PCOS: Understanding the Root Causes Beyond Irregular Periods
- 17 hours ago
- 4 min read
Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions, yet it is often reduced to irregular cycles or fertility concerns.
PCOS is primarily a metabolic and hormonal signaling condition — not just an ovarian issue.
Common Symptoms
• Irregular or absent periods
• Acne
• Excess facial or body hair
• Hair thinning
• Weight changes
• Difficulty losing weight
• Blood sugar fluctuations
• Fatigue
• Fertility challenges
Not everyone experiences all symptoms, and presentation varies widely.
What Causes PCOS
Insulin resistance
Elevated insulin signals the ovaries to produce more androgens, disrupting ovulation.
Elevated androgens
Higher testosterone levels can lead to acne, hair changes, and irregular cycles.
Chronic inflammation
Low-grade inflammation can worsen hormonal signaling.
Nervous system stress
Chronic stress can influence insulin and hormone regulation.
Genetic predisposition
There is often a family history of metabolic or hormonal conditions.
The Different Types of PCOS (Why Symptoms Can Look So Different)
PCOS is not one single presentation. Understanding the underlying driver helps guide treatment and expectations.
Insulin-resistant PCOS
This is the most common type. Elevated insulin levels stimulate the ovaries to produce more androgens, which disrupts ovulation and contributes to symptoms like irregular cycles, acne, and weight gain.
Inflammatory PCOS
Chronic low-grade inflammation can interfere with hormone signaling and ovarian function. This type may be associated with autoimmune tendencies, gut imbalance, or chronic stress.
Stress-related (HPA axis) PCOS
Chronic stress and nervous system dysregulation can elevate cortisol and alter hormonal signaling, sometimes leading to irregular cycles even without significant insulin resistance.
Post-pill PCOS
Some individuals develop temporary PCOS-like symptoms after stopping hormonal contraception as the body recalibrates ovulatory signaling.
PCOS Is a Whole-Body Condition
PCOS affects far more than the ovaries. It influences metabolic, neurologic, and inflammatory pathways throughout the body.
This is why symptoms may include:
• Blood sugar fluctuations
• Fatigue after meals
• Mood changes or anxiety
• Sleep disturbances
• Skin changes
• Increased cravings
• Difficulty building muscle
Understanding PCOS through a whole-body lens allows treatment to address underlying physiology rather than just cycle irregularity.
Long-Term Health Considerations
Without proper metabolic support, PCOS can increase risk for:
• Insulin resistance and prediabetes
• Type 2 diabetes
• Cardiovascular disease
• Fatty liver
• Infertility
• Endometrial hyperplasia
This is not meant to be alarming — it simply highlights why early support matters.
PCOS and Fertility
Ovulation may occur inconsistently with PCOS, but many people conceive successfully with proper metabolic and hormonal support.
Supporting ovulation often involves improving insulin sensitivity, reducing inflammation, and stabilizing hormonal signaling.
Why Traditional Care Often Falls Short
Conventional management often focuses on:
• Birth control
• Metformin
• Symptom suppression
While these may be appropriate in some situations, they don’t always address the underlying metabolic and hormonal drivers.
A root-cause approach focuses on improving signaling pathways so the body can regulate cycles more consistently.
What Improvement Can Look Like
With targeted support, many patients notice:
• More predictable cycles
• Improved energy
• Reduced cravings
• Clearer skin
• Improved mood stability
• Better metabolic markers
Progress is often gradual but meaningful.
FAQ
What is the main cause of PCOS?
The most common driver is insulin resistance, which increases androgen production and disrupts ovulation, though inflammation, stress, and genetics also play roles.
How do I know if I have PCOS?
Diagnosis typically involves a combination of irregular cycles, signs of elevated androgens (like acne or hair changes), and sometimes ultrasound findings. Not everyone needs cysts on ultrasound to meet criteria.
Can you have PCOS with regular periods?
Yes — some individuals ovulate irregularly or have subtle hormone imbalances despite seemingly regular cycles.
Is PCOS reversible?
While the underlying tendency toward insulin resistance may remain, symptoms often improve significantly with targeted metabolic and hormonal support.
Can PCOS cause anxiety or depression?
Yes. Blood sugar instability, inflammation, and hormone imbalances can all influence mood regulation.
Why is it so hard to lose weight with PCOS?
Insulin resistance promotes fat storage and increases hunger signaling, making weight loss more challenging without addressing metabolic factors.
Do you have to be overweight to have PCOS?
No. Lean PCOS exists and involves similar hormonal mechanisms despite a normal body weight.
Can PCOS go away after pregnancy?
Symptoms may improve temporarily, but underlying metabolic tendencies often remain and benefit from continued support.
Does PCOS get worse with age?
Without metabolic support, insulin resistance may progress, but symptoms can improve significantly with appropriate care.
Can PCOS affect sleep?
Yes — blood sugar fluctuations and hormonal changes can contribute to insomnia or non-restorative sleep.
Is PCOS linked to thyroid problems?
There is a higher prevalence of thyroid dysfunction in individuals with PCOS, particularly autoimmune thyroid conditions.
Why do doctors prescribe birth control for PCOS?
Birth control can regulate bleeding and suppress androgen production, but it does not treat underlying metabolic drivers.
Can diet really help PCOS?
Yes — nutrition plays a major role in improving insulin sensitivity and reducing inflammation, which directly impacts symptoms.
What labs are helpful for evaluating PCOS?
Evaluation may include markers of insulin resistance, androgens, thyroid function, and metabolic health alongside clinical history.
Can stress make PCOS worse?
Chronic stress can worsen insulin resistance and disrupt hormonal signaling, amplifying symptoms.
Is acne from PCOS hormonal?
Yes — elevated androgens increase oil production and skin inflammation.
Why am I not ovulating with PCOS?
Elevated insulin and androgens can interfere with normal ovarian signaling, preventing consistent ovulation.
Can PCOS increase risk of diabetes?
Yes — insulin resistance increases long-term metabolic risk, which is why early support is important.
How long does it take to see improvement with PCOS?
Many people notice changes in energy and symptoms within a few months, though cycle regulation can take longer.
Will I be able to get pregnant with PCOS?
Many people with PCOS conceive successfully with appropriate support that improves ovulation and metabolic health.
Dr. Kseniya Zvereva (ND) is a licensed naturopathic doctor in Washington, California, and Minnesota and founder of Xenia Integrative. She specializes in hormone imbalance, fatigue, gut dysfunction, pain, and stress-related conditions using personalized, evidence-informed naturopathic medicine.
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