What causes PCOS?
Photograph by Erol Ahmed.
You can’t do anything about it and we don’t know what causes it. That’s what I was told 16 years ago when I received my diagnosis of Polycystic Ovary Syndrome (PCOS). Oh, how mistaken my doctor was. I’d originally visited him concerned about my excruciating and very erratic periods. But what I didn’t bank on, was a label that I had a hormonal disorder at 15 years old, which also explained my horrendous acne and why I wasn’t a 'skinny minnie' like everyone else in my family back then. Even worse, I was told that I had high male sex hormones and cysts on my ovaries. It honestly made me feel like I was somehow less of a woman.
“For now,” he said, “just take the pill and we’ll hope for the best that you can have kids one day”.
Photograph of Kay Ali by You Need A Nutritional Therapist Ltd.
Sadly, through working with my PCOS clients I realise that my experience at the doctors still echos on. I have lost count of the number of women that have wept feelings of hopelessness and confusion since their diagnosis. “What causes PCOS? Why do I have it? And more importantly, what can I do to fix it?” Thankfully, I’ve spent the best part of 16 years getting up close and personal with this condition. In my own body and many other women’s like yours. Here are the answers we should have been told.
PCOS affects 1 in 5 women in the UK, but its cause is not always the same. In fact, I’ve identified in my clinic four different types of PCOS, each with very distinct functional causes.
But firstly, despite the name, PCOS actually has nothing to do with cysts on your ovaries. It’s true. What my doctor saw on my ultrasound, and likely on yours too, were follicles or eggs. Unless they're abnormally large indicating functional cysts or endometrioma, this is normal. It’s possible to have many eggs and balanced hormones; it’s also possible to have no “cysts” and imbalanced hormones. This is why I believe that diagnosing PCOS through ultrasound isn’t the most accurate assessment.
Rather, PCOS is better defined as an excess of our male sex hormones (androgens), that can’t otherwise be associated with other reasons for high androgens. That’s to say that your elevated male sex hormones aren’t the result of high prolactin, birth control or a rare condition called congenital adrenal hyperplasia. So what does this all mean?
Well, if your diagnosis was made because your doctor saw “cysts” but your androgen levels are normal, it’s possible you’ve been misdiagnosed and should seek a second opinion from another medical doctor. But if your androgens are high, you’ve got facial hair and/or jawline acne, and those factors I’ve outlined aren’t the cause, then chances are you do have PCOS. But the question still remains, why?
PCOS numero uno: insulin resistant PCOS
Photograph by Holly Stratton.
The problem? Sugar sugar sugar. Approximately 70% of PCOS is prediabetes. It’s a form of this condition that is driven by high insulin. You can find this out by running a simple insulin blood test. But be careful, sometimes practitioners will test glucose instead. This is not the same thing and cannot tell you whether you have insulin resistance. For those of you that test positive, symptoms should be supported by blood sugar management and exercise.
Not you? Perhaps then your PCOS is type numero dos?
PCOS numero dos: post contraceptive pill-PCOS
Photograph by Simone Van Der Koelen.
If your androgens are high, you’ve ruled out other causes for high androgens, you have jawline acne and/or facial hair, your insulin is normal and all of this started after coming off the pill, you may have post contraceptive pill-PCOS. The good news is, this is usually short term. It’s a side effect of the drug withdrawal process. Often it will balance itself out. But if you want to help things along, focus on managing stress and nourish your body with foods high in zinc, magnesium, selenium, B6, B12, folate and vitamins E and C. You’ll also find some useful information here.
If your symptoms existed pre birth control or you haven’t been on (or off) the contraceptive pill then perhaps your PCOS is type numero tres?
PCOS numero tres: Adrenal PCOS
Photograph by Lesly Juarez.
Most of us that have PCOS have high androgens across the board. That means ovarian testosterone and androstenedione, as well as adrenal DHEAS are all elevated. But, if only adrenal DHEAS is high (and the other two are normal) then this could mean you have adrenal PCOS. What does this mean? Stress is your main driving factor. Interventions that support your stress response may help your condition. I’ve found these clients to be highly responsive to magnesium, daily meditation and adaptogenic herbs like ashwagandha and maca.
Still doesn’t sound like you? Maybe then you have the last and final type of PCOS?
PCOS numero cuatro: Inflammatory PCOS