Although the symptoms of PCOS are hormone-driven, hormonal imbalances are actually not the root cause(s). In reality, there are a few major downstream factors that can impact your hormones if left unchecked. So let’s dive into the 3 main offenders. 

Metabolic Dysfunction

We’ve probably all experienced the misery of a blood sugar spike and crash at one time or another, perhaps after indulging in too much halloween candy as a kid, drinking an oat milk latte without eating breakfast or a marathon day of traveling. Not only are blood sugar swings not fun, they are also super stressful on your body. Let’s talk physiology for a moment. When your blood sugar surges, your pancreas sends insulin into your bloodstream to help transport glucose (sugar) into your cells and out of your blood. If this becomes the norm, your cells can eventually stop responding to the constant influx of insulin (leading to insulin resistance) or your pancreas may fail to produce any insulin at all (causing diabetes). If insulin resistance occurs, large amounts of insulin remain in your bloodstream, also known as hyperinsulinemia. This creates a few different possible pipelines: 

  • The first is that your ovaries pump out extra testosterone in response to your high insulin levels. This is because elevated insulin inhibits your liver’s production of sex hormone binding globulin (SHBG), which is responsible for binding up excess androgens. This hyperandrogenism (or high androgen levels) is what causes hirsutism (unwanted hair growth), hair thinning, acne, irregular cycles, lack of ovulation and low progesterone. 
  • The second is that your Hypothalamic Pituitary Adrenal (HPA) axis gets impacted, altering your brain’s secretion of gonadotropins such as luteinizing hormone (LH) and follicle stimulating hormone (FSH). This leads to a high FSH:LH ratio and associated symptoms like irregular cycles, lack of ovulation, fertility struggles and low progesterone. 
  • The final pathway occurs when your adrenal glands overproduce cortisol (a stress hormone) to compensate for the high levels of insulin in your blood. Elevated cortisol levels may snowball into more insulin resistance, impaired glucose tolerance and increased blood sugar levels. In other words, insulin and cortisol exacerbate each other, resulting in a vicious cycle and symptoms such as weight gain (particularly around your belly), muscle wasting or difficulty putting on muscle, brain fog, mood swings and sleep disturbances. 

As you can see, ALL three of these pathways cause imbalances in your hormone levels, which directly contributes to the manifestation and presentation of PCOS. 

Chronic Inflammation

One of the main culprits of inflammation is oxidative stress. Essentially, this is when there is an imbalance between harmful molecules called “free radicals” or “reactive oxygen species” (ROS) and your body’s natural ability to detoxify them or repair the resulting damage. It might be helpful to think about this conundrum as too much trash in a city without enough trash trucks to pick it up. Lab tests almost always reveal that women with PCOS have higher than normal levels of oxidative stress. 

So what causes oxidative stress in the first place?

  • High intake of processed foods, creating gut inflammation, dysbiosis and hormonal imbalances
  • Chronic stress, leading to HPA axis dysregulation
  • Low intake of antioxidants found in plant foods like colorful fruits and vegetables
  • Lack of exercise, reducing your body’s antioxidant response 
  • Poor liver detoxification, causing a build up of harmful substances including free radicals
  • Nutrient deficiencies (especially Omega-3s, B vitamins, Vitamin C, Vitamin D, CoQ10 and L-Carnitine)

Impaired Mitochondria

Your mitochondria are the powerhouses of your cells, driving every single cellular process in your body. When your mitochondria are suffering, there is a major domino effect throughout the rest of your body systems and many of them can be downstream sources of PCOS.

As related to ovarian health, your mitochondria play a crucial role in the function of your ovaries, including follicular development, steroidogenesis (the production of hormones like estrogen and progesterone) and oocyte (immature egg) maturation. When your mitochondria aren’t functioning properly in your ovaries, you may notice that these essential reproductive processes are impaired, which may cause some abnormalities in your follicle development and ovulation – telltale signs associated with PCOS. 

In regard to metabolic health, your mitochondria are involved in producing energy for your cells and assisting in insulin signaling pathways so that your blood sugar and insulin levels remain stable and normal. If your mitochondria are generally ailing, your insulin signaling gets out of whack and you may experience insulin resistance, which we now know is a major cause of PCOS. 

Impaired mitochondria can alter the activity of the specific enzymes involved in your body’s creation of androgens – specifically, the cytochrome p450c17 (CYP17) and 3B-hydroxysteroid dehydrogenase (3B-HSD) enzymes. This translates to increased androgen production and, you guessed it, PCOS. 

Circling back to oxidative stress for a moment, your mitochondria are actually a big source of reactive oxygen species (ROS) in your cells. This is all fine and normal when your mitochondria are functioning properly because these ROS are used in biochemical pathways and they ultimately get converted to a number of safe, non-damaging molecules. The trouble is when your mitochondria are not healthy and functioning properly, in which case you may see higher ROS production, impaired antioxidant defense mechanisms, leading to subsequent oxidative stress and PCOS.

In that same vein, impaired mitochondria can trigger a cascade of inflammatory responses in your cells, contributing to low-grade inflammation (often seen in women with PCOS). When your mitochondria are damaged or not operating as they should, your immune system gets alerted and releases dangerous molecules called DAMPs, or damage-associated molecular patterns. Pro-inflammatory cytokines may also be triggered, which activate inflammatory pathways and create inflammation in your ovaries and other tissues.

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