Root Causes of PCOS | Where PCOS Symptoms Come From
There are 3 root causes of PCOS symptoms that I talk about frequently in my work as a PCOS nutrition professional. These root causes of PCOS- insulin resistance, inflammation, and adrenal dysfunction are often unknown or not well understood. I’d like to introduce you to a concept today that has helped me explain a root cause approach to pcos nutrition is polycystic ovary syndrome (PCOS) very well over the years. I call it the Priority Pyramid.
What is PCOS?
You likely already know that Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women. It is characterized by a combination of symptoms, including irregular menstrual periods, excess androgen levels (male hormones), and polycystic ovaries (enlarged ovaries containing multiple small cysts). PCOS can lead to various health complications, including infertility, insulin resistance, weight gain, and increased risk of type 2 diabetes and heart disease. Management of the root causes of PCOS typically involves lifestyle changes, such as diet and exercise, along with medications to address specific symptoms and improve overall health.
What is a root cause approach to PCOS?
The temptation with any kind of PCOS approach is to focus on the hormone imbalances in PCOS first: things like high testosterone, low progesterone, or estrogen dominance.
After all, these are the things that cause the majority of visible symptoms in PCOS like facial hair, hair loss, acne, and irregular periods.
But to focus on only these misses the point and likely won’t help much with improving your underlying health with PCOS. If it did, we would see methods like birth control being curative for PCOS. Yes, they will regulate periods while you’re on them, but birth control often has numerous side effects and in PCOS, we typically see symptoms return as soon as birth control is stopped.
Instead, it is far better to focus in deeper, on the 3 main root causes of pcos symptoms. This will help bring healing from the core and improve not just hormone balance, but overall health as well.
Why do PCOS symptoms happen after birth control?
Hormones are signalers and they send messages to the body. In PCOS, birth control suppresses the signals sent and keeps hormones levels low but doesn’t address the deeper metabolic issues driving the irregular signals. In short, birth control is a bandaid approach that makes things seem better while you’re on it, but doesn’t actually fix the root causes of pcos.
Nutrition for the True Root Causes of PCOS
A root cause of PCOS focused nutrition approach is based on identifying which of the three PCOS root cause issues are driving your symptoms the most and placing most of your energy and focus on diet and lifestyle changes for it. You can learn more about your potential PCOS root causes here.
Once we know the root causes of PCOS (and our own unique combination of them), it can be very overwhelming to figure out what to do first, especially since so many of us are dealing with issues from all three PCOS root causes. That’s where the concept of the Priority Pyramid comes in.
The Priority Pyramid
The question to ask ourselves is why our hormone signals are so irregular in the first place?
To answer that question, we have to look deeper than what’s right in front of us. We have to actually find the root causes of PCOS symptoms and extract information about how those issues are driving our problems.
Our sex hormones like estrogen, progesterone and testosterone can be altered by several deeper physiological processes. The most important of these are: stress hormones, thyroid function, blood sugar balance and insulin production, immune system function and inflammation, and cellular health and nutrient deficiency.
The hormone issues we see
We know the fundamentals of where our PCOS symptoms come from. Take the graphic on the left. It shows where PCOS facial hair comes from- the complex dance between our ovaries, testosterone, dihydrotestosterone and enzymes like 5-alpha-reductase.
But why do we have so much testosterone in the first place?
To understand this, I’ve created the Priority Pyramid concept which I’ll hopefully help explain in the rest of this article.
The Priority Pyramid: Where PCOS symptoms really come from
PCOS Symptoms and Primal Safety
Root Causes of PCOS Symptoms: Start with the foundations of health
For me as a nutrition professional, I’m starting with the base. And yes, blood sugar is often key to those early days because it helps with energy and focus but focusing on blood sugar exclusively at the expense of nutrient density and anti-inflammatory eating misses the point and will likely result in few long term changes to hormones.
Deeper root causes of PCOS symptoms: Adrenals and Stress
You might be agreeing with me by this point. Maybe it makes sense to start with deeper issues before expecting your hormones to change. But maybe you’re wondering how exactly to do that?
That is a complex question, but let’s discuss some actionable strategies to help your PCOS hormone symptoms using the Priority Pyramid.
