Episode #195: The Four Root Causes Behind PCOS

So what are our PCOS symptoms trying to tell us? What if the cravings, the fatigue, the irregular cycles, the skin changes, the mood shifts—what if they were all following a pattern, a physiological pattern, that once we understand it, it finally makes sense what is going on inside of our body?

Because here's what I've seen over and over for myself with my PCOS, for myself with the way that my hormones and my whole entire body and systems and root causes work, as well as in other women that I've worked with with PCOS: the moment that we understand our root causes, everything shifts. And not just practically, but emotionally.

The overwhelm drops, the frustration softens, and for the first time, we feel like we can actually understand what's going on inside of us. And the mental load, the heaviness, the burden of PCOS becomes so much lighter.

So in today's episode, we're going to be talking about the four root causes behind PCOS symptoms. Now, I know I talk about the root causes a lot, but each year as we approach September, which is PCOS Awareness Month, I like to kind of go back through and, from a new angle, from a new perspective, discuss the root causes and all the things that we want to consider when it comes to what's going on under the surface of our PCOS. And then ultimately, how can we go about addressing it in a practical way that's sustainable in our life?

All right, so let's dive in.

Welcome back to the PCOS Repair Podcast. Hi, I'm Ashley. I'm really glad you're here. And if this is the first episode that you're listening to, this podcast is dedicated to science-backed, grounded information about PCOS, or its new name, PMOS, and practical approaches of how to go about managing it in real life without having to be an all-or-nothing approach—something that's sustainable and enjoyable so that you can live your life feeling your best in your body without PCOS running the show.

So if you listened to last week's episode, we were talking about root causes and we were talking about some of the physiology behind PCOS. But in today's episode, I want to go forward and build a little bit more on this topic by looking at the four different root cause categories that tend to drive PCOS symptoms and patterns.

And I want to be really clear about something before we get started. These are not a diagnosis. They're not more boxes to label ourselves with or to box ourselves in with. They're not about rigid categories that define us forever. Okay? These are patterns. This is about understanding and not feeling like, "Oh no, I have this problem." It's about understanding what's going on in your body so that we can become more literate in what our body is trying to communicate to us.

So these physiological patterns, they help to explain why our symptoms are showing up the way they are. Understanding these patterns is the beginning to being able to understand and support our body. And so I don't want them to become one more Debbie Downer of, "Oh, I have this problem." Instead, it's like, "Oh, I can finally understand what this thing I've been struggling with actually is so that we can fix it." There's a big difference, I think, in how we think about that.

And so I just want to start today's episode saying, hey, this is about looking at the positive, like, "Oh, I'm so glad I finally understand what's happening," rather than, "Oh great, one more thing to add to my list of what's wrong with me."

So first of all, one question I get a lot is, why does everyone who has a PCOS diagnosis seem to have such a different experience? Why does it look so different for everyone else? The reason is that PCOS describes a pattern of symptoms, as the name indicates. PCOS, polycystic ovarian syndrome, or the new name, polyendocrine metabolic ovarian syndrome.

Both of them end in the word syndrome. Syndrome is a medical term for a collection of symptoms. So when we see this collection of symptoms—weight struggles, irregular or absent periods, acne, hair changes, hair growth in other places on the body that isn't usually seen or in excess, mood changes, fatigue—these all paint a picture of PCOS. And then we do a little testing to kind of see if we're seeing more criteria than just this collection of symptoms that create the syndrome. But ultimately, that's where this diagnosis comes from.

But what this label of diagnosis of PCOS does not describe is the various causes of these symptoms. And the causes are these actual physiological drivers down below the symptoms.

Think of it this way: two women can have irregular periods, low energy, and frustration with their weight. On the surface, they look the same, but one woman's symptoms are primarily driven by her body's way of handling insulin and blood sugar. The other's might be driven primarily by her stress hormones and the fact that she's running on overdrive.

Same symptoms. On the surface, they look almost identical, but completely different root causes and therefore a completely different path towards a healing journey for them.

So this is where PCOS advice creates so much frustration. It doesn't look at those root causes. It doesn't look at which environmental factors you're currently dealing with. And then it doesn't look at what are your current health goals.

We just listed three different symptoms: energy, cycles, weight. Well, once we figure out which one has which root cause, we still have to look at, well, what actually of those three symptoms is the one that's bothering them the most? Is it the weight? Is it the fertility? Or is it the energy?

Because sometimes we get hung up on, "I just don't have the energy. I just don't have the energy." But what we're really looking for is, "But I want to lose the weight, and every time I just feel like my energy is holding me back," right? So what is it that's ultimately our health goal?

This is where PCOS creates so much frustration. It's built from various versions that don't account for the individual. And when we apply generic advice, it tends to feel like it's almost working, but then it falls short. And most women that I talk to, they will tell me, "I didn't have enough discipline. I couldn't get it together. I was doing great for a while, but life happened and I just couldn't keep going."

