PCOS - Polycystic Ovary Syndrome


Understanding the Metabolic and Hormonal Puzzle

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age, yet it is still widely misunderstood. While often thought of as a gynecological issue, PCOS is fundamentally a metabolic and endocrine condition that disrupts hormones, ovulation, insulin regulation, mood, and long-term health.

At its core, PCOS is not just about ovaries or cysts—it is a systemic disorder that involves the entire hormonal network, including the brain, pancreas, thyroid, adrenal glands, gut, and fat tissue.

What Causes PCOS? The Physiology Explained

PCOS is believed to stem from a complex interplay of genetic, metabolic, and environmental factors. The condition is characterized by a vicious cycle of:

  • Insulin resistance
  • Hyperandrogenism (excess male hormones)
  • Disrupted ovulation

Insulin resistance plays a major role in many cases. When the body’s cells become less responsive to insulin, the pancreas compensates by producing more. This excess insulin can:

  • Trigger the ovaries (and/or adrenal glands) to produce more testosterone
  • Suppress ovulation
  • Increase LH (luteinizing hormone), worsening androgen production

At the same time, high androgens (like testosterone and DHEA-S) disrupt follicle maturation in the ovaries, leading to multiple immature follicles (what we call “polycystic” ovaries on ultrasound) and irregular or absent periods.

 Endocrinology of PCOS

PCOS isn’t a one-hormone problem—it affects multiple endocrine pathways:

  • High LH:FSH ratio: Often >2:1 in PCOS (normal is closer to 1:1). High LH drives ovarian theca cells to make more androgens.
  • Low or normal FSH: Follicle-stimulating hormone may be suppressed, impeding egg development.
  • Elevated androgens: Testosterone, DHEA-S, and androstenedione are often high.
  • Low progesterone: Due to lack of ovulation (anovulation), progesterone stays low, contributing to PMS, anxiety, and uterine lining issues.
  • High insulin: Drives androgen production and weight gain.
  • Thyroid dysfunction: Hypothyroidism or Hashimoto’s can overlap or mimic PCOS.
  • Altered SHBG (sex hormone binding globulin): Insulin and androgens lower SHBG, leaving more free testosterone circulating.

 Spectrum: Ovarian vs. Adrenal PCOS

There are different subtypes of PCOS depending on the dominant driver of androgen excess:

1. Ovarian-Driven PCOS

  • Main source of androgens is the ovaries (high LH/testosterone)
  • Most common phenotype
  • More likely to show classic symptoms like cystic acne, irregular periods, and hirsutism

2. Adrenal-Driven PCOS

  • Androgens come mostly from the adrenal glands, especially DHEA-S
  • May be triggered or worsened by chronic stress and high cortisol
  • Less typical ovary dysfunction; often missed on ultrasound
  • Mood swings, anxiety, fatigue, and sleep issues may dominate

Both types may overlap and contribute to metabolic and reproductive dysfunction.

Is PCOS Genetic?

Yes, PCOS has a heritable component. First-degree relatives (mother, sister) have a higher risk. While no single gene causes PCOS, multiple genes related to insulin signaling, LH receptor function, and androgen production are involved.

Environmental factors such as diet, toxins, gut health, and stress can influence gene expression (epigenetics), which may explain why PCOS looks different in each woman.

Symptoms of PCOS

  • Irregular or absent periods
  • Cystic acne or oily skin
  • Excess hair growth (face, chest, abdomen)
  • Hair thinning (scalp)
  • Weight gain or difficulty losing weight
  • Bloating, fatigue, brain fog
  • Anxiety or depression
  • Sugar cravings or energy crashes
  • Fertility issues (anovulation)
  • Sleep disturbances or insomnia

What Happens If PCOS Is Untreated?