Addressing stress for PCOS
Let’s say we’ve looked at our health and agree there are some stress hormone, thyroid, or blood sugar issues. The first thing to do is also scan ourselves to see if we might also be dealing with some inflammation, digestive issues, or nutrient deficiencies.
Ask yourself also if you deal with any immune issues like autoimmune conditions, recurrent infections like yeast infections, or inflammatory issues like arthritis.
If the answer is yes, you may want to incorporate a few of these strategies as you have time and energy, but don’t put all of your focus here. Instead, skip to the next section and make that your top priority.
You can find more on my approaches to managing PCOS stress here: Top Signs of High Cortisol and Adrenal Dysfunction in PCOS
Strategies to help the middle rung
Helping the middle rung of the priority pyramid when it is not being triggered directly by the base rung or foundations of health, is often more about how you eat than what you eat.
The first step is to improve your stress responses as best you can so start with nutrition and lifestyle changes aimed at the adrenals. This might look like the following:
- Eating regular meals at regular times
- Slowing down while eating, avoiding eating on the run
- Adding regular mindfulness practices every day
- Cutting back on exercise (if overdoing it)
- Increasing exercise (if under-doing it) Signs of Adrenal Dysfunction
- Increasing protein with each meal to stabilize blood sugar
- Including bursts of activity when anxious or stressed
- Cutting back on obligations, learning to say no
- Self care strategies
- Sleeping, at least 8 but close to 9 hours if possible
It is fairly rare in my work to see people with adrenal and blood sugar issues that don’t also have some inflammatory or cellular issues. If in doubt, it doesn’t hurt to focus on the foundations and if you see improvement in your symptoms, you know you’re on the right track.
Likewise, if incorporating the above advice daily for three months doesn’t make any difference for your PCOS symptoms, you may need to address deeper issues.
Foundations of PCOS health: Immune and Cellular Health
Addressing the foundations of health: immune and cellular health involves several important strategies. The goal here is nourishment and nutrient repletion.
Here are some strategies helpful for this rung:
- Increasing PCOS superfoods, at least one daily 9 Superfoods for PCOS
- Addressing gut health and inflammation Addressing Chronic Inflammation in PCOS- Where it comes from and what to do- An Amber a Day Podcast
- Eating more plant foods, especially leafy greens and other vegetables
- Consuming more protein (my Ultimate Guide to Protein for PCOS should help!)
- Supplementing wisely to improve nutrient status and support the mitochondria http://www.amberfischernutrition.com/supplements
- Increasing physical activity, strength and cardio
- Increasing sweating, potentially through infrared sauna
- Avoiding inflammatory foods and foods you are allergic/sensitive to
- Test and address Vitamin D deficiency
- Read about and determine your PCOS root cause to take this knowledge even deeper PCOS Self Assessment Quiz and Guide- PCOS diagnosis Quiz
Adding in some of these strategies should help improve the foundations of your health but will also support your stress responses and blood sugar balance. Basically, the impacts of these things trickles up and, given time, will improve your PCOS hormone balance as well.
More help for PCOS root causes
It’s very easy to feel overwhelmed by all the things that are suggested to help PCOS. That’s why I created PCOS Foundations. It’s my starter course to the functional nutrition for PCOS lifestyle and shows you how to actually incorporate strategies for all the major PCOS root causes at the same time. Basically, I take all the guess work out of how to eat and what to eat and when to eat and organize it for you. There are also some great bonuses included like the “PCOS guide to Meal Prepping and Planning” and 4 weeks of meal plans with recipes and grocery lists to match.
If you’d like to see more about PCOS Foundations, you can find it here.
Conclusion: The Priority Pyramid
I hope this article helped you learn to think about your PCOS hormones a little differently. While it’s tempting to focus on the annoying symptoms we can see, I always think of symptoms as information. My body is trying to wave a red flag and get my attention to tell me that something is wrong. The important thing is to keep pulling on the thread of that question and continue asking why.
Your PCOS hormone symptoms come from three main root causes: insulin resistance, inflammation, and adrenal dysfunction. Notice that all three of those exist on the second and base of the pyramid. Looking deeper at your hormone imbalances as information from the priority pyramid can help you narrow down your approach and create more targeted change.
I also find that working from the base to the top of the pyramid gives us quicker and more satisfying results than just trying to block hormones like testosterone. I hope it helps you as well!