What I hear in there is they're blaming themselves, but what I'm seeing them having tried is something that wasn't a good fit for them. And this is where I think there's a lot of harm done when it comes to trying to help people support their PCOS hormones. And it's not intentional, but it's there.

And so where I like to start is with the root causes. So let's go through those four root causes as kind of a refresher and take a new perspective of them.

So if this is your first episode, there are many other episodes that discuss root causes and all the things about PCOS. But each one I try to take a little bit of a different bend so that we can get more and more of a full picture over time.

So the first root cause is the insulin effect. I don't know if anyone else calls it that. I came up with this myself. I'm sure other people have continued to use it and talk about it this way as well. It makes a lot of sense to me because we're not talking about someone who has diabetes or someone who has insulin resistance necessarily. We're talking about how insulin functions in our body, given certain environmental factors and our PCOS tendencies that leave us a little bit more susceptible to our environment when it comes to the insulin system.

The first root cause category we're going to talk about is the insulin effect. Insulin is simply a hormone, okay? It's a signaling hormone, and its job is to help cells take glucose from the bloodstream and use it for energy. When the signaling process is working well, blood sugar levels stay relatively stable, energy is consistent, and our reproductive system tends to function more smoothly.

When insulin signaling is under strain, or when insulin signaling is being used too often, a few things can happen. Cells become less responsive to insulin messaging. That's something that happens later on, but our body tends to compensate by producing more insulin.

And so this is something where we have these elevated levels of insulin, or perhaps our environment is creating situations where insulin is needed more often than is optimal. And those two situations lead to, overall throughout the day, more insulin having circulated our system.

And the more insulin we have circulating our system, the more that we have told our ovaries to produce more androgens. So now we have androgens such as testosterone affecting our ovulation, our cycles, our skin, our hair, and so forth.

So when a woman's symptoms are primarily driven by the insulin effect, they often notice things like strong cravings, especially for things that are simple carbohydrates or sweets. They notice energy spikes and then crashes around mealtime. You may have this feeling where you just ate a nice big meal and then you need to go take a nap, and you just feel like your entire energy is going down. You felt good for a little bit, and then now it's kind of crashing.

Difficulty with body composition. So difficulty with weight management, cycle irregularity that seems to be connected to what they eat and how they move, but they're not really quite clear on how. Skin changes like acne or hair changes.

But the good news about the insulin effect as a root cause is it is incredibly responsive to lifestyle support. So the body signaling can shift meaningfully, and it can change with nutrition timing. It can shift with food, it can shift with body composition, movement patterns, and sleep. So when we start to make environmental changes, this root cause is very, very responsive, which is really nice.

The second root cause that I want to talk about is stress response. So this is one that is connected to our HPA axis, and it governs how our body responds to the demands put on it, whether those demands are physical, emotional, psychological, or even nutritional.

It's a brilliant system. The system is so amazing. It allows us to survive in so many different conditions. It's what helps humans be so resilient. When you think back over history, all the different ways that we've been able to live and survive and the types of climate changes and things that we've been able to adapt to and live through, it's quite remarkable. And a lot of it has to do with this system.

This is the system that allows us to go from being a normal person in everyday life to being like a superhero under stress and be able to lift heavier things and move faster when we need to because we're under threat. So this system is amazing.

In modern society, this system is often being overtaxed. And if you follow anything in the health and wellness space on social media, things like that, I'm sure you've heard about nervous system regulation, about cortisol, about the importance of relaxing or the letdown of our energy, and so much about energy these days, right?

This is something that can be a huge driver to PCOS symptoms, and it is closely related to the insulin system because insulin and blood sugar play a big part in that fight-or-flight response. So these two are connected.

So if we're constantly living in a high-stress situation, or if we're constantly living in an elevated-stress way of living, we are, in a sense, activating our insulin system alongside our cortisol system. And so a lot of times we do see these two root causes in tandem.

So cortisol, the primary stress hormone, communicates directly through our hypothalamic-pituitary-ovarian axis. This is the HPO axis. This is a system that regulates our menstrual cycle and our ovulation.

And when cortisol is chronically elevated, the brain can essentially deprioritize ovulation. This is a survival standpoint, and it makes sense. Pregnancy is not a priority when everything around us, when our environment, feels like a threat.

So women with symptoms of stress response often notice things like cycle changes, and it may correlate with stressful events. But oftentimes what we're dealing with in modern culture is less that we had a stressful event and then our cycle was irregular for a couple of months, but we're finding that, "I feel like I'm just living my daily life," and if we dive into it, we're living in a chronic stressful situation, and our cycle has been irregular or absent for a long period of time.

