PCOS- Symptoms, Signs & Causes?
You have the worse PCOS symptoms, and your doctor prescribes you a medication, tells you to lose weight and change your lifestyle. All pumped up, you start to eat healthy and hit the gym daily but inspite of that you still don’t lose an inch ( urrgh!). The PCOS medications prescribed to you make you feel even more groggy, fatigued & anxious. You change your doctor in every other visit with a hope to hear something different or an advice that is more specific to your PCOS! But sadly, it’s the same monologue –
“Take the medication, change your lifestyle & lose the weight!”
Almost a decade back, during my own quest to find answers to understand my PCOS, all those “unilateral conversations” in the doctor’s office didn’t resonate well with me! Sadly, none of them explained - what’s causing my symptoms, or what does “lifestyle change” mean or why am I not able to lose the weight and how will my PCOS go away!
One of the biggest challenges is that PCOS can show up in different forms, as a result we end up seeing doctors from different specialities – finding answers to your irregular periods, acne, depression, disordered eating. A proper diagnosis never happens because, the dots never get joined.
Most often this leads to fragmented medical advice leaving us even more frustrated & defeated. More than a decade ago, I have been there myself, waiting in long queues to see different doctors trying to find answers to understand my PCOS!
It was then when I began my own research to find the answers! I understood that PCOS is quite complex & can affect each of us differently! Means “my” PCOS symptoms can vary from “your” PCOS symptoms. Just losing weight cannot alone provide relief for every case. Our genes, environmental factors & our lifestyle , together can influence our hormones in their own way. In order to manage our PCOS, each of us must understand our unique PCOS triggers and then accordingly devise a lifestyle change plan. One size fits all treatment is surely NOT the answer to PCOS management.
I put my research and all those answers together & started PCOS Club India with an aim to educate more and more women about PCOS so that they do not have to go through the distressing journey &suffer for years searching for answers like I did!
So Here we go with the basics of PCOS!
What is PCOS?
PCOS is a hormonal disorder with a combination of reproductive, metabolic and psychological symptoms. It’s that annoying condition that makes you lose your hair on the head while gives you hair at all other places where you do not want, gives you a belly like you are 8 months pregnant and makes go on a search mission to find your ever long missing periods !
PCOS can affect each of us differently and interestingly the symptoms might change as we grow older. If you have PCOS you could notice some or many of the below symptoms
Irregular periods or missing periods
Cystic Acne (especially around the jaw line)
Excess facial and body hair
Acanthosis nigricans (darkening of skin behind neck, underarms , groin)
Weight gain (obesity ) / Trouble losing weight ( Lean PCOS)
Alopecia (Scalp hair loss)
Fertility issues (Poor Egg quality, Ovulatory dysfunction)
Sleep disturbances
Chronic fatigue/ Daytime sleepiness
Mental health issues (mood swings, anxiety , depression)
Sleep disorders (Sleep Apnea)
Sexual Dysfunction (Low / high libido, vaginal dryness)
What causes PCOS?
Studies and science have not confirmed just one cause of PCOS. What we know so far is that environmental factors, genetics, lifestyle could lead to PCOS.
International Evidence based PCOS guidelines 2023 indicate that Insulin resistance affects almost 75% of lean women and 95% of overweight women.
What the heck is Insulin Resistance
The food that we eat is broken down into Glucose which is literally our body’s main fuel. All parts of your body, including our muscles & brain, run on glucose. So, to get glucose into our muscles, pancreas secrete the hormone called Insulin. Insulin arrives at the surface of each cell; helps open the door of the cell membrane so that glucose can enter the cells and our body can get its fuel for energy! Thus, Insulin is that ‘Sugar Police’ that helps regulate the levels of glucose in our body!
Let’s say, you had Chickpeas & rice for lunch. The carbohydrates from this meal will break down into glucose i.e., sugar and will release into the blood stream. As soon as Pancreas detect this glucose, it will release the “sugar police a.k.a. n insulin hormone that helps our cells absorb this glucose so that we get the much-needed fuel and maintain balanced glucose levels in our blood stream
Insulin resistance is when cells in our muscles don’t respond well to insulin and can’t absorb glucose from your blood for energy.
