What is causing your PCOS

What could be contributing to your PCOS? And why you need to know.


Many women forget to ask the most important question regarding their PCOS: ‘What is the cause of PCOS?’ I often see comments on Facebook or Reddit from people asking questions such as, ‘What is the best diet for PCOS?’ or ‘What supplements should I take for PCOS?’ This is completely understandable and natural, but it’s kind of like asking, ‘What type of fuel should I put in my car?’ The answer is, “It depends on what type of car you have.”

In terms of PCOS, the answers to all of those questions depend on the type of PCOS you have or, more accurately, your personal cause of PCOS. PCOS is a syndrome with a few common elements, but the cause of those, and therefore the treatment, differ for every woman.

I worked with three really interesting clients with PCOS, ‘Kat,’ ‘Sarah,’ and ‘Megan’. They all came to me with the problem of being unable to get pregnant, but that’s where the similarities stopped. Had I treated them all in the same way then I would have most likely made their PCOS worse.

Kat was diagnosed with PCOS after she failed to get pregnant. She experienced:
– Normal periods before going on the pill, aged 21.
– Periods didn’t return when she came off it.
– No other typical symptoms of PCOS.

Sarah had always struggled with her weight:
– Weight gain of 3-4kg each year, starting at high school.
– Diagnosed with PCOS and insulin resistance.
– Subsequently told to lose weight if she wanted to get pregnant.
– Could never successfully maintain any weight loss.

Megan was a city lawyer:
– Always a normal weight, with no period issues.
– Began exercising to ‘lean up’ before her wedding.
– Happy with initial results, then began to put weight on. Weight wouldn’t budge.
– Noticed changes to periods when she came off the pill to try and get pregnant.
– Gynecologist diagnosed her with PCOS after she tried for a year to get pregnant.

All of the women that I’ve provided details about have PCOS, but they all presented with different symptoms. For me to know how to help those women, I needed to know their own individual cause of PCOS. But first, let’s look at what PCOS actually is.


What is Polycystic Ovarian Syndrome?

PCOS is a condition where a woman doesn’t ovulate because the body is producing excess androgens.  Androgens are a group of hormones that include testosterone, as well as DHEA-S and androstenedione. They are responsible for most PCOS symptoms, including infertility, acne, hirsutism, and male pattern balding. According to the Androgen Excess and PCOS Society Taskforce guidelines, PCOS should be diagnosed by a blood test to test your androgen levels, the presence of polycystic ovaries (or lack of ovulation).

Even a minor amount of excess androgens can stop normal menstruation and ovulation. But the great news is that it’s totally possible to reduce these levels and begin ovulating again. The secret is to treat what’s androgen levels to be high in the first place.


What Causes PCOS?

Contrary to the name, cysts do not cause PCOS. Cysts are simply a symptom of the metabolic and hormonal storm that’s going on in the body. The cysts are egg follicles that were not released when ovulation was meant to occur. Rather than being released, they remain ‘stuck’ on the ovary and appear as cysts.

Up to 25% of ‘normal’ woman have poly (many) cystic ovaries. However, to have PCOS you also need to have the high levels of androgens. Therefore, when we talk about the cause of PCOS, what we are actually taking about is the cause of the high androgen levels.

There is a genetic component to developing high androgens and PCOS. However, these genes can be turned on and off by environmental factors. This is called epigenetics. Individuals with PCOS genes become more susceptible to developing the condition when the right environmental factors are present. This means that if we remove these environmental factors, i.e. treat the root cause of PCOS, then PCOS symptoms can be reversed.

The secret is finding which factors are affecting you.

This article will outline the top causes of high androgens.

The Most Common Causes of PCOS

PCOS and Insulin resistance and Inflammation

Inflammation and insulin resistance are the biggest contributors to PCOS. Sarah, who I mentioned above, was a classic example of this. Studies show that 70% of women with PCOS have insulin resistance.

Insulin is our storage hormone. When we eat, our body detects a rise in blood sugar. When blood sugar is high for prolonged periods of time, our body doesn’t like it. This is because it can lead to damage in the cells of our brain, liver, pancreas, heart, and eyes. Therefore, the body stores excess blood sugar in muscle and liver cells for later use.

Insulin is the hormone that tells the cells to open up and let glucose in. It’s excreted by the pancreas and binds to a receptor on the cell. This works in a similar way to a key opening a door. When the key has been used too much, or there is chronic low grade inflammation, the lock starts to get a bit worn and clogged up. The key no longer fits. This is insulin resistance.

Why is High Insulin Bad?

