What is PCOS?
The name Polycystic Ovary Syndrome implies there is a problem with your ovaries, but really it’s a whole body disorder that affects ovulation and causes your body to produce too many androgens (masculine hormones like testosterone).
This causes symptoms like irregular or missing periods, acne, facial hair growth, thinning hair on your scalp, and weight gain.
There has been much debate about the name PCOS as it doesn’t accurately describe what’s going on in your body.
For starters, the name was coined due to the “cyst-like appearance” of follicles seen on ultrasound scans.
Researchers noticed women with PCOS often had ovaries that looked like a string of pearls – with lots of tiny, under-developed follicles.
These “cysts” aren’t really cysts at all, but multiple “baby eggs” that attempted to grow but never made it to full size.
It’s common for baby eggs to begin developing but become stalled due to the hormonal imbalances associated with PCOS.
Once the egg becomes stalled, your body decides to discard that baby egg and try again with a new one.
It often takes several tries before your body is able to grow a full-sized egg and release this at ovulation.
Once you have finally ovulated, this is followed by a period around two weeks later. This is why very long cycles or missing periods are a common feature of PCOS.
Does PCOS mean you have cysts on your ovaries?
Interestingly, not all women with PCOS have polycystic ovaries.
You can still meet the criteria for diagnosis based on other signs and symptoms including irregular cycles (more than 35 days between periods) and hyperandrogenism (high testosterone on blood tests and/or physical signs like acne and hirsutism).
In young women in particular, ultra-sounds are an unreliable means of diagnosis as up to 70% of healthy women under 21 have polycystic ovaries.2
Since PCOS doesn’t involve true cysts on your ovaries, and some women have normal ovaries on ultrasound, researchers have proposed several different names to more accurately describe what is going on in your body.
Some of my personal favorites include “Metabolic Reproductive Syndrome” and “Metabolic Hyperandrogenic Syndrome.”3
For now, we’ll stick to the name PCOS, but watch this space for updates!
Is PCOS a disease?
PCOS is a syndrome not a singular disease.
It is a group of symptoms related to too many androgens.
Other syndromes you might have heard of include irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS).
What’s common between these syndromes is that they describe a group of symptoms, which can have multiple root causes.
Let’s think about an IBS scenario for a minute.
Sarah developed IBS because she caught a stomach bug whilst on holiday in Thailand and ended up with a parasite infection.
Tara has IBS because she works a highly stressful job and drinks lots of coffee on an empty stomach to keep up with the workload.
Both Sarah and Tara experience painful bloating, alternating diarrhea and constipation, and stomach cramps.
However, the treatment that will help resolve their symptoms is likely completely different.
Sarah might benefit from a course of antibiotics to kill the parasite, while Tara might benefit from learning stress management techniques and swapping coffee for green tea.
Syndromes don’t have one simple test that can be used to diagnose them.
Similarly, syndromes don’t have one singular medication or procedure that will work for everyone because the root cause is different in each case.
If you have been officially diagnosed with PCOS, this is because you met a specific criteria of symptoms. To understand what is causing these symptoms, we need to look deeper.
You might be experiencing your PCOS symptoms because of your body’s sensitivity to stress hormones.
It could be a combination of your genetics making your insulin function less efficiently as well as eating a diet that doesn’t support your blood sugar levels.
You might have increased levels of inflammation in your body due to an underlying food sensitivity that has gone unaddressed.
Or you might have recently stopped taking the birth control pill, causing a temporary overproduction of androgens in your ovaries.
This is why a very low carb or ketogenic diet worked for a PCOS influencer you saw on Instagram, but you felt worse when you tried it.
Or why your friend with PCOS feels amazing after an early morning HIIT class, but your energy is tanked for the rest of the day.
In the same way that we need to know why someone is experiencing IBS in order to prescribe the right treatment, to truly heal your PCOS, we first need to understand your root cause.
What are the PCOS "Types" or "Root Causes"
In my many years working with women with PCOS, I discovered that there are four distinct root causes (or “types”) of PCOS:
- Insulin resistance
- Adrenal (stress-based)
- Inflammatory
- Post-birth control.
For a Cyster with insulin-resistant PCOS and no issues with her adrenal glands or stress hormones, a very low carb diet and high intensity exercise plan could be incredibly helpful in reversing her symptoms.
For another Cyster with adrenal PCOS, the same plan could leave her feeling moody, stressed, hungry, and with no improvement in her symptoms.
Over the next few chapters, you’ll discover exactly which one (or combination) of these four root causes is driving your symptoms.
We will then create an individualized, step-by-step plan to reverse your PCOS type.
