Polycystic Ovarian Syndrome (PCOS), Pt 2: Root Causes
Polycystic ovarian syndrome (PCOS) occurs in 15-20% of females and is one of the common hormonal conditions that people see me in-office for naturopathic medical treatment. In Part 1 of this 3-part series, I spoke about the symptoms of PCOS, the diagnostic criteria for PCOS, and the different types of PCOS. For this second part, you will learn about some of the root causes of PCOS and the testing and work-up options for PCOS.
If you are just jumping into Part 2 without reading Part 1, make sure to click here.
4 Root causes of PCOS
1. Insulin resistance:
Insulin resistance is when the body produces high levels of insulin to regulate and balance blood sugar levels. However, when there is too much sugar and too much insulin, cellular sensitivity to insulin declines, leading to insulin resistance. There is evidence that the high levels of insulin that occurs in insulin resistance stimulates the production of androgens the ovaries, which leads to the symptoms of high androgens seen in PCOS. In addition to producing more androgens, insulin resistance can reduce the production of sex hormone binding globulin, which leads to higher levels of free testosterone in the system.
2.Hypothalamic-pituitary-adrenal (HPA) axis dysfunction:
The adrenal glands are hormone-secreting glands that release cortisol, DHEA, DHEA-S, neurotransmitters, and others. DHEA is a hormone that can be actively transformed into testosterone in ovarian cells, but it can also be transformed into DHEA-S within the adrenal gland itself. And, literature reveals that those with PCOS have higher levels of DHEA, DHEAS, and testosterone.
3. Inflammation
Inflammation has been hypothesized to play a role in the development of PCOS. Research shows that those with PCOS have higher levels of inflammatory markers in ovarian cells, and these inflammatory markers in ovarian granulosa cells have been connected with high androgens seen in PCOS. Although, more high-powered studies need to be completed since we have yet to fully understand how inflammation in PCOS is connected to high androgens.
4. Hormonal Birth control
Certain types of hormonal birth control can have androgenic effects in those taking them, leading to some symptoms found in PCOS, such as acne.
Specific types of hormonal birth control that are androgenic are:
Levonorgestrel
Norgestrel
Norethindrone acetate
Ethynodiol diacetate
Drospirenone
Some doctors hypothesize that discontinuation of these forms of hormonal birth control may lead to the development or worsening or acne as well in addition to symptoms of PCOS. Doctors hypothesize that when these forms of hormonal birth control are discontinued that it causes a rebound in androgen hormone activity due to spikes in luteinizing hormone. Although, studies need to be conducted to confirm this hypothesis and fully explain what could be taking place.
Testing & Work-up options for PCOS
Testing and work-up are necessary and helpful to identify the root cause of PCOS since it helps target treatment recommendations better. Testing and work-up options to identify root causes for PCOS that your provider may recommend:
Bloodwork:
Foundational blood work that may include complete blood count, comprehensive metabolic panel, lipid panel, thyroid panel, and more
Luteinizing hormone
Follicle stimulating hormone
DHEA-S
Free and total testosterone & Di-hydrotestosterone
Estradiol & Progesterone
Sex hormone binding globulin
Hemoglobin A1c & Fasting insulin
HS-CRP and/or CRP
Urinary functional testing:
Dried urine test for comprehensive hormones (DUTCH) testing might be ordered by some licensed naturopathic and functional medical providers to get a better understanding of sex hormone levels, sex hormone production pathways, and sex hormone detoxification pathways; and a comprehensive understanding of what may be causing PCOS and other hormone imbalances. I usually order this test in addition to more-targeted and more-personalized blood work to get a full picture of a person’s baseline biochemistry.
Imaging:
Ultrasound imaging may be ordered by a doctor to visualize if there are any polycystic ovaries. Remember, ultrasound isn’t needed in the diagnosis of PCOS. But, it can be helpful to understand the extent of the condition on ovarian tissues.
Summary
In this second part of my 3-part PCOS blog series, you learned about the root causes of PCOS and sore testing and work-up options that a provider may recommend. Concerning root causes, there were 4 root causes that were discussed: 1) insulin resistance, 2) HPA axis dysfunction, 3) inflammation, and 4) hormonal birth control. And, labs and imaging will help identify extent of PCOS in addition to identifying root causes.
In part 3 of this PCOS blog series, you will learn about integrative and naturopathic treatment options to manage PCOS symtpoms that a licensed provider may recommend that addresses root causes. If you have any friends, family, or loved ones who might be experiencing any of the symptoms or common concerns above, make sure to share this post with them and let them know to follow along for this series on PCOS!
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