High insulin levels stimulate the ovaries to produce more androgens. They also reduce the amount of Sex Hormone Binding Globulin (SHBG) in the blood. SHBG is like a sponge for excess hormones. If levels of it are low then the levels of hormones in the blood will be much higher.

Not all women with high insulin develop excess androgens and/or PCOS. This is the reason that scientists propose that genes play a role.

You may have heard about insulin resistance. But you probably haven’t been told about its connection to inflammation. Inflammation occurs when your immune system is chronically activated. Studies have now shown that inflammation can cause insulin resistance. It may also have to be present for insulin resistance to occur in the first place. This is an important consideration when deciding on the best course of treatment for PCOS. It’s also the reason why simply removing carbs isn’t an effective treatment for many women. The inflammation must also be treated.


‘Post-Pill’ PCOS

‘Post-pill PCOS’ is a term coined by Dr Lara Briden. Briden is an amazing naturopathic doctor, hormone health advocate, and author of the Period Repair Manual. According to her, ‘Post-pill PCOS is the second most common type of PCOS. This is something that I agree with. Kat is the perfect example of somebody with post-pill PCOS.

The pill disrupts communication between the brain and ovaries, thus stopping ovulation. For most women this communication returns to normal after they stop taking the pill, and their periods and ovulation resume. But for some women, it doesn’t. In these cases, it’s not the androgens causing problems, but the ratio of Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH). LH and FSH are the hormones which kick-start ovulation. If the ratio of LH to FSH become greater than 3:1 then ovulation doesn’t occur.

Post-pill PCOS isn’t a well recognised form of PCOS. As a result, there’s very little information available about it. If, like Kat, you had normal periods before going on the pill and don’t present any other PCOS symptoms, then it’s likely that you have post-pill PCOS.


Stress-based PCOS

Stress-based, or ‘adrenal’, PCOS is the third most common cause of PCOS that I see. Megan was an example of this. ‘Stress’ relates to both physical stress, e.g. too much high intensity exercise, or psychological stress. Frequently, as was the case with Megan, it’s a combination of the two, such as a highly stressful job and too much high intensity exercise.

When we put ourselves under a lot of stress, the brain stimulates the adrenal glands to produce stress hormones. These hormones are adrenaline (the ‘fight-or-flight’ hormone) and cortisol, adrenaline’s long-term cousin. At the same time however, the brain also produces androgens, such as DHEA-S and androstenedione. Most people, even some physicians, are not aware that 50% of women with PCOS have excess adrenal androgens.

The following could be an indication that stress hormones are causing or contributing to your PCOS:
– Feeling tired all the time.
– Waking up tired, even after 7-8 hours sleep.
– Feeling exhausted after exercise.
– Feeling tired, but wired, at night.


Inflammation (Non-Insulin Resistant)

When your immune system is chronically activated, inflammation occurs. As I mentioned above, it often goes hand in hand with insulin resistance, but it can also act alone. Many things can cause inflammation, including:
– Eating foods that you’re intolerant to.
– Poor gut health.
– High stress hormones (yes, it goes hand in hand with stress PCOS too!).
– Environmental toxins

Inflammation has been shown to increase androgens and stop ovulation, even without insulin resistance. If you get recurrent infections or are sick all the time then this could be an indicator that you have chronic inflammation. Other signs includes allergies, asthma, sore joints, irritable bowel syndrome, or skin problems like eczema.


Hidden Cause or Contributor

So you’ve read through the four sections above, but nothing is jumping out at you as being your cause of PCOS. If so, you may have a ‘hidden’ cause of PCOS, instead. A thyroid condition is the one that I see most often. Given that up to a quarter of women with PCOS have a thyroid condition, this isn’t surprising. Unfortunately, many women never have their thyroid markers tested. Even if they do, it’s usually only Thyroid Stimulating Hormone (TSH) that’s measured.

TSH should be a good indicator that there is something wrong with your thyroid. Unfortunately, this isn’t always the case. It’s been shown that the range deemed ‘normal’ is far too high. Studies show that it should be 2.5mIU/L, but it’s currently set at 4mIU/L. Inflammation may also have an effect on TSH levels, making them appear normal even when they’re not. Stress has been shown to have a similar effect. Given that inflammation and stress have both been found to be a cause of PCOS, you can see that a thyroid condition could also be a cause of PCOS.

High cholesterol and hair loss are both symptoms of a thyroid condition. Hair loss is also a symptom of PCOS, so it can be missed as one for a thyroid. Please get your thyroid tested if you’re suffering from high cholesterol or hair loss.


