What Are the Root Causes of PCOS?

What Are the Root Causes of PCOS?

Polycystic Ovary Syndrome (PCOS) is a common hormonal condition that affects up to 1 in 5 women of reproductive age. While it’s often discussed in terms of symptoms—irregular periods, acne, weight gain, and infertility—the real question many people ask is: what actually causes PCOS? To understand the root causes, we need to explore how a combination of genetics, insulin resistance, hormonal imbalance, and environmental factors contribute to its development.

1. Genetic Predisposition

PCOS often runs in families, suggesting a strong genetic component. Studies have found that women with a first-degree relative (mother or sister) who has PCOS are more likely to develop the condition themselves (Goodarzi et al., 2011). Multiple genes related to insulin regulation and androgen production have been implicated, making genetics a foundational cause that sets the stage for PCOS.

2. Insulin Resistance

One of the most well-documented root causes of PCOS is insulin resistance. Insulin is a hormone that helps cells absorb glucose from the bloodstream. In PCOS, the body’s cells become resistant to insulin, leading to higher insulin levels. This excess insulin stimulates the ovaries to produce more androgens (male hormones like testosterone), which disrupt ovulation and lead to many of the hallmark PCOS symptoms like acne and excess hair growth (Dunaif, 1997).

3. Androgen Excess

Women with PCOS produce higher-than-normal levels of androgens. While all women have small amounts of these hormones, in PCOS, the levels are elevated due to both genetic factors and insulin resistance. This hormonal imbalance is a root cause of anovulation (lack of ovulation), which leads to irregular or missed periods and the formation of ovarian cysts (Azziz et al., 2004).

4. Chronic Inflammation

Low-grade chronic inflammation is common in women with PCOS. This can trigger the ovaries to produce androgens and exacerbate insulin resistance. Inflammatory markers like CRP (C-reactive protein) tend to be elevated in PCOS patients, indicating that inflammation may be both a cause and a result of the condition (González, 2012).

5. Lifestyle and Environmental Factors

While genetics load the gun, lifestyle often pulls the trigger. Sedentary lifestyle, poor diet, excessive sugar intake, and stress are all known to worsen insulin resistance and inflammation, making PCOS symptoms more severe. Exposure to endocrine-disrupting chemicals (like BPA found in plastics) has also been suggested as a possible environmental contributor (Diamanti-Kandarakis et al., 2009).

6. Hypothalamic-Pituitary-Ovarian (HPO) Axis Dysfunction

The HPO axis regulates reproductive hormones. In PCOS, the axis is often disrupted, leading to imbalances in luteinizing hormone (LH) and follicle-stimulating hormone (FSH). A high LH to FSH ratio is common and can lead to increased androgen production and abnormal follicular development (Franks, 1995).

Wrapping Up

PCOS is not caused by just one thing—it’s a multifactorial condition with roots in genetics, insulin resistance, hormonal imbalances, inflammation, and environmental triggers. Understanding these causes can help in creating a holistic and personalized management plan. While PCOS can't be "cured," it can be effectively managed through a combination of diet, exercise, medications, and hormonal regulation strategies.

Disclaimer

This blog post is for informational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personalized guidance and treatment options if you suspect you may have PCOS or any other hormonal condition.

References

• Azziz, R., Woods, K. S., Reyna, R., Key, T. J., Knochenhauer, E. S., & Yildiz, B. O. (2004). The prevalence and features of the polycystic ovary syndrome in an unselected population. The Journal of Clinical Endocrinology & Metabolism, 89(6), 2745-2749. https://doi.org/10.1210/jc.2003-032046

• Diamanti-Kandarakis, E., Bourguignon, J. P., Giudice, L. C., Hauser, R., Prins, G. S., Soto, A. M., ... & Gore, A. C. (2009). Endocrine-disrupting chemicals: an Endocrine Society scientific statement. Endocrine Reviews, 30(4), 293-342. https://doi.org/10.1210/er.2009-0002

• Dunaif, A. (1997). Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocrine Reviews, 18(6), 774-800. https://doi.org/10.1210/edrv.18.6.0318

• Franks, S. (1995). Polycystic ovary syndrome. The New England Journal of Medicine, 333(13), 853-861. https://doi.org/10.1056/NEJM199509283331307

• González, F. (2012). Inflammation in polycystic ovary syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids, 77(4), 300-305. https://doi.org/10.1016/j.steroids.2011.12.003

• Goodarzi, M. O., Dumesic, D. A., Chazenbalk, G., & Azziz, R. (2011). Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nature Reviews Endocrinology, 7(4), 219-231. https://doi.org/10.1038/nrendo.2010.217