Episode #154: The Hidden Layers of PCOS: Do You Have More Than One Root Cause?

Hi, and welcome back to the PCOS Repair Podcast. Today, we’re going to be addressing a question that I’ve been asked several times, and I want to talk about it here on the podcast. That question is: Can I have more than one root cause of PCOS?

The short answer is yes—most women do. In fact, technically, we all do. When you think about the tendencies toward inflammation, insulin resistance, and the metabolic and endocrine causes of hormone imbalances, we all have those components going on to some degree in every body with PCOS. Our genetics make us more prone to them depending on our environment, but it’s our environment that will highlight different root causes at different times.

The point of determining your PCOS root cause is to identify where you need the most support so you can focus your efforts and see the best results. So let’s say you have a bit of inflammation—that’s important to address. But ultimately, if you’re dealing with a lot of insulin-related issues—maybe your labs don’t show insulin resistance, but if you were wearing a continuous glucose monitor (CGM), you’d see constant spikes in your blood sugar throughout the day—then you’re likely producing a lot of insulin. That excess insulin circulates continuously in your bloodstream, stimulating your ovaries to secrete more testosterone and elevate your LH. This throws off your LH ratio, disrupts your cycle, increases testosterone, and triggers the cascade of PCOS symptoms.

In that case, reducing inflammation would be helpful, but addressing insulin would have a much bigger impact. That’s why understanding your primary PCOS root cause is so important. Otherwise, it’s easy to get frustrated doing “all the things” and still not seeing results, which affects motivation and consistency.

So, yes—the short answer is that you can definitely have more than one root cause. But what do we do with that information? How do we avoid falling into the one-size-fits-all approach? Because let’s face it—we just want a solution. We want to live our lives, do the things we enjoy, and take care of our responsibilities so we can get back to doing what really matters to us.

PCOS often feels like one more thing on our to-do list—like now we have to address it through lifestyle. But what we really want is to get back to living, enjoying our relationships, our hobbies, and experiences. So how do we balance all of that?

When it comes to discovering how to support our PCOS, it’s tempting to look for shortcuts—“That worked for her, maybe it’ll work for me.” But PCOS doesn’t work that way, and that’s what we’re diving into today. Specifically, we’re going to explore how multiple root causes can show up and how to navigate that so you can streamline your efforts and get back to living your life—while creating an environment that supports your body in healing and reversing PCOS symptoms.

So how do we get started? First and foremost, I recommend taking my PCOS Root Cause Quiz. It’s free, and you’ll find the link in the show notes, or at the bottom of most of my emails if you’re on my list. If you can’t find it, just send me a message on Instagram @nourishtohealthy.

The quiz is straightforward and insightful. You’ll find that even the questions can help you start paying attention to things in your day-to-day life that may be impacting your PCOS. It’s not a comprehensive medical assessment like I’d use inside my programs, but it does a great job of pointing to your dominant root cause based on your symptoms.

That said, some women do get results that feel “in between” two root causes. Maybe they answer one question a little differently and get a different result. That’s because they likely have two root causes showing up at similar intensities. For example, maybe their insulin component isn’t extremely high, but they also have a significant inflammation component. So how do we navigate that?

Let’s take a step back and quickly review the four PCOS root causes. I’ve covered each of these in-depth in previous episodes and in miniseries, but I’ll summarize them here using my own terminology, which may differ from what you see in books or hear from your doctor.

1. The Insulin Effect
   I use this term instead of “insulin resistance” because the effects of excess insulin start impacting your body long before traditional labs show insulin resistance. Even a mild insulin imbalance can cause weight issues, irregular periods, unwanted hair growth, hair thinning, acne—the list goes on. We’ve covered how this works in detail in past episodes, and I can point you to those if you message me.
2. Chronic Inflammation
   I specify chronic inflammation—this isn’t about a weekend injury flaring up your PCOS. This is the low-grade, ongoing inflammation that stems from your lifestyle, stress, allergies, autoimmune disorders, or even chronic joint pain. Chronic inflammation worsens PCOS symptoms and can be both a trigger and a symptom itself.
3. Stress Response
   Also referred to as adrenal dysfunction, adrenal fatigue, burnout, or cortisol imbalance. It’s not just about feeling stressed—it’s how your body processes stress. Constant rushing, being behind, feeling pressure, or lacking true rest all contribute. It’s not just big stressors; it’s the constant hum of never feeling relaxed that plays into this.
4. Hormone & Nutrient Disruption
   This one’s a bit of a catch-all. It includes the after-effects of birth control, poor diet, nutrient deficiencies, and imbalances that continue long after the initial cause. We’ve covered this in other episodes too.

Now, what happens when you have more than one root cause? All of these can play off each other. For example, if you have the insulin effect, over time you may gain weight, which increases both insulin resistance and inflammation. That weight gain may trigger stress, and that stress might further disrupt your hormones. So now all four root causes are being affected—even though only one was the initial driver.

If you took my full assessment—or even just the quiz—you’d likely show the insulin effect as your primary root cause, with lower scores in the others. But by focusing on your primary cause, you can indirectly start improving the others too.

That’s why I recommend focusing on one root cause at a time. It helps you stay sane and focused. And no, you don’t pick the one you like the most. If you love exercise but struggle with nutrition, don’t default to workouts. Often, the area we enjoy is already being addressed. The key is to work on the area your primary root cause is pointing you toward.

Inside the PCOS Root Cause Bootcamp, I break down how to support different combinations of root causes. For example, if your quiz shows both insulin effect and stress response as high, that’s a tricky one. These two are deeply intertwined—cortisol elevates insulin, and stress can spike your blood sugar even if you’re eating well. So if you’re managing your blood sugar with healthy eating but ignoring stress, the insulin effect can still show up prominently. That’s why we look at combinations and prioritize accordingly.

There are many possible combinations depending on lifestyle factors and personal goals, which is why personalized guidance matters so much.

Once you’ve identified your primary root cause, it’s also helpful to note your secondary one. The full assessment even gives you a breakdown of how strong each root cause is so you can see if one clearly outweighs the others or if they’re fairly close. If they’re neck and neck, we approach that differently than if there’s one clear winner.

From there, we look at your main goal:
Is it weight loss, more energy, better cycles, or fertility? Your goal will influence how you approach your root cause. And once you have that clarity, you can start designing your unique plan—deciding what to include, what to reduce, and how to prioritize your efforts.

This doesn’t take long to figure out. You could sit down and assess all of this in a day—or over the course of a weekend if you want to take your time. Implementing changes takes longer, of course. But you don’t have to do everything at once. Every small change gives you benefits. You’ll start to feel better with every positive shift you make.

To recap:
Yes, you can have more than one root cause of PCOS. In fact, you do. Some are dormant, some are mildly active, and one or two are likely dominant. Once you identify them, you can begin creating a lifestyle that supports your body more effectively. Understanding your root cause gives you a map—a clearer picture of how your body is struggling and what you can do to support it.

I hope you found today’s episode helpful. I know the root cause concept can feel vague, and in some ways it is—because PCOS can look so different for every woman. But I hope this gave you a clearer idea of how to think about multiple root causes and how they show up.

If you haven’t already, take the PCOS Root Cause Quiz—I’ll link it in the show notes below. If it’s been a while, retake it. You may see a different picture now than you did before. I’ll also link the four podcast episodes that go deeper into each root cause so you can explore them based on your quiz results.

If you have any follow-up questions, I’d love to hear from you. You can find me on Instagram @nourishtohealthy. And until next time, bye for now.