Hence the glucose from our meals keeps sitting in the bloodstream waiting to be absorbed leading to spike in our blood sugars. To control this high glucose, the pancreas will now try to produce even more insulin to control the rising glucose levels, Sudden downward spiral of sugars in our blood stream sends a message to our brain that now we need more sugars and hence we have these symptoms of cravings & bloating.
What happens when insulin levels increase
High insulin levels over the period can cause the ovaries to make even more androgenic hormones such as testosterone causing thickening & darkening of the skin (acanthosis nigricans), Increased body hair (hirsutism), Hair loss, acne, & irregular periods. High insulin can also lead to build up of more lower abdomen fat (this is the reason losing weight with PCOS becomes challenging)!)
Insulin resistance if ignored can increase the risk of developing type 2 diabetes. Below factor and/factors have key role to influence our blood glucose levels:
Eating Patterns: A daily diet consistently high on carbohydrates, high glycemic levels, processed foods can lead to frequent blood sugar spikes leading to insulin resistance
Obesity & Waist to hip ratio: Excess weight especially too much fat in the lower abdomen is a leading cause of insulin resistance. High levels of fat inside our muscle cells can interfere with insulin’s job of regulating blood sugar levels in our bodies. It is recommended to maintain the waist to hip ratio under 0.89 as per the latest International PCOS guidelines.
Chronic Stress: studies have indicated a higher degree of chronic psychosocial stress to be associated with Insulin resistance and has been found that cortisol levels were positively associated with insulin and, glucose levels. For example, work stress and low emotional support in women and sleeping disorders in women with PCOS have been associated with development of insulin resistance and Type 2 Diabetes.
Inflammation & Visceral Fat: Studies have also shown that belly fat makes hormones and other substances that can contribute to chronic, or long-lasting, inflammation in the body. Inflammation also may play a role in insulin resistance, type 2 diabetes, and cardiovascular disease. This is true even if your (BMI) falls within the normal range, such as a Lean pcos case where you may have a normal BMI but still have high cholesterol and high visceral fats that could contribute to inflammation and insulin resistance
Sedentary lifestyle: Not getting enough physical activity is linked to insulin resistance and prediabetes. Regular physical activity causes changes in your body that make it better able to keep your blood glucose levels in balance.
Vitamin Deficiencies: Vitamin D3 & B12 deficiency can increase inflammation and insulin resistance in our bodies. Also, chances are high for people who bleed heavily , they could be low on iron levels. These deficiencies can further impact our immunity, cause mental health issues, and poorly affect our metabolic health!
Genetic Profile: Family history of Diabetes, hypertension, obesity, high blood pressure, high triglycerides have higher chances of developing insulin resistance. Let me remind you, India is a diabetic capital of the world, and South Asians tend to have higher waist to hip ratio. So unfortunately, the south Asians are more susceptible to get insulin resistance and hence chances of PCOS could be higher !
Apart from the above factors , adrenal fatigue, chronic stress , side effects of medications could lead to hormonal imbalances and if left uncontrolled for long periods of time could lead to PCOS.
Is there a permanent cure for PCOS?
The above causes should explain that why our hair loss, skin health, hirsutism, weight gain are the symptoms that can only be resolved or reversed once the primary root causes are addressed via lifestyle and/or medications. Any product / service selling you a quick solution to cure PCOS or make you lose 10 kgs in a week or just saying that it will cure your PCOS is most probably a Lie! Science confirms that PCOS doesn’t have a Cure but it’s definitely possible to reverse the symptoms and manage the PCOS . Its important to ensure to get a periodic medical check ups and have a holistic team of your trusted health providers e.g. doctors, nutritionist, fitness coach, therapist to help you as you go along your pcos management
To know more about ways to reverse your symptoms and manage your PCOS, keep reading and follow me on Instagram, YouTube and my new Podcast PCOS & “You”!
Be #strongerthanpcos !
Nidhi S.
PCOS Coach & Holistic Nutritionist