When we're waking up in the middle of the night or early in the morning and having a hard time getting back to sleep, we may be exhausted towards the end of the day, but we feel wired as we try to go to bed. We may wake up feeling fatigued, but at the same time, even when we get a good night of sleep, it's not really addressing our energy. We still feel really low energy.

We feel wired but tired, particularly in the evenings. We may have heightened anxiety, or we may have heightened irritability, like we may snap faster. We may be more emotionally sensitive. Some people will become kind of irritated. Some people will become rather weepy.

Symptoms can feel worse during particularly demanding periods. So we may feel like we're kind of doing okay, but then any little pressure put on us and all of a sudden these things really heighten, like the irritation comes out of nowhere. We feel like we have a short fuse. Those kinds of things can oftentimes be because of the stress response root cause PCOS.

Women often double down on intense exercise or strict dietary protocols because they feel like it'll be more beneficial if they can just be healthier. Sometimes that actually deepens this dysregulation rather than resolving it.

Now, I am not an advocate for reducing exercise. I think that intense exercise is actually a very good stress on the body. We need to stress the body in order to increase its capacity for fitness. However, when and how we do it is really important, and I go into that in other episodes and inside the PCOS Root Cause Bootcamp.

But I just want to put that little caveat there. There's a lot of bad information out there on social media and in the world about over-exercising being a real problem for PCOS. In my experience, over-exercising is rarely a problem. A stop-and-start, kind of a weekend warrior type, not consistent exercise, but going out and doing too much and then having to recover from it, that tends to be problematic.

Also, the fact that we tend to not be doing anything and then we try to go full amount instead of working at the level that we're at, those things tend to be problematic. Otherwise, the stress of our day-to-day tends to be way worse than the 45 minutes of stress we put on our body during a workout.

So I think that's something that's been a big myth in the PCOS space online.

And then the third root cause is inflammation.

So this isn't just having a sore knee because you overworked something or you injured something. Inflammation isn't inherently bad. It's actually part of our immune system's normal response to injury, infection, or cellular stress.

The problem for PCOS is that many of us carry chronic low-grade inflammation, and it sits in the background, quietly influencing every system. Inflammation affects hormone production, it affects the signaling, it disrupts ovarian function, it increases the body's stress load, and it's energy expensive. So it can make us feel really heavy, lethargic, and run down.

Running extra immune activity in the background has a really high cost day-to-day on how we feel.

Women with inflammation root cause PCOS typically find that they have symptoms of skin that reacts easily. It's like acne, redness, just sensitive to things. It may be sensitive to products. Joint discomfort, general sense of physical heaviness, bloating, digestive discomfort that seems to be a bit unpredictable.

It's not that you're allergic or sensitive to a certain thing. It's like it kind of comes and goes a little bit. And that's because it's less to do with the thing that you came in contact with today. It has more to do with the environment of your body overall.

Fatigue can feel really different than tiredness. It can feel like you just feel heavy, like you're carrying around weights on your ankles and a weighted vest all day long and you just feel like you're dragging. That's different than, "I'm sleepy."

Symptoms that worsen with certain foods, alcohol, or disrupted sleep. And again, it's not that those things are inherently bad. I mean, they may be things we want to limit. However, it's that our body is already kind of at the tipping point.

So any little thing kind of pushes it over the edge, and we've lost a little bit of that resilience that we normally have when we're living in a place of good health.

Inflammation as a root cause is often closely connected to our gut health, our dietary patterns, our sleep quality, our environmental inputs. But it also frequently overlaps with other root causes because when we have chronic underlying inflammation, it affects several other systems inside of our body.

It can make the symptoms of insulin resistance worse or insulin effect worse. So if we're struggling with weight gain and inability to lose weight, the inflammation can make that that much harder. And it can make us more insulin resistant just by having excess inflammation in our bodies.

And just by reducing the inflammation, our insulin patterns and where we are on the insulin spectrum can improve. It also makes our cortisol stress system work harder. And so all of that can all of a sudden become worse as well.

And then the fourth root cause is hormone and nutrient disruption.

Now, this is one where it's probably inaccurate to say that this is its own root cause, but I do because I think it's one of these ones where it's easier to address it when we have, like, okay, this is its own category, and we do address it differently, and that's why we've created its own category.

But really what's going on here is probably just a little bit of each of the other root causes, as well as kind of a burnout from what we've been doing in our environment. And so if we've been on birth control, we may have things that are depleted in the body or hormones that are in a negative feedback loop as compared to running well.

We may also have nutrient deficiencies from yo-yo dieting. We may have nutrient deficiencies from various fad dieting. We may have kind of burnout exhaustion going on. We may also just have some things that are kind of low-grade, and so they're not so extreme that we're seeing a specific, "Hey, this root cause is really bad."

So sometimes we'll see this in younger people or people that have really good health overall but went off of birth control recently, or people who have relatively good health now, but maybe that's a new thing and they're just having a really hard time kind of getting that last little bit of everything humming and going the way it should again.

