What Causes PCOS?

Medically Reviewed by
Dr. Stacy Henigsman
Nutritionally Reviewed by
Felice Ramallo, RDN

The question of what causes PCOS is a complicated one.

As with many medical conditions, sometimes it feels as if there are more questions than answers. Nevertheless, the complex issue of what triggers PCOS, who is at risk for it, and how to manage it are all queries that 10% of women around the world would like an answer to. (Afterall, to make sense of all the symptoms and implications that accompany PCOS, it helps to understand what’s behind these changes that you live with everyday).

So that’s what we’ll be exploring in this article: what is polycystic ovary syndrome, what causes PCOS, symptoms associated with this reproductive health condition, and why more time and effort needs to be dedicated to understanding it.

Let’s dive in.  

What is PCOS?

Polycystic ovary syndrome, otherwise known as polycystic ovarian syndrome, is often shortened to its acronym: PCOS.

PCOS is a complex condition, which is more frequent than you may at first believe. In fact, a lot of women with PCOS do not even know they have it. Generally, this condition is characterized by an imbalance of hormones in the body, since women with PCOS have higher-than-normal amounts of male hormones (known as androgens). This hormonal imbalance can trigger symptoms like missed periods, acne, excess hair growth, weight gain, and other issues. However, this isn’t always the case, and other essential markers of PCOS also include the presence of polycystic ovaries and irregular or entirely absent menstrual cycles.  

Because of PCOS’ impact on a woman’s ability to ovulate, it is associated with trouble getting pregnant as well. In fact, PCOS is understood to be the leading cause of infertility (as well as the most common endocrine disorder) among reproductive-age women. And this condition may be more common than you might think: according to the CDC, it affects between 6% and 12% of US women who are of reproductive age, while one study found that 70% of women with the condition didn’t even know they had it.

Unfortunately, it can be common for women with PCOS to go on to develop even more serious health problems, such as diabetes, heart disease, high blood pressure, sleep apnea, and even stroke.

Now, the above symptoms and implications of PCOS are common results of the systemic inflammation associated with untreated PCOS, but it’s not a definite sentence. Just because you are diagnosed with PCOS doesn’t mean you’re going to suffer from every problem that we just mentioned, and there are ways you can work with your body to mitigate symptoms. For this, check out our article on 5 ways to manage PCOS pain, as well as our piece on the best PCOS supplements for naturally healing PCOS.

What Are The Symptoms of PCOS?

We briefly touched on some symptoms that are frequently associated with PCOS (such as weight gain and a lack of periods), but just as PCOS is a complex condition, the way it shows up in women can vary case by case.

Here’s a complete list of symptoms to look out for if you’re wondering if you have PCOS:

  • Irregular menstrual cycle (or no periods at all)
  • This is the result of the hormonal imbalance, a key part of PCOS, that prevents ovulation each month
  • Hirsutism
  • This is a fancy way of saying ‘excess hair growth,’ and for women with PCOS this can be an extremely psychologically and emotionally stressful symptom, showing up on the face, neck, chest, and back.
  • Oily skin/acne
  • Excessive androgens are the culprit when it comes to this symptom. Acne can appear on the face, chest, and upper back.
  • Thinning hair or hair loss
  • Weight gain (or difficulty losing weight)
  • The majority of women who have PCOS struggle with weight gain, and for those women who do maintain their weight and not experience this symptom, unfortunately they also have increased chances of diabetes (compared to their counterparts of similar ages and weights who do not have PCOS)
  • Darkening of skin
  • This symptom will most likely show up on neck creases, around the groin, and underneath the breasts
  • Skin tags
  • These are small excess flaps of skin, usually present under the arms or around the neck  
  • Ovaries that have cysts
  • A woman without PCOS can have cysts on her ovaries, and women with other reproductive health conditions can also suffer from cystic ovaries (as a result of endometriosis, for instance).
  • That being said, PCOS is often associated with large or many cysts on the ovaries. These cysts can cause pain; other times they are painless. If you do get an ultrasound, the presence or lack of cysts will not necessarily preclude you from a PCOS diagnosis. They are one of three criteria used to determine if you have polycystic ovarian syndrome. Check out our article on how PCOS is diagnosed to learn more.

So What Causes PCOS, Exactly?

Unfortunately, what causes PCOS isn’t a cut and dry answer. Medical experts believe that PCOS is triggered by insulin insensitivity, which prevents the ovaries from producing hormones and ovulating normally. The decreased sensitivity of cells to insulin causes higher production of insulin in the blood, and propagates the ongoing imbalance of hormones, as too much insulin increases the production of more androgens (male hormones).