We’ll identify the most important food, movement, mindset, and supplement changes to address your unique root cause and reverse your symptoms for good, so you can start thriving with PCOS
How did I get PCOS?
Research in this area is still developing, however at this point in time, there seem to be three key influences that increase your risk of developing PCOS: genetics, endocrine development, and environmental exposure.
When researchers examined families of women with PCOS, they found that both male and female relatives were much more likely to have metabolic syndrome, insulin resistance, high blood pressure, and high cholesterol.
This suggests that there may be a familial genetic link involved with the development of PCOS.
Research has also shown that early exposure to endocrine disrupting chemicals like pesticides, phthalates and Bisphenol A (BPA) as a fetus or in early childhood may impact the development of your hypothalamus pituitary-ovarian axis (the way your brain talks to your ovaries).
This can lead to issues with ovulation and increased production of androgens, causing the symptoms of PCOS.
Increased stress hormones and chronic dieting in the years before and during puberty have also been linked with an increased risk of developing PCOS later in life.
Finally, there are several environmental triggers that have been shown to accelerate or “switch on” your development of PCOS. These include insulin resistance, inflammation, and stress hormones.
In some women, taking the oral contraceptive pill can also temporarily trigger the symptoms of PCOS due to a surge in androgens.
Think about it like this: You are born with an increased likelihood of developing PCOS, and then certain triggers in your environment and your lifestyle cause that gene to be switched on, leading to the symptoms of PCOS.
While we can’t change your genetics or what happened in your early life, we can change your current environment to minimize the expression of your PCOS and eventually reverse your symptoms.
How does my root cause create my PCOS symptoms?
Women with PCOS have an increased likelihood of making too many androgens and having problems with ovulation due to their family history. Over time, certain things in life "switch on" our PCOS gene.
The factors that triggered our PCOS are likely different from those of another Cyster, which is why every case of PCOS is unique.
At the heart of it, your unique root cause stimulates your body to produce too much testosterone or other androgens.
The way this happens depends on which root cause of PCOS (or combination) you are dealing with.
Testosterone gets into the oil glands under your skin, particularly around your chin and jawline, and causes excess sebum (skin oil) production.
This extra oil blocks your hair follicles and causes an infection, leading to those frustrating spots we know as pimples.
In some women, the fine, soft hairs known as vellus hairs on your chin, upper lip, breasts, lower abdomen, inner thighs, and lower back are hormone sensitive.
This means that when you have high levels of testosterone, these hairs change from vellus hairs to terminal hairs –long, coarse and dark hairs which grow much faster (and mean you need to shave or wax constantly).
This situation is known as hirsutism and commonly includes the thinning of hair on your scalp.
Scalp hair follies are also hormone sensitive, but instead of becoming terminal hairs, testosterone is converted into dihydrotestosterone (DHT) – a very potent version of testosterone.
DHT causes the hair follicles to die and fall out – leading to thinning hair on your head.
As well as causing acne and hair changes, insulin, testosterone, stress hormones, chronic inflammation, and thyroid imbalances can all disrupt your ovulation and periods.
This can lead to very long cycles or missing periods altogether.
If you aren't having regular periods, your doctor might have talked to you about the importance of bleeding regularly and may have prescribed medication like the pill or the Depo Provera shot to artificially induce a bleed.
This is because going for long periods of time without shedding your endometrial lining (which is what happens when you bleed on your period), may increase your risk of endometrial cancer.
While regular bleeds are important, regular ovulation is arguably even more critical because this is how we keep our heart, bones, and breast tissue healthy.
Not ovulating can significantly impact your bone density as well as increase your risk of cardiovascular disease.
By addressing your root cause, you can support your body to start ovulating naturally and having regular cycles again.
Not only will this improve your lifelong disease risk, but it will also mean that you are having regular, natural bleeds without the need for medication.
This is because ovulation is always followed by a period bleed (unless you're pregnant).
Can the pill regulate my cycle or fix my PCOS symptoms?
There is a common misconception that the birth control pill can "regulate your cycle."
This is because, when you follow the pill schedule on the packet, your period magically arrives every 28 days, creating a false sense of regularity.
In reality, the bleed you have whilst on the pill is caused by a withdrawal from the synthetic hormones, rather than due to ovulation.
A normal cycle involves ovulation, followed by (if you're not pregnant) the shedding of the lining of your uterus in the form of your period roughly two weeks later.
In contrast, the pill works by shutting down ovulation in order to prevent pregnancy.
In the final week of most pill packets, you will find placebo tablets. They are often marked by a different color.
These tablets are "inactive" – meaning they don't contain synthetic hormones.
