Taking a Deep Dive into the Causes of PCOS –Magical School Bus-Style!

Class––as your teacher, Ms. Fertil-izzle, it’s my responsibility to show you the world and how it works. Today is all about the human body––specifically, a woman’s body.

Ever heard of Polycystic Ovarian Syndrome (PCOS)? Maybe not, but after today you’ll be an expert. PCOS affects up to 5 million women in the US and can have major effects on those women’s health.

PCOS is one of the biggest culprits behind female infertility, plus it increases the risk of all kinds of serious, long-term diseases like diabetes, heart disease, stroke, and cancer.

On today’s class field trip, we’re going to find out how PCOS works and why it causes the symptoms it does––but first, some background so we know what we’re looking for.

What is PCOS?

Here’s the bottom line on PCOS: It’s condition where a woman’s reproductive hormones––namely, androgens like testosterone––are out of balance. This leads to a whole cascade of symptoms, which often begin in puberty and abate as one gets older, and closer to menopause.

Someone with PCOS may not release eggs from her ovaries, so she may have trouble getting pregnant and her menstrual cycles may be irregular or completely nonexistent. When her cycles do come, they tend to be heavy, painful, and all-around miserable.

Once we embark upon our class trip (woohoo!), you’ll notice a bunch of bouncy, fluid-filled sacs in on the ovaries, which are follicles. Unfortunately, those can be painful and cause loads of discomfort.

So, who exactly does PCOS affect and how do you know if you have it?

Right now, scientists estimate that PCOS affects between 6% and 12% of US women. That’s about 1 in every 10 women of childbearing age! A few characteristics can increase one's risk:

  • Being obese
  • Having a mom, sister, or aunt with PCOS

Meeting any two of these three criteria is grounds for a PCOS diagnosis:

  1. Irregular periods
  2. Hyperandrogenism, meaning having excess amounts of typically “male” steroid hormones like testosterone, androstenedione and DHEAS
  3. A lot of immature follicles in your ovaries (it’s the PCO in Polycystic Ovarian Morphology)

My little sis, Ms. Sizzle, was diagnosed with PCOS at 22 years old. It's common for women to be diagnosed in their 20s and 30s, since it’s a time when many try to get pregnant but aren’t able to do so easily because of the condition.

What’s happening in the body of someone with PCOS?

That’s the question I’ve been waiting for! Class, since you know a little bit about PCOS now, it’s time to take a deep dive into the body of a woman who has it. Ms. Sizzle has graciously allowed us to travel inside her to investigate the underlying causes of PCOS.

Class, to the bus!


When it comes to reproductive hormones, most people think of testosterone as the “male” hormone and estrogen as the “female” hormone. In reality, testosterone is integral to female reproductive functioning just as estrogen is integral to the male reproductive system. However, when the female body produces too much testosterone (which is part of a class of hormones called “androgens”), this can cause problems.

Ms. Sizzle and other women with PCOS may produce high levels of androgens, but let’s see why that is:

  1. Overactive hormone response. Our brains produce a hormone called “gonadotropin releasing hormone” or GnRH, in our hypothalamus. GnRH does what its name implies, it tells another part of the brain, the pituitary, to release two gonadotropin hormones, called LH and FSH.
  2. LH and FSH are important hormones that signal the gonads (ovaries in women and testes in men) to produce sex hormones. In women these are estrogen and small amounts of testosterone. In the most common form of PCOS, the ovaries are a bit too eager and produce way more androgens than they should. In this form of PCOS, this leads to:
  3. Insulin resistance. We produce another important hormone called insulin that takes sugar out of our blood and gives it to our cells for energy. When we become resistant to the effects of insulin, more sugar stays in the blood, which leads to diabetes and weight gain. In addition to more sugar, there’s also more insulin hanging out in the blood. That leads to––you guessed it––increased androgen production! Obesity further complicates the problem by increasing the effects of insulin resistance.

