PCOS, your questions answered...

Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting women of reproductive age.  It is characterised by a combination of symptoms including irregular
menstrual cycles, weight gain, acne, and excessive hair growth. While the exact cause of
PCOS remains unclear, it is often associated with hormonal imbalances, particularly
involving testosterone, oestrogen, and progesterone as well as the role of adrenal function and blood sugar regulation. It is important to understand these hormonal interactions, along with the influence of lifestyle and dietary factors, which are crucial for effectively managing PCOS.
In women with PCOS, there is often an excess of androgens, including testosterone and dihydrotestosterone (DHT), which is a potent form of testosterone. Elevated testosterone
levels can lead to symptoms such as irregular periods, ovulatory dysfunction, and the
development of male-pattern hair loss or hirsutism (excess hair growth).
High DHT levels can exacerbate these common PCOS symptoms such as hirsutism, acne,
and hair thinning. DHT is known to affect hair follicles and skin, leading to increased hair
growth in unwanted areas and a reduction in scalp hair.
We also know that this higher level of testosterone levels may also contribute to insulin
resistance, a common issue in PCOS, which can exacerbate weight gain and metabolic
issues.
Oestrogen is crucial for regulating the menstrual cycle and reproductive health. In PCOS,
the balance between oestrogen and testosterone may be disrupted, leading to irregular
ovulation and menstrual cycles.
Individuals with PCOS may experience higher levels of oestrogen due to factors such as obesity, which can further complicate hormonal balance and increase the risk of endometrial hyperplasia.
Progesterone plays a vital role in preparing the body for pregnancy and regulating the
menstrual cycle. In PCOS, the lack of regular ovulation often leads to lower progesterone
levels, causing oestrogen dominance which can contribute to irregular menstrual cycles and other symptoms. Maintaining a healthy balance of progesterone is essential for reproductive health and overall hormonal balance.
Insulin resistance plays a significant role in polycystic ovary syndrome (PCOS), contributing to various symptoms and complications associated with the condition.
Insulin resistance can lead to elevated insulin levels in the bloodstream (hyperinsulinemia), which may increase the production of androgens, including testosterone. This hormonal imbalance is a hallmark of PCOS and can result in symptoms such as irregular menstrual cycles, acne, and excessive hair growth.
These elevated insulin levels can disrupt the normal functioning of the ovaries, leading to
irregular or absent ovulation (anovulation). This can cause irregular menstrual cycles and
difficulty in conceiving.
Insulin resistance is often associated with weight gain and obesity, which can further
exacerbate insulin resistance in a vicious cycle. Women with PCOS and insulin resistance are at a higher risk of developing metabolic issues such as type 2 diabetes, hypertension,
 and dyslipidemia (abnormal lipid levels), therefore managing insulin resistance is crucial for reducing these risks.
Addressing insulin resistance through dietary changes can be effective. A diet rich in whole foods, high in fibre, low in refined carbohydrates and sugars, and balanced in healthy fats and proteins can help stabilise blood sugar levels and improve insulin sensitivity.
Regular physical activity is essential for improving insulin sensitivity. Both aerobic and
resistance training exercises can help lower insulin levels, aid weight management, and
improve overall metabolic health.
The adrenal glands also play a significant role in polycystic ovary syndrome (PCOS),
primarily through their production of hormones, particularly androgens, which can impact the condition in several ways:
The adrenal glands produce androgens, such as dehydroepiandrosterone sulfate (DHEAS)
and testosterone. In many individuals with PCOS, there is an overproduction of these
hormones, which can contribute to symptoms such as hirsutism (excess hair growth), acne, and irregular menstrual cycles.
The adrenal glands are responsible for managing the body’s response to stress by
producing cortisol. Chronic stress can lead to elevated cortisol levels, which may further
stimulate the adrenal glands to produce more androgens, exacerbating PCOS symptoms.
These elevated cortisol levels can contribute to insulin resistance, which is commonly seen in PCOS. Insulin resistance can lead to increased insulin levels, which may further stimulate the ovaries and adrenal glands to produce more androgens, creating a vicious cycle that worsens PCOS symptoms.
The hormonal imbalances caused by excessive androgen production from the adrenal
glands can disrupt the normal menstrual cycle, leading to irregular or absent periods. And
increased cortisol production can also impact progesterone levels by lowering them and
causing more oestrogen dominance symptoms.
The adrenal glands and ovaries are interconnected in hormone regulation. The
overproduction of androgens from the adrenals can affect ovarian function and contribute to anovulation (failure to ovulate), a common issue in PCOS.
We do know that some individuals may have a form of PCOS primarily driven by adrenal
hormone excess rather than ovarian dysfunction. This variant is sometimes referred to as 'adrenal PCOS' and may require different management strategies.
There is a notable link between polycystic ovary syndrome (PCOS) and thyroid issues,
particularly hypothyroidism and autoimmune thyroid diseases like Hashimoto's thyroiditis. Both PCOS and thyroid disorders involve hormonal imbalances. In PCOS, elevated levels of androgens and insulin resistance are common, while hypothyroidism is characterised by insufficient levels of thyroid hormones, which can disrupt metabolic processes. These imbalances may exacerbate each other, leading to more pronounced symptoms.

Women with both PCOS and thyroid dysfunction often experience menstrual irregularities. Hypothyroidism can cause irregular or heavy menstrual bleeding, while PCOS can also cause irregular cycles and anovulation. This overlap can complicate diagnosis and management. Both conditions can contribute to weight gain and difficulty losing weight. Insulin resistance in PCOS and the metabolic slowdown associated with hypothyroidism can make weight management challenging, leading to a cycle of worsening symptoms.
There is a higher prevalence of autoimmune thyroid conditions in individuals with PCOS.
The presence of one autoimmune condition may increase the risk of developing another,
suggesting a potential underlying immune dysfunction associated with PCOS.
We do know that symptoms of thyroid dysfunction, such as fatigue, hair loss, and changes in skin texture, can overlap with those of PCOS. This can make it difficult to distinguish
between the two conditions without proper testing.
Given the potential link between PCOS and thyroid issues, it's essential for individuals with PCOS to be screened for thyroid dysfunction. Proper diagnosis and management of thyroid conditions can significantly improve overall health and may alleviate some symptoms associated with PCOS.
We also offer a DUTCH test. The DUTCH test (Dried Urine Test for Comprehensive
Hormones) is a specialised hormone test that measures various hormone metabolites in
urine. It is particularly useful for diagnosing conditions like Polycystic Ovary Syndrome
(PCOS) and assessing women's hormonal health. It helps to identify hormonal imbalances that could be contributing to PCOS symptoms such as irregular cycles, weight gain, and acne.
It also assesses adrenal function and stress hormone levels, which can affect overall
hormonal balance and exacerbate PCOS symptoms.
We also offer a comprehensive thyroid screen including antibodies which is essential to understanding the autoimmune component. In addition elevated antibodies can be present  while other thyroid numbers are in normal range so we need to fully understand the big picture to support women optimally. 
If you are dealing with any of these issues, or would like to delve deeper into your hormonal health, please do get in touch or book a discovery call to find out how we can help support you.