Your Cause of PCOS: You Don’t Need to Fit in Just One Group

You may have read this and thought that you fit into a couple of boxes. This is quite normal, especially in my clients who are corporate professionals. Working long, stress-filled hours with tight deadlines, exercising daily to try to keep your weight in check. Adrenal hormones can exacerbate what may start as insulin resistance and inflammation.

Years ago, I was in a similar position. At the time, I was completing a dual honours degree whilst training for World Triathlon championships. I was training twice a day, living on sports drinks and gels (hello insulin resistance!), and feeling absolutely shattered. As a child, I regularly had tonsillitis. That meant that I had 20 rounds of antibiotics before I was 10 years old. This caused me to have a host of gut problems and chronic inflammation. Unsurprisingly, my tests results showed:

– Insulin resistance.
– High inflammatory markers.
– High DHEA-S and cortisol that was three times the normal range.
– A possible thyroid condition. This wasn’t picked up until much later. Rather than being a cause of my PCOS, I believe that it was caused by inflammation and high stress hormones.

I significantly reduced my carb intake after I was diagnosed with insulin resistance. However, it wasn’t until I addressed the inflammation, stopped all endurance exercise, fixed my gut health and stress hormone levels that I started to see any improvements in my PCOS. The point that I’m trying to make here is don’t try and squeeze yourself into one box. Instead, get as many blood tests as possible to try to determine all possible factors that could be your unique cause of PCOS.


What PCOS Symptom Tests Should I Get?

Now that you understand all of the different causes, you’re probably wondering how you can find out your own cause of PCOS. Symptoms are a good indicator of PCOS. However, a blood test is necessary to be absolutely sure. You should try to get everything tested to make sure that nothing is missed out.

Some more blogs you might be interested in

Season 6 Episode 6: Your Guide to Birth Control (Part 3): Permanent Birth Control ProceduresThe PCOS Nutritionist PodcastAdrenal PCOS

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  1. That’s brilliant info! Thank you! I’ve only found out bout your work recently, it would have been fantastic when I was at my worst with PCOS a few years ago! I’ve since worked with a nutritionist and with change to my diet and supplements I’ve managed to improve and to get pregnant twice (expecting my second at the moment). I would love to hear what you have to say on the topic of how to manage your PCOS symptoms while breastfeeding, as there isn’t much info out there and my doctor for example doesn’t recommend to take many of my usual supplements while breastfeeding. My PCOS symptoms seems to subside while I’m pregnant, but with my first they came back worse! And I’m sure it was a big factor why I got PND, and had to stop breastfeeding by 7 months as I was put on antidepressants and metformin for a few months to tear PND and my PCOS. Thankfully after about 3 months on them I was able to stop and back to my usual regime. I’d love to breastfeed for longer this time but I’m worried my PCOS will get so bad again and might trigger PND again. I’m sure if I was able to take my supplements I’d control it better, but I don’t seem to find research on it. I’d love to hear what you have to say or even work with you on this matter if you have any experience on it perhaps? Thank you so much for your time. Kind regards

  2. I wasn’t able to download the test I should have done can you email them please. Thank you for all this helpful information I have read today.

  3. Hi Clare. Thank you very much for all this information. I love how you explain everything here. I haven’t received the PDF for the tests yet. Do you think you can help me with this? Many thanks!! 🙂

    1. Hi Yunuen, Sorry to hear that you haven’t got the PDFs. Have another try and if it doesn’t work, send us a message through the content form and we’ll email it directly to you.

  4. Thank you so much for this information. Would you be able to send me the PDF of labs that should be drawn? I’ve had labs drawn a couple of years back and I’m sure it wasn’t as thorough as it should’ve been. It’s time to get tested again 🙂 Thanks again.

    1. Hi Jenny, Great, I’m glad that you’re getting some more tests done. Just beware of the ‘normal’ reference range for tests. The medical ‘normal’ range does not mean optimum and is far to broad in most cases. if you can, work with a functional medicine practitioner who can interpret them using the optimum reference range. I’ve sent you the pdf as well.

      1. Is there any way that I could get emailed the list of labs to get drawn. I was just diagnosed with PCOS and we are wanting to have just 1 more child so our son doesn’t grow up an only child. Thank you so much

  5. Hi…I have been diagnosed with PCOS a few years ago, I am not trying to get pregnant and my doctor does not seem to be worried that I have this but after reading this and seeing all the other things that are related it makes me wonder if I should do something…what are your thoughts on keaving it untreated sine I am not trying to get pregnant?