Okay, so a mix of insulin insensitivity and a hormonal imbalance trigger the symptoms we mentioned above. But then the question becomes, what prompts this domino-effect in the first place?

Well, researchers don’t have all the answers yet. But they have a few hypotheses, based on studies and evidence.

There may be a genetic component

It appears that PCOS may be, to some extent, hereditary. In a study conducted by the University of Alabama at Birmingham, researchers discovered that just under ¼ of women with PCOS had a mother with PCOS, while almost ⅓ had a sister with PCOS. Keep in mind this was a small study, with less than 100 participants, so the results may be taken with a grain of salt, but the CDC echoes the sentiment on their own website: “women whose mother or sister has PCOS or type 2 diabetes are more likely to develop PCOS.”

The thing that most scientists can agree on here? They’re not sure exactly what genes in particular trigger PCOS; likely it is a combination of genes, though, as opposed to one single factor that triggers this condition.

An evolutionary experiment

PCOS is older than you might think.

While the University of Utah Health reports that the first official PCOS case was identified in 1935 (it appears there weren’t significant attempts to understand the condition or to diagnose it for decades after), another article published in 2012 put forward the idea that PCOS is an ancient disorder, finding ancient medical records (from as early as 460-377 BC) that describe women with symptoms which sound very similar to PCOS as we know it today.

So if PCOS dates back thousands of years, but causes reduced fertility, why would it continue across generations?

In a nutshell: because it offers other advantages. Specifically, the aforementioned article argues, “the reduced fecundity of affected women potentially would have been offset, at least in part, by [women’s] greater studiness and improved energy utilization, a rearing advantage for their children and kin, and a reduction in the risk of maternal mortality.”

So there you have it – if you have PCOS, you may be evolutionarily advantaged, which is at the very least an interesting thought, if not pretty cool altogether.

Should More Be Known About PCOS?

You would think with 10% of women suffering from the condition, and its history (there may be some disagreement about when PCOS began, but we know at the very least it’s almost a century old) that there would be more focus on the condition in trials and research.

But the fact is, women’s reproductive health in general is not well funded, or well researched when compared with other conditions.

In fact, in a UK government report, it was found that though 1 in 3 women surveyed experienced “severe reproductive health symptoms” in the last 12 months, only 2.5% of the health budget tackles research in this area. And it’s not just limited to the UK: The National Institutes of Health (NIH) lists Reproductive Health as one of the lowest funded research, disease, and condition categories. Out of a list of 14 categories, women’s health ranks at number 10. This is perhaps not surprising given it was only as of 1993 that a law passed stating that women needed to be included in clinical trials; for decades until that point women were often excluded from clinical drug trials thanks to the belief that fluctuations in female hormones (depending on what stage women were in their reproductive cycle) would make women more difficult to study than men.

That being said, despite there still being a lot to know about where PCOS exactly comes from, it is well known that it can be managed.

Managing PCOS

So let’s say you have read our article on if you may have PCOS, and you see that you have some of the most common symptoms of PCOS.

What now?

Well first of all, you want to consider working with a gynecologist to get a diagnosis (and we at Allara can also help you get a speedy diagnosis on what the problem may be), so you can explore the safest and most effective treatment options for you.

Second, take comfort in knowing that it is possible, using a holistic approach – with guidance from a comprehensive medical care team – that takes into account diet, exercise, medication, and supplementation, to reduce symptoms and heal your body.

After all, PCOS is a condition that affects more than one part of you – to intentionally and thoughtfully tackle unwelcome implications, a holistic approach is needed. So if you would like to begin managing your PCOS symptoms as soon as possible, and create a tailored plan that works with your body to feel your best: then check out our PCOS resources, here.

Allara Health provides personalized treatment for hormonal, metabolic & gynecological conditions that utilizes a holistic plan that merges nutrition, lifestyle, medication and supplementation, and ongoing, expert support to heal your body.

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“I was given an explanation of how my hormonal imbalance was affecting me as a whole- body & mind- & tools so that we could start to manage my condition. I am happy to announce after a year of trying, I found out that I was pregnant & I couldn’t be happier!”

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“I was given an explanation of how my hormonal imbalance was affecting me as a whole- body & mind- & tools so that we could start to manage my condition. I am happy to announce after a year of trying, I found out that I was pregnant & I couldn’t be happier!”

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