fuel up on these vitamin D-rich foods, and talk to your doctor about supplementation.)

While the symptoms paint a pretty good picture of whether or not someone has PCOS, testing to discover the root of the problem is critical. Lab work to check your sex hormones (like estrogen, progesterone, LH, FSH, testosterone, SHBG, DHT, androstenedione), glucose tolerance, insulin, liver enzymes, lipid panel, inflammation markers, adrenal function, vitamin D status, and thyroid function (including antibodies), and other standard parameters such as a pelvic exam, ultrasounds of the reproductive organs and liver, and a month-long saliva hormone test and/or dried urine hormone test are all part of the PCOS diagnosis journey.

Have you been diagnosed with PCOS? Read up on treatment options for PCOS, including simple dietary and lifestyle changes you can implement.