There is actually no need to consume these tablets, however manufacturers add them to the packet to help you keep the routine of swallowing a pill each day.
The reason these placebo tablets are there is to cause a temporary withdrawal from the synthetic hormones that trigger your endometrial lining to shed.
This is the bleed that looks like a period.
Whilst it can feel like the pill has fixed your irregular cycles because you are bleeding regularly, the reality is that you still have not addressed the root cause of why you aren't ovulating.
This means that when you stop taking the pill, your irregular cycles will very likely return.
Hormonal birth control can also be very helpful in managing some of the other frustrating symptoms of PCOS like acne and hair changes.
These symptoms are caused by high levels of testosterone and other androgens.
Certain brands of the pill have strong anti-androgenic effects – meaning they block the effects of high testosterone.
This is why you may have been offered the pill as a "solution" to your symptoms by your doctor.
Unfortunately, while the pill can block the effects of testosterone temporarily, it cannot teach your body to produce less.
This means that once you stop taking the pill, these symptoms will likely reappear and often more severely than before.
While the pill and other medications absolutely have a place in supporting severe symptoms, I want you to choose these medications informed with the knowledge that they are temporary, band-aid solutions.
I know all too well that sometimes we just need a break from the debilitating symptoms of PCOS.
I have used the pill and other medications myself out of desperation, and I am grateful that they were there when I needed them.
However, when you are ready to reverse your symptoms for good, it's time to address your root cause.
This isn't going to be an overnight fix, but putting some targeted strategies in place now to support your unique PCOS type will greatly improve your symptoms, boost your fertility, and reduce your lifelong disease risk.
Plus, you'll likely experience other bonus "side effects" like increased energy, smooth digestion, improved moods, better sleep, and increased libido!
The principles you will learn in this book will support your body for the rest of your life, not just for a few weeks or months.
I cannot wait for you to experience how empowering it is to finally understand what your body needs and create a lifestyle that supports this.
What will happen if I don’t address my root cause?
If you don’t address why your body is producing too many androgens and having issues with ovulation, your symptoms probably won’t improve and will likely get worse over time.
You may also increase your risk of developing more severe conditions over time.
Let’s look at some issues that can happen with each root cause if it goes unaddressed for a long time. I’ve provided these points to keep you informed and to motivate you – not to scare you.
It’s important to understand what putting the work in now can mean for your future.
Just because these risks are listed for your root cause does not mean you are destined to experience them.
If you take action now to take charge of your PCOS, you can dramatically reduce your risk of the conditions mentioned below.
Insulin resistance in PCOS
Research indicates that around 70% of people with insulin resistance go on to develop type 2 diabetes when left untreated.
Type 2 diabetes signficantly impacts your entire body – from eyesight to blood vessels, blood flow to your feet, sexual function, heart, nerves, and kidneys. It also increases your risk of developing heart disease and certain cancers.
Having high insulin also heightens your risk of pregnancy complications if your insulin is not under control during pregnancy.
Studies show a 24% increased risk of preeclampsia and around a 40% increased risk of gestational diabetes for women with high insulin.
High insulin has been shown to reduce the effectiveness of certain fertility drugs like letrozole and clomid.
If conceiving in the future is a priority for you, improving your insulin resistance now will have dramatic effects on both your ability to conceive and to have a healthy pregnancy with fewer complications.
Less life threatening, but still hugely impactful on your quality of life, suffering from insulin resistance causes rollercoaster fluctuations in energy, sugar and carbohydrate cravings as well as brain fog, "hangry' attacks," mood swings and stubborn weight gain (particularly around your midsection).
Having experienced imbalanced blood sugar levels myself, I cannot overstate the night and day difference of getting this under control.
Before I addressed my insulin resistance, I couldn't go two hours without a meal or snack.
If I did, I would end up shaking, lightheaded, cranky, and not able to think straight.
This meant I had to constantly think ahead, pack my snacks, and know where and when I would be eating next.
I also dealt with overwhelming sugar cravings after every meal and felt like I was always thinking about food.
My thoughts were consumed by food, and I found myself thinking of what sweet treat I would eat before I even finished my main meals.
Healing your insulin resistance now will dramatically improve your lifelong disease risk, significantly lower your risk of pregnancy complications, support you to find a healthy weight, and stop cravings from ruling your headspace and energy levels.
High stress hormones in PCOS
Back in cavewoman times, cortisol and adrenaline were the hormones our body used in short bursts to give us energy to escape danger.
Our adrenal glands dump glucose into our bloodstream to help power our muscles to run away or fight a predator.
This system works really well when you are dealing with occasional threats to your survival that require you to run fast.