As a result of making too much androgen, women with PCOS experience symptoms like:

  • Infertility and abnormal periods. High androgen levels prevent the ovaries from releasing eggs regularly or at all, which makes periods irregular or nonexistent and makes getting pregnant extremely difficult.
  • Extra hair growth. Androgens are responsible for facial and bodily hair growth in men. In women, that means hair may grow in places Western society deems undesirable––the face, back, stomach, and thighs, to name a few.
  • Hair loss or baldness. Women may also lose hair in places where they’d prefer to keep it. Since hair patterns in PCOS mimic hair patterns in men, it also makes sense that women may lose hair on their heads--exactly what happens with male-pattern baldness.
  • Acne. It turns out that our sweat glands contain androgen receptors, so when women produce too many androgens, those receptors and sweat glands are more likely to be activated. Overactive sweat glands can lead to acne.

That’s not all though. Remember that androgens are “typically” male hormones. When women produce too many androgens they may suffer from some symptoms or conditions that are more common in men like obstructive sleep apnea. In sleep apnea, you don’t get steady levels of oxygen while sleeping. Overproduction of androgens (especially when combined with obesity) make sleep apnea a common experience in women with PCOS.

As you can see, the cycle of increased androgen production and insulin resistance only makes PCOS worse. Another symptom of this relationship? Skin-darkening. See how Ms. Sizzle has dark brown patches on her neck and other folds of the skin? Technically, that’s called acanthosis nigricans. The more severe the insulin resistance, the more noticeable the skin-darkening.

And we can't forget about those ovarian cysts...Under normal conditions, women’s ovaries contain eggs inside little sacs called follicles. The follicle releases the egg once it's ready, but in PCOS, those eggs usually don’t mature to the point where they are ovulated. This can cause prolonged periods where a woman is not ovulating, called “anovulation” and is why women with PCOS often have irregular or completely absent periods.

Sheesh! Do symptoms of PCOS ever go away?

As Ms. Sizzle gets older, she’ll eventually reach a time in life when her ovaries naturally stop releasing eggs--menopause. In women with PCOS, the menstrual cycle tends to become more regular as they get closer to the menopausal transition, most likely as a result of the natural decline in eggs in the ovaries and the decrease in testosterone with age. The long-term risks of PCOS, however, like diabetes, sleep apnea, and heart disease, will still be a concern. Ms. Sizzle and other women with PCOS are also at higher risk for abnormal uterine bleeding and cancer of the endometrium (lining of the uterus).

What can women do to reduce negative outcomes of PCOS?

Luckily, Ms. Sizzle was diagnosed with PCOS relatively early. Because of that, she and her doctor were able to put together a plan to try to reduce some of the negative outcomes. That plan includes weight loss and maintaining a healthy weight over time, plus following a healthy diet to decrease the risk of insulin resistance. She also takes birth control pills, which can help balance out her reproductive hormones and avoid some of the physical symptoms like facial hair and acne.

Class, if any of you want to learn about your own reproductive health, taking a fertility hormone test like the one Modern Fertility offers can give you a peek into your own body––and can help you better understand PCOS. A doctor will review the results of your fertility profile, and a personalized report will help you understand what they mean. The report will explain:

  • Your ovarian reserve
  • Whether you might have an early or late menopause
  • If egg-freezing or IVF is right for you

You’ll also be able to track your individual profile year after year so you can stay on top of any significant fertility changes.

Not planning on having kids any time soon? You can get ahead of the game - the results of your fertility hormone test will give you an idea of how to properly prepare if you do decide to try to get pregnant. With PCOS having such a huge impact on fertility, knowing your status early is one of the best health decisions you can make!



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Megan Nichole

Megan Nichole is a public health pharmacist, healthcare copywriter, and multi-passionate millennial blogger. Connect with Megan on LinkedIn. https://www.linkedin.com/in/megannicholebrown/

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