Causes and Risk Factors for PCOS

PCOS was once regarded solely as a reproductive disorder affecting women of childbearing age, but it is now recognized as a metabolic disorder with a variety of causes and risk factors. Insulin resistance, obesity, chronic inflammation, and exposure to endocrine-disrupting chemicals are all involved in the development of PCOS.^{1 2 3} One theory worth highlighting is that insulin resistance is a significant contributor to the development of PCOS.  Women with PCOS are prone to defects in insulin signaling, which increases the synthesis of androgens in the ovaries and adrenal glands. Excess androgens encourage insulin resistance, leading to elevated insulin levels, which in turn stimulate further androgen synthesis. This vicious cycle results in a “snowball effect”, worsening PCOS symptoms and making sufferers especially susceptible to weight gain and insulin resistance, conditions that significantly compound the syndrome’s progression.^{5 4}

Another avenue of research has led scientists to suggest that PCOS may be an autoimmune disorder. It is theorized that due to excess androgen production the body attempts to compensate by increasing estrogen secretion – and this increased estrogen secretion causes the production of autoantibodies that target self-tissues. Excess estrogen has been linked to different autoimmune diseases, such as rheumatoid arthritis or systemic lupus erythematosus.  Therefore, anyone with PCOS should consider having testing done for autoimmune markers to help discover better treatment options.^{7 8 9 10}

Dietary and Lifestyle Changes

Restoring insulin sensitivity is an essential place to start for anyone with PCOS. Focus on filling half your plate with vegetables and fruit, sources of healthy carbohydrates, then add a serving of quality protein and some healthy fat to create a balanced meal. Eating this way at every meal is one of the keys to optimal health and blood sugar balance.

Exercise helps PCOS by improving insulin sensitivity and increasing metabolism. Exercises like walking, weights, Zumba, or Fertility yoga all can be restorative, but it’s most important that you discover a form of exercise you enjoy doing and aim for doing it 5 days a week for at least 30 minutes a day.

D-chiro inositol (DCI)

D-chiro inositol (DCI) is potentially the most promising inositol compound for PCOS. Inositol compounds play a (often unappreciated) role in insulin signaling. Low levels of DCI have been observed in individuals with impaired insulin sensitivity and PCOS.¹¹ A study from the Medical College of Virginia found that DCI taken daily had multiple beneficial effects in the treatment of 22 overweight women with hormonal imbalance. Not only did it improve insulin sensitivity, but a significant number of the women saw an improvement in ovulation. Serum androgen (male hormone) and ovarian androgen production also decreased in the group that was supplemented with DCI, suggesting it also helped restore hormone balance.

Chromium

Chromium is one of the most widely studied nutritional interventions for glucose and insulin-related irregularities. Chromium picolinate, specifically, is the form that has been used in a number of studies on insulin resistance. Researchers at the University of Texas Health Science Center at San Antonio found that chromium picolinate (200mcg/d) improves glucose tolerance when compared with placebo in women with PCOS.¹²

Vitamin D

Several studies have highlighted the link between PCOS and vitamin D status. Researchers from the Medical University of Graz, Austria found that women with higher blood levels of vitamin D were much less likely to be insulin resistant.¹³ Interestingly, a study conducted by researchers at Columbia University found that vitamin D combined with calcium supplementation helped normalize menstrual cycles for seven of 13 women with PCOS. Of the seven, two became pregnant and the others maintained normal menstrual cycles. These results suggest that abnormalities in calcium balance may be responsible, in part, for the arrested follicular development in women with PCOS and may contribute to its pathogenesis.¹⁴

Omega-3 Fatty Acids

There is a strong association between Non-Alcoholic Fatty Liver Disease and PCOS, consistent with the central role of insulin resistance in the pathogenesis of both conditions.¹⁵ Hyperinsulinemia promotes uptake of triglyceride-rich lipoproteins by the liver and results in increased storage of fatty acids in the liver. Because of their strong anti-inflammatory activity, omega-3 fatty acids help ameliorate non-alcoholic fatty liver disease, helping improve liver health and cardiovascular health in women with PCOS. In an Australian study, omega-3 fatty acid supplementation reduced liver fat content and other cardiovascular risk factors, including triglycerides, and systolic and diastolic blood pressure in women with PCOS. In particular, researchers found that omega-3 fatty acids were helpful in reducing hepatic fat in PCOS women with hepatic steatosis.¹⁶

Cinnamon

A small study published in the journal Fertility and Sterility showed cinnamon greatly reduced insulin resistance in women with PCOS.¹⁷ This may be due to the fact that unique compounds in cinnamon bark produce a 20-fold increase in sugar metabolism.^{18 19} Achieving this glucose balance is important for women with PCOS.

Saw Palmetto

Saw Palmetto, an herb typically thought of as a supplement that benefits prostate health, inhibits the activity of an enzyme, 5-alpha reductase, thereby reducing the conversion of testosterone to dihydrotestosterone, the more androgenic form of the male hormone. This may have implications for reducing acne, excess facial and body hair, as well as male pattern hair loss.²⁰

Peony Root

Peony glucosides are a time-honored component of traditional Chinese medicine; today it is certified as a drug in China for its use in autoimmune disorders. Peony glucosides act naturally, not only to suppress inflammation, but also to rebalance the disordered immune system. Thus, peony glucosides work to simultaneously suppress excessive harmful immune functions while also boosting calming immune components. In numerous studies, peony glucosides have been demonstrated to significantly restore immune system balance.^{21 22}

D-Glucarate

D-Glucarate may help remove excess hormones. Oral supplementation of Calcium-D-glucarate has been shown to inhibit beta-glucuronidase, an enzyme produced by colonic microflora and involved in Phase II liver detoxification. Elevated beta-glucuronidase activity is associated with an increased health risk involving elevated hormones.²³ Calcium-D-glucarate’s inhibition of beta-glucuronidase activity allows the body to excrete hormones such as estrogen from the bowels before they can become reabsorbed.

Maca

Maca helps to balance estrogen and progesterone in the body, which may help to encourage a healthy menstrual cycle. While maca traditionally acts as an energy-producing herb known for boosting libido and reducing stress, it also contains 50 phytochemicals known for balancing hormone levels.

In females with PCOS, maca is believed to help by controlling estrogen levels in the body. Estrogen levels that are either too high or too low can make it difficult for a woman to ovulate and become pregnant. Therefore, balancing the amount of estrogen that a woman produces, and in turn the amount of related progesterone produced, is very important for increasing reproductive health, fertility, and decreasing symptoms related to PCOS – such as irregular menstrual cycles, excess hair growth, and more.²⁴

Quercetin

Quercetin has unique constituents that have been shown to decrease inflammation, balance hormone function, and improve pregnancy outcomes in those suffering from PCOS. In a 2023 randomized clinical study, 72 women diagnosed with PCOS were either given 500 mg of quercetin per day for 40 days or a placebo. Those in the quercetin group saw an improvement in health of the oocyte (immature egg cell), embryo grade, and overall pregnancy rate. Hormone levels—including what’s known as the luteinizing hormone (LH), impacting follicular growth, egg maturation, and ovulation—were all improved in those taking quercetin.²⁵ The study concluded, “Regular consumption of quercetin has been shown to decrease inflammatory and LH parameters, making it beneficial for the management of PCOS and related diseases.”²⁶

References

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