The problem with modern-day stress is that we very rarely experience stress from a physical threat.
More often, our stress is experienced sitting at a desk with a demanding boss or running late and stuck in the car in traffic.
Rather than in a short burst, we often experience stress relentlessly.
This means that, over time, our body continues dumping glucose into our bloodstream to help us run or fight, but we aren't using the energy.
This extra glucose can cause our bodies to become less responsive to insulin, eventually leading to insulin resistance.
Chronically high cortisol impairs your immune system function, making it harder to fight off infections and increasing your recovery time.
This is because our bodies are prioritizing keeping us safe from the immediate stress, rather than fighting viruses or infections.
Running off adrenaline can feel really good at the time and can actually be quite addictive.
There have been many periods of my life where I have run off a couple of hours of broken sleep, way too much coffee, and the buzz of looming deadlines.
For a while you can feel superhuman and tick so many things off your to-do list.
However, over time, our adrenal glands can't keep up with the constant output of cortisol and we end up feeling "tired but wired."
This is where your energy levels go from sky-high to rock bottom for the majority of the day.
All of a sudden, you may struggle to complete normal tasks or even get out of bed without caffeine.
You never feel refreshed, even after a full night's sleep, and struggle to deal with normal levels of exercise or stress.
You find yourself wandering around during the day in a foggy haze, then, often right before bedtime, you experience a sudden surge of energy that can prevent you from sleeping, further worsening your fatigue.
I've personally experienced complete burnout in my energy levels after asking too much of my adrenals and had to take significant steps to recover.
You can reverse this situation, however it is significantly more difficult once you are already depleted.
If we can address your stress hormones before you get to rock bottom, it will be a much simpler and faster process.
Inflammation in PCOS
Chronically high levels of inflammation increases your risk of developing certain autoimmune conditions like rheumatoid arthritis, Hashimoto's thyroiditis, and Lupus.
It also increases the likelihood of experiencing inflammatory conditions like hypertension, poor mental health, and cardiovascular disease.
Not all inflammation is "bad." Inflammation is a necessary part of our immune system and we want it in small amounts to help our body fight acute infections and deal with injuries.
Our body uses inflammation to send immune cells to parts of the body that need help fighting foreign invaders (like a virus) and to heal damaged tissue.
In a healthy inflammatory situation, an event triggers increased inflammation – for example, contracting the common cold.
The immune system mounts its response, kills the virus, and we get better.
Now that the threat has passed, we can switch off the inflammation and go back to normal.
The problem with our modern lifestyle is that the inflammation doesn't switch off after the threat disappears.
This means our immune system doesn't have a chance to rest and recover before the next event.
When it is chronically activated, our immune system can become tired and confused and start to attack our own tissues instead of just foreign invaders.
This is what leads to autoimmune diseases like those mentioned earlier.
By addressing the cause of your increased inflammation now (for example, poor gut health, food intolerances, or low vitamin and mineral levels), you can dramatically reduce the chances of your immune system becoming overstimulated and developing the conditions above.
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polycystic ovary syndrome: a systematic review and meta-analysis. Fertil Steril.
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Phase of Premenopausal Women Differs between Ovulatory and Anovulatory
Cycles. Geburtshilfe Frauenheilkd. 2015;75(12):1250-1257.
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5 Comments
What is the difference between the androgen blocker and gleeful supplement? I’m very interested in your product but I’d like to know the differences. I’ve tried to compare but I never succeed.
Reply to Tina Stephensen
As I was a child I grew up with pscos I was diagnosed at the age of 16 and they put me on metformin and spiral lactone I eventually gained weight had black areas around my neck my pelvic area and under my breast I also had cyst on my ovaries at several times and did not have my period at times at all I am a big candidate for this I was told I could never bear children
Reply to Elizabeth m sawyer
As I was a child I grew up with pscos I was diagnosed at the age of 16 and they put me on metformin and spiral lactone I eventually gained weight had black areas around my neck my pelvic area and under my breast I also had cyst on my ovaries at several times and did not have my period at times at all I am a big candidate for this I was told I could never bear children
Reply to Elizabeth m sawyer
I also had heritism so I had all the signs of PCOS
Reply to Elizabeth m sawyer
This blog explains PCOS in a very practical way by focusing on root causes rather than a one-size-fits-all approach.
Understanding insulin resistance as a driver for many symptoms helps make treatment choices feel more targeted and realistic.
Additional context on this topic is discussed here: https://www.pharmacyuk.com/why-glp-1-receptor-agonists-in-pcos-insulin-resistance-are-gaining-attention/
Reply to Aria Walker
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