  6. Hi ! I loved your explanation with regards to PCOS.i was diagnosed at 37.i couldn’t believe this .I have 2 kids already andy husband n I was trying for baby no 3.i have to the doctor n he started me on glucophage, and DS24 multivitaminbut it has been horrible been on it.i spend my most my day in the ladies.i am now 40.i work long 12 hours and work is very stressful being a nurse.I was told to lose weight,be on a good diet, exercise and all will work out for me.n it will get me pregnant if I stick by it.i have been over the past 2 yrs , b3n on diet ,very minimal weight lose,and still not pregnant.please tell me what should I do.time is running out with my age.

  7. Hi! I have a similar case with Sarah (mentioned on the article) i was diagnosed with PCOS and my symptoms are having weight gain with difficulty losing wight, problem with my ovulation (accdg to my OB) and i really wanted to conceive. Can you help me with some tips and effective ways? 😊

  8. “Twenty rounds of antibiotics before 10 years old”… that sounds like me! Mine was for strep throat, which I had frequently as a child. I’ve been wondering if all that infection and repetitive antibiotics had anything to do with my current health issues. Thanks for this information.

  9. Hello. Back in July of this year I was so excited to be going to my Dr that I thought would be more than happy to run the tests I ask for only to be disappointed. She would only run the normal TSH test and said she’d do more if that one didn’t come back “normal”. My cholesterol was 201 and my triglycerides were 434. Her solution was medicine, to which I declined because I breastfeed. I decided to completely change my eating and go at it alone. Where can I get tests done, since my Dr is unwilling?

  10. hi i would br very happy If you could send the PDF test to my email. I am struggling with PCOS. I have a 5 month old baby and he has got eczema on his body I was wondering if my PCOS has triggered that. I would be glad for an answer thank you.

  11. Good day,
    I have been diagnosed with PCOS, 3 kids later and hysterectomy done, however my hair falls out and seems as if it has stopped growing. There is also marks under and around my chin which darkens every now and then. please help with what test i should have done?

  12. I’ve had multiple labs ran and only ones high are cholesterol , uric acid ,and c reactive protein was high . My thyroid has never been bad. My PCOS has gotten out of control. In my 20’s full head of hair. 40 make balding severe, rosacea, facial hair etc.
    any suggestions ?

  13. Wonderful article. But I can’t download the list of blood tests for some reason. Would you be able to email it to me?

  14. Howdy! I кnow this is somewhat off topic but I waѕ wondering if you knew where
    I could find a caρtcha plugin for my comment form? I’m using thе same blog platform as
    yоurs and I’m having difficulty finding one?
    Thanks а lot!

  15. Hii.. I am suffering from pcos. I have read many articles about pcos.. my symptoms are having weight gain with difficulty losing wight, problem with my mensuration cycle, bad hair loss, ache on my face, can’t get pregnant.. I am 29 years old.. I have 2 kids.. bt nw I have difficulties in having kids.. I have been trying for 2 years nw.. bt no result.. i really wanted to conceive. Can you help me with some tips and effective ways? 
    Medicines for this ?? Plz help.. ..

  16. I’m going to the doctor to get more tests done, however I’ve already had most of the tests done on the list and my results were normal. However I have server hair loss and facial hair and acne. So obviously something is wrong. Where do I go from here if everything appears ‘normal’?

  17. I have read multitudes of informationon PCOS for over 13 years now, this is when my periods stopped entirely at age 17. I was not sexually active so there was no way I was pregnant. It wasn’t until about 5 years ago that this was confirmed by a gynecologist, however, many important tests were not done then and have not been to this day.
    I definitely fit, almost fully, into all these “PCOS types” except the pill one, as i have never taken birth control. There is just so much that I have only been able to speculate and guess, not a lot has been professionally confirmed just due to lack of means. I am thorough with my researching though, from identifying my affliction to how to remedy it at home. With the few things I have been able, or forced, to see a medical professional about, my self diagnosis was always confirmed. Sadly, with PCOS, there is no cure only treating, or attempting to treat, it’s various symptoms.
    Personally, I am perfectly happy with no periods and infertility, but the hair thinning on my head and excess, thick, dark body hair has been devastating me for several years. I have facial, chest, abdomen, lower back and now recently some upper back growth. These two issues are really all I am wanting to improve but have failed to find anything successful in my many years of trying.
    I could keep rambling on, but I think I have done so more than I should have already. All the years of suffering this I’ve felt alone, your site here has lessened this for me. Thank you so much.

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