While researchers are not certain of the exact cause of PCOS, it is known that an imbalance of the endocrine (hormonal) system is responsible for many of the changes associated with PCOS. However, it is still not known exactly what causes those changes. The following plausible causes will be discussed:
- Hormone connection
- Insulin resistance
- Weight
- Genetics
In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also produce. High levels of these hormones affect the development and release of eggs during ovulation.
Problems with Ovulation
Hormones are proteins produced by a structure within the body that causes a change within a cell or organ. The Hypothalamic-Pituitary-Ovarian (HPO) axis is a system of hormonal control within the body. The hypothalamus is a gland within the brain that, when stimulated, produces a hormone known as Gonadotropin-Releasing Hormone (GnRH). This then travels to the pituitary gland, another small structure in the brain. The pituitary gland produces a variety of other hormones which regulate and maintain many body functions, including ovulation.
In a normal menstrual cycle, follicles grow on the ovaries. Within those follicles eggs develop, one of which will reach maturity faster than the others and be released into the fallopian tubes. This is known as ovulation. The remaining follicles (sometimes hundreds) will degenerate. This happens in response to hormone changes ‒ the fluctuation of estrogen and progesterone. This response is stimulated by hormones released from your pituitary gland ‒ the Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH).
In the case of polycystic ovaries, however, the ovaries can appear much larger than normal, and there are a series of undeveloped follicles that appear in clumps, like a bunch of grapes.
Hormonally, elevated androgens inhibit FSH, thereby inhibiting development and maturation of the follicles. High testosterone levels elevate LH levels (but not in all cases). Testosterone levels can be twice the normal range (20‒80ng/dL).
Hyperprolactinemia
About 25% of PCOS sufferers have elevated prolactin, known as hyperprolactinemia. This results from abnormal estrogen negative feedback via the pituitary gland. Elevated prolactin can, in turn, also contribute to elevated estrogen levels, suppress progesterone release and compromise normal GnRH function, contributing to lack of ovulation.
Hormones and Stress
The impact of adrenal stress on our complex hormonal system is not to be underestimated, hence the area of study on the Hypothalamic Pituitary Adrenal (HPA) axis. DHEA, an adrenal stress hormone, is found to be elevated in 50% of women with PCOS. This excess DHEA then converts to androgens via adrenal metabolism, which in turn contributes to the typical elevated androgen levels in PCOS.
Estrogen Imbalance
Our body produces three types of estrogen. In some cases, the body will attempt to normalize the high levels of androgens through conversion to estrogen (i.e. estrone). This, however, creates an imbalance in the estradiol (E2): estrone (E1) ratio.
Exposure to xenoestrogens (environmental estrogens) due to lifestyle choices will also contribute to an estrogen dominant state. Examples of these are Bisphenol ‒ A (BPA e.g. in plastic drink bottles), parabens (e.g. in beauty products) and dioxins. This is why it is of the upmost importance that you use natural body products and cleaners. Everything that comes in contact with your skin enters your body!! Even better, save money and have fun by making your own cleaners and body products!
Thyroid Link
Estrogen dominance and PCOS have been positively correlated with the risk of thyroid dysfunction and disease. Hypothyroidism (an underactive thyroid gland) may also contribute to the symptoms of PCOS (e.g. irregular periods, weight gain, mood swings). One study found 68% women with hypothyroidism had menstrual abnormalities compared to only 12% in controls.3
A recent German study has found that PCOS sufferers have an increased risk for Hashimoto's, an autoimmune thyroid disease. The researchers believe that the progesterone deficiency associated with PCOS makes women more susceptible to this autoimmune condition. It may also be that women with thyroid conditions are more likely to develop PCOS. Healthy thyroid function is necessary for healthy ovulation.
Insulin Resistance
There is good evidence to suggest that many cases of PCOS are caused, in part, by insulin resistance, a metabolic problem that also causes weight gain and diabetes.
Seventy percent of women with PCOS are insulin resistant. Insulin is a hormone that controls the change of sugar, starches and other food into energy for the body to use or store. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgens, leading to problems such as anovulation (lack of ovulation), acne, hirsutism and weight gain.
Does the Pill Cause PCOS?
Even though the Pill has been a standard treatment for PCOS, it can cause permanent hormone changes, even once it is stopped. The bad news for Pill users is that the Pill appears to worsen the metabolic problem that is at the root of the condition, leading to insulin resistance. But that's not all. It also leads to weight gain, suppresses thyroid function, increases the likelihood of depression and the deposition of cellulite, and can induce testosterone deficiency, impacting on libido. I choose not to use the Pill for religious reasons, but the health issues related to the Pill should also make you consider if the risk is worth it.
Weight
Carrying more weight worsens insulin resistance and the existing symptoms of PCOSPCOSPCOS can therefore be reduced if you follow a healthy diet and lifestyle.
Genetics
Immediate female relatives of women with PCOS (i.e. daughters or sisters) have up to a 50% chance of having the condition, so most researchers believe there is a genetic link, although at this time it‟s not known exactly what that link may be. This is made difficult due to the lack of a single diagnostic test, as well as the role that external factors (such as obesity, diet and exercise habits) may play in the development of the syndrome. It is likely to be complex and involve multiple genes that control:
- insulin regulation
- androgen production
- the hormones involved in regulating ovulation and menstruation
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