PCOS is not benign. Without treatment, it can lead to:

  • Infertility
  • Endometrial hyperplasia or uterine cancer (from chronic unopposed estrogen)
  • Type 2 diabetes or insulin resistance
  • High cholesterol and heart disease
  • Sleep apnea
  • Anxiety, depression, or eating disorders
  • Increased miscarriage risk

PCOS = A Metabolic Condition

While PCOS affects the ovaries, its roots lie in metabolic dysfunction. That’s why successful management often starts with restoring insulin sensitivity, reducing inflammation, and supporting hormonal balance from the ground up.

Diet and Nutrition for PCOS

There is no one-size-fits-all diet, but key principles include:

  • Low-glycemic, anti-inflammatory foods: Leafy greens, berries, cruciferous vegetables, avocado, fish, olive oil
  • Balance carbs with protein and fat: Avoid insulin spikes
  • Limit added sugars, refined carbs, and processed foods
  • Time meals to align with circadian rhythms (avoid late-night snacking)
  • Track food sensitivity and gut health (many women with PCOS also have leaky gut or dysbiosis)

GLP-1s (like Ozempic or Mounjaro)?

GLP-1 receptor agonists help:

  • Improve insulin sensitivity
  • Promote satiety and weight loss
  • Reduce inflammation and potentially androgen levels

They may be useful in overweight PCOS patients—but are not a substitute for lifestyle. They work best alongside dietary and hormonal support.

Exercise for PCOS

Movement is medicine for PCOS. Aim for:

  • Strength training: Improves insulin sensitivity, builds lean muscle
  • High-intensity interval training (HIIT): Regulates blood sugar and boosts metabolism
  • Yoga, walking, and stretching: Reduces cortisol and improves mood

Consistency is key—too much intense cardio without recovery can worsen adrenal PCOS.

Mood, Anxiety, and PCOS

Many women with PCOS experience:

  • Anxiety
  • Depression
  • Mood swings
  • Brain fog

These are not just emotional responses—they’re linked to:

  • Low progesterone (which calms the brain)
  • High androgens
  • Blood sugar crashes
  • Inflammation
  • Gut microbiome dysbiosis
  • Poor sleep

Addressing these root causes can dramatically improve mental clarity and mood stability.

 Fertility and PCOS

PCOS is one of the most common causes of infertility due to anovulation. However, many women with PCOS can and do get pregnant—with or without medication—once insulin, inflammation, and hormone levels are balanced.

Options include:

  • Ovulation tracking
  • Inositol supplementation (myo- and D-chiro)
  • Nutritional therapy
  • Clomid or Letrozole (if needed)
  • IVF (in complex cases)

Is Estrogen High in PCOS?

Yes—often, but not always. In many women, estrogen is elevated but unopposed by progesterone, due to lack of ovulation. This can lead to:

  • Breast tenderness
  • PMS
  • Heavy periods (when they do occur)
  • Uterine lining overgrowth

In some lean PCOS types or post-pill PCOS, estrogen may be low. It’s important to test before treating.

Fun Facts About PCOS

  • PCOS affects up to 1 in 10 women, but may be underdiagnosed
  • Not all women with PCOS have ovarian cysts
  • Men can carry the gene and pass it on (manifesting in sisters or daughters)
  • PCOS may have protective benefits in the past—stronger bones, delayed menopause, and better survival in famine
  • Women with PCOS are more likely to have high AMH (anti-Müllerian hormone), which may preserve fertility longer in life

Final Thoughts

PCOS is not just a reproductive disorder—it’s a whole-body condition driven by metabolic, hormonal, and inflammatory imbalances. The key to managing PCOS is not just hormone treatment, but addressing the metabolic root: blood sugar, insulin, stress, and inflammation.

With a comprehensive plan that includes nutrition, exercise, targeted supplements, and hormone support when needed, most women can regain hormonal balance, restore fertility, and feel like themselves again.

 We Can Help

Our clinic specializes in personalized hormone and metabolic care for women with PCOS.

Whether you're looking to regulate your cycle, lose weight, improve fertility, or simply feel better — we’re here to guide you every step of the way.

 Don’t settle for “it’s just hormones.” Let’s find your balance.

📞 Contact us today to schedule a consultation.

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