Causes of Polycystic Ovary Syndrome (PCOS) and Polycystic Ovaries (PCO): Why Do I Have PCOS?

Polycystic Ovary Syndrome (PCOS) and the mere presence of polycystic ovaries are often confused, but they are distinct conditions. If you have polycystic ovaries, we have a dedicated article on the subject: the difference between PCOS and PCO. While both may be related, their causes, symptoms, and implications differ. This article explores the various potential causes of PCOS and polycystic ovaries, including often overlooked aspects such as thyroid issues, prolactin levels, stress, excessive dieting or exercise, inflammation, trauma, and burnout.

Polycystic Ovaries vs. Polycystic Ovary Syndrome (PCOS)

Polycystic Ovaries (PCO):

• Refers to the presence of multiple follicles on the ovaries observed via ultrasound.
• The follicles are not cysts but undeveloped eggs.
• Can be asymptomatic and does not necessarily involve hormonal imbalances.

Polycystic Ovary Syndrome (PCOS):

• A hormonal disorder characterized by symptoms such as irregular menstrual cycles, high levels of androgens, and polycystic ovaries.
• Often associated with insulin resistance and metabolic symptoms. We have a comprehensive article on the different types of PCOS based on your hormonal profile.

Causes of PCOS

Genetics and Family History One of the most documented causes of PCOS is genetics. PCOS tends to run in families. About one-third of women with PCOS have a close relative who is also affected. However, no single gene has been identified as responsible, suggesting the involvement of multiple genes.

Research indicates that genetic or chemical modifications occurring in the womb may also play a role in the development of PCOS. This discovery opens the door to further studies on the influence of prenatal factors on long-term hormonal health.

Hormones: Causes and Consequences of PCOS

Hormones play a central role in PCOS. These are chemical substances produced by the body that carry messages through the bloodstream and regulate various bodily functions, including growth, energy, reproduction, and digestion.

Elevated Androgens: Cause and Consequence of PCOS? Some studies suggest that elevated androgens may play a causal role in the development of PCOS. High levels of androgens can lead to ovulatory disorders, a hallmark of PCOS. Genetic and environmental factors may also contribute to this elevation of androgens, predisposing certain women to PCOS.

In reality, there is likely a bidirectional interaction between androgens and PCOS. Elevated androgens may contribute to the development of PCOS, and the anomalies associated with PCOS can, in turn, exacerbate androgen production. This positive feedback loop complicates the understanding of direct causality.

Sources of Elevated Androgens

1. Ovarian Production

   • The ovaries are the primary contributors to hyperandrogenism in women with PCOS. This overproduction of androgens can be due to:
     • Ovarian Dysfunction: Polycystic ovaries contain many immature follicles that produce excess androgens.
     • Increased Response to Luteinizing Hormone (LH): High levels of LH, often seen in women with PCOS, stimulate the theca cells in the ovaries to produce more androgens.

2. Adrenal Production

   • The adrenal glands can also play a role in elevated androgens, often referred to as adrenal PCOS.

3. Insulin Resistance and Hyperinsulinemia

   • Insulin resistance, common in women with PCOS, significantly contributes to elevated androgens:
     • Hyperinsulinemia: Insulin resistance leads to high insulin levels in the blood, directly stimulating the ovaries to produce more androgens.
     • Synergistic Effect: Insulin amplifies the effect of LH on the ovaries, further increasing androgen production.

4. Genetic Factors

   • Genetic predispositions play a crucial role in the hyperandrogenism observed in women with PCOS. PCOS tends to run in families, suggesting genetic factors that predispose to excessive androgen production.

Thyroid and Prolactin: Causes of PCO

Thyroid health is closely linked to the overall hormonal function of the body. Thyroid dysfunctions, such as hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid), can exacerbate PCOS symptoms but do not cause PCOS. An underactive thyroid can lead to symptoms similar to PCOS, such as irregular periods, weight gain, and fatigue, complicating the differential diagnosis. The thyroid is therefore a cause of PCO.

Prolactin, a hormone produced by the pituitary gland, also plays a crucial role. Elevated prolactin levels, a condition called hyperprolactinemia, can interfere with ovulation and cause menstrual irregularities similar to those seen in PCOS. However, high prolactin is not a cause of PCOS. Considering prolactin levels is therefore essential in evaluating women with PCOS symptoms. It is important to note that hyperprolactinemia is a cause of PCO.

Inflammation: A Possible Cause of PCOS

Chronic inflammation is another potential cause of PCOS. Research shows that women with PCOS often have elevated markers of inflammation in their bodies. This inflammation may be linked to insulin resistance, creating a vicious cycle where inflammation and high insulin levels reinforce each other. Chronic inflammation can also stimulate the ovaries to produce androgens, exacerbating PCOS symptoms.

Causes of PCOS: Chronic Stress, Trauma, and Burnout

Emotional trauma and burnout may also play a role in the development of PCOS. Extreme and prolonged stress can disrupt hormonal balance by increasing cortisol levels, a stress hormone. Elevated cortisol can, in turn, negatively affect insulin and androgen production. Women who have experienced traumatic events or suffer from burnout may therefore be at higher risk of developing PCOS symptoms.

The Impact of Stress Stress is an often underestimated factor in the development of PCOS. Chronic stress can disrupt hormonal balance, increasing cortisol and adrenaline levels. These stress hormones can influence insulin and androgen production, worsening PCOS symptoms.

Stress management techniques, such as meditation, yoga, and therapy, can be beneficial for women with PCOS. By reducing stress, it is possible to lessen the impact of hormonal imbalances and improve overall quality of life.

Weight: Cause or Consequence of PCOS?

Weight as a Cause Obesity can play a causal role in the development of PCOS:

• Insulin Resistance: Excess weight, particularly abdominal fat, is often associated with insulin resistance. This resistance can lead to high insulin levels, which may stimulate the ovaries to produce more androgens, contributing to the development of PCOS.
• Inflammation: Obesity is associated with a chronic inflammatory state, which can also affect hormone levels and contribute to the development of PCOS.

Weight as a Consequence PCOS itself can lead to weight gain and difficulty losing weight:

• Hormonal Imbalances: Hormonal imbalances associated with PCOS, such as elevated androgens and insulin resistance, can lead to weight gain. High androgens may promote abdominal fat storage.
• Slowed Metabolism: PCOS can affect metabolism, making weight loss more difficult for women with this syndrome.

In reality, there is a bidirectional interaction between weight and PCOS. Excess weight can contribute to the development of PCOS, and PCOS can, in turn, exacerbate weight issues. This feedback loop complicates the understanding of direct causality.

Studies have shown that lifestyle changes, such as increased physical activity and a healthy diet, can have a significant positive impact on managing PCOS. It is important to note that weight loss should be approached healthily and sustainably, avoiding yo-yo dieting and extreme restrictions.

Prevention and Management of PCOS

There is no proven method to prevent PCOS, but there are many ways to manage its symptoms naturally: PCOS and treatments. The key lies in a holistic approach that includes stress management, a balanced diet, moderate physical activity, and careful attention to other hormonal conditions such as thyroid dysfunctions, prolactin levels, and inflammation.

Conclusion

PCOS is a complex condition with many potential causes. Genetics, hormonal imbalances, lifestyle factors, chronic inflammation, emotional trauma, and burnout all play a role in its development. Understanding these various causes helps better manage and treat PCOS, thereby improving the quality of life for women affected by it.