PCOS and Your Hormones: A Complete Guide to What’s Really Happening
If you’ve been diagnosed with Polycystic Ovary Syndrome (PCOS), you’re likely wondering exactly what’s going on inside your body. As a naturopathic physician who has worked with hundreds of women navigating PCOS, I understand how overwhelming it can feel to hear medical terms thrown around without truly understanding