PCOS is the most common hormonal disorder in women of reproductive age, affecting between 8 and 13% of the population. That’s a lot! Yet, conventional medicine is still not talking about the nutrition and lifestyle changes that can help — by addressing the root causes of PCOS symptoms! PCOS is a syndrome (a collection of symptoms and markers), so everyone who has PCOS experiences it differently. So, what exactly is the root cause of PCOS? There are several! And you can have more than one!

PCOS Diagnosis & Symptoms

In order to be diagnosed, you need to meet 2 of the three following criteria:

• Hyperandrogenism –  high levels of androgens or male hormones (testosterone or DHEA) as seen on a blood test OR symptoms of high androgens (like acne, hair loss, or hirsutism)
• Polycystic ovaries – multiple small immature egg follicles in each ovary (not true “cysts”)
• Irregular or no ovulation or periods – menstrual cycles longer than 35 days or anovulatory cycles

This is different from the signs and symptoms of PCOS, which can occur in different combinations depending on the PCOS root causes you have. Here are some of the more common symptoms: 

• Androgenic alopecia male pattern (hair loss)
• Hirsutism (excess facial or body hair growth)
• Acanthosis nigricans (dark patches of skin around the neck, armpits, or knees)
• Acne (typically along the jaw line)
• Weight gain or difficulty losing weight
• Fatigue
• Cravings (especially for carbs/sugar)

The Science Behind the Symptoms

So, what is causing all of this, and why do different people have different symptoms of PCOS? It depends on the root cause(s) of your PCOS symptoms!.

PCOS Root Cause #1: Insulin Resistance

One of the main drivers of PCOS is insulin resistance.

Insulin is the hormone that tells your cells to take in sugars from the bloodstream. Think of it like the “key” that unlocks the “door” to your cells.

Normally, your cells respond to insulin, and take in the glucose, which gives them the energy they need to do their jobs. As a result, the glucose in your blood goes down.

But with insulin resistance, the cells ignore the signal from the insulin and don’t take in glucose as they should. As a result, your cells are low in glucose (energy) and your blood sugar goes UP. So your cells are literally starving while there is plenty of glucose available. This leads to those killer carb cravings. 

Insulin resistance can lead to weight gain, irregular periods, and, if left unchecked, a higher risk for type II diabetes. 

And with PCOS, insulin resistance can worsen high androgens. High insulin signals your ovaries to produce more testosterone — leading to more symptoms from testosterone.

The problem is, conventional doctors are rarely checking insulin levels, even though insulin can start rising a full decade before your blood sugar and hemoglobin A1c start to go up.

PCOS Root Cause #2: Inflammation

Inflammation is another major root cause of PCOS symptoms.

So, what exactly IS inflammation? Inflammation is the release of inflammatory compounds (such as cytokines and others) that trigger an inflammatory response in the body. Inflammation can come from many places — the gut, a chronic injury, etc. Even “healthy” activities such as exercise can trigger inflammation!

With PCOS, inflammation is a vicious cycle — high blood sugar and overweight and obesity can make inflammation worse,  And inflammation makes it harder to lose weight and increases the risk for insulin resistance.

The good news is, we can combat this with anti-inflammatory diet and lifestyle changes! (And no, it does not mean having to cut gluten or dairy out of your diet!)

PCOS Root Cause #3: Hormone Imbalances

We know that for most women with PCOS, androgens play a big role in symptoms. But did you know that other hormones can be imbalanced as well? Hormone imbalances are one of the major PCOS root causes for most women with the condition.

While testosterone is made (mostly) in the ovaries, DHEA is another androgen that comes (mostly) from the adrenals. The bad news is DHEA comes from stress – something most women have too much of in our lives! However, genetic factors also seem to be the reason why about 20-30% of women with PCOS have high DHEA. This in turn causes the symptoms associated with PCOS such as weight gain, hair loss, body and facial hair and fertility problems. 

DHT is an androgen that is even more potent than testosterone, and it can come from either testosterone OR DHEA. And DHT is activated in skin cells and hair follicles – leading to symptoms like acne, male pattern hair loss and hirsutism.

So the first step in determining *which* of your hormones are imbalanced is to figure out WHERE those androgens are coming from for you. If it’s the ovaries, then lowering your insulin will be key. If it’s the adrenals, it’s more a matter of stress reduction and lifestyle changes.

But, with PCOS, androgens aren’t the only hormone to worry about… estrogen can be high or low, cortisol can be high or low, thyroid hormone can be high or low… Just because you have an androgen imbalance, it doesn’t mean that you don’t ALSO have other hormone imbalances.

PCOS Root Cause #4: Gut Imbalances

The last common root cause of PCOS symptoms is actually the gut. Are you surprised?

We’re just starting to understand how our gut and the millions of microbes that live in there (known as the microbiome) are related to conditions like PCOS. Recent studies show that women with PCOS actually have a different microbiome than women without PCOS, including less diversity in their microbiome.

We don’t even know what we don’t know about the microbiome yet, but we DO know that the types of organisms that are present can dictate our blood sugar balance, our metabolism and weight, inflammation, digestion and absorption, and mood. So your gut microbiome can very well be making your PCOS symptoms worse. Even if you’re not struggling with gut symptoms that are common in women with PCOS such as constipation, loose stools, IBS / IBD, heartburn / GERD, and gall bladder issues!

Root Causes are Different for Everyone!

Different combinations of these root causes can be causing the symptoms that make up your particular experience with PCOS. Treatment approaches using nutrition, lifestyle, and targeted supplements are different depending on the root cause(s).  

Not only that, but most women have more than one root causes of PCOS underlying their symptoms!

Because everyone’s root causes are different and can occur in combination, it’s best to work with a professional who can help you identify and treat YOUR root causes. There is no one size fits all when it comes to PCOS!

Click here to read more about why it’s so hard to lose weight with PCOS. And click here to find out what you should do instead.

And to join the next round of The PCOS Root Cause Roadmap 6-week program, click here to sign up.

Or sign up for our free masterclass – PCOS Period Success: 3 Simple Diet Shifts You Can Make NOW to Get Your Period Back now to learn more!

Cowritten by Jeani Hunt-Gibbon.