So this is where basically all of our root causes are somewhat in play, but not so strongly that one stands out as the primary problem.

This is one that perhaps is kind of layered. It encompasses a range of factors influencing how our body produces and uses its hormones. Nutrient status plays a significant role here. Specific vitamins, minerals, they all become really important to be testing and optimizing, making sure that we don't have other underlying conditions.

So really looking at our thyroid as well as our methylation pathways and ovulation and really seeing, are we having just like a shadow of ovulation, but not strong enough to fully get the effect that we're looking for?

These are all things that come into play with this type of a root cause. It can seem a little bit less obvious on the surface, but when we see that this is really what's going on, the path forward still has very clear steps of what we want to do.

This may be some of the symptoms, though, that women with hormone and nutrient disruption often notice: cycle irregularity that doesn't seem clearly connected to food, stress, or weight. So you're eating really well, you're not overly stressed, your weight's relatively managed, but you're still having cycle irregularity.

They may notice some hair changes, whether it's thinning, shedding, changes in texture, kind of dry and brittle. And again, there's not a clear, "This is what we're pointing to of what the root cause is." However, we are really seeing this in the superficial symptoms of PCOS.

They may feel sluggish in recovering from exercise or illness. Their recovery time may be slower than what we would expect.

They may have mood fluctuations, and usually for this root cause, their mood fluctuations really do fall in line with their cycle, which kind of tends to indicate that each hormone is kind of sluggish or overproducing, and it's having a hard time getting into that harmonious symphony of how we would like our hormones to be functioning.

Another odd one with this one is we may feel cold or fatigued, and it may be in a different way than what we see with our stress response, our inflammation, and our insulin effect. In this case, fatigue can feel almost like a sleepy, but sleep doesn't really affect it.

We also might have difficulty really regaining ovulation. So we may have done so much work in the other areas, even before we really understood that maybe we were just following generic advice or otherwise living a relatively healthy lifestyle. We have more or less kept the other root causes in check or catered to them and cared for them.

But for some reason, ovulation is still struggling. And this is what we address primarily in this root cause as we have our path towards healing.

Now, as we lay out those four root causes, it sounds so nice and clean, right? We've got these four different distinct root causes. And then, of course, what would follow is four distinct paths to regaining cycles and improving and reversing symptoms, and four unique individual paths towards healing.

But unfortunately, like with most things, it's not quite that simple and clear.

Most women have some overlap. So it's really important to understand what those four categories are. And it's also important to understand that it is very okay to have some overlap between them.

So here's something that I really want you to take away from this episode. Most women don't fit neatly into one single root cause category, and that's perfectly fine.

The four root cause patterns are happening in every person—with PCOS, without PCOS, men and women. We all have these systems running in our body, and we all have the potential for our environment to influence them positively or negatively.

When it comes to PCOS, we tend to be a little bit more sensitive to the environmental factors that can negatively impact these systems, and that's why we need to take extra care of them, and that's why we need to learn about these root causes.

However, if you're listening and you're thinking, "I see myself in three of those different ones," or, "Two of those different ones that you just mentioned," that's not a problem. This is actually a really accurate reflection of how complex and interconnected our physiology really is.

The goal here is that understanding the root causes, it's not about labeling ourselves. It's just a start to see our symptoms as a pattern rather than as just frustrating things that nothing seems to work for.

As we understand that our body is communicating something that's really important, then we can begin to understand how to support our body more effectively.

Inside the PCOS Root Cause Bootcamp, I have an extensive assessment. It's similar to the PCOS Root Cause Quiz that you can take for free, and that's a really great place to start.

But as we go through the assessment, what we see is that it will actually give you back kind of percentages of how much you are of each root cause. And then we're going to focus primarily on that top root cause, and that way we know where to put our efforts.

And then, a lot of times, like we talked about, they're all interconnected. A lot of times just focusing on that top one will begin to improve the other ones as well. And if it doesn't completely resolve them, then we know where to go next.

So that really simplifies our entire approach as we're trying to figure out what would be helpful to do to improve our symptoms.

So as we wrap up today, if you found this episode helpful, I hope you hit that subscribe button because we're going to be talking about what's going on in the root causes, what's causing our PCOS, what kind of environmental things are contributing, and all of those things over the next few weeks. So be sure to hit that subscribe button.

As I mentioned, the free PCOS Root Cause Quiz is a fantastic place to start, and you can find that in the show notes below.

And ultimately, I want to thank you so much for being here, for sharing the time to go through what PCOS is, how it's working. I hope that today was able to give you some clarity into what's happening with your root causes in PCOS and shed some light on them from a different angle.

If you have questions or if you have topics that you would like me to create into episodes here on the PCOS podcast, I would love to hear from you over on Instagram. You can find me at @nourishedtohealthy.

And until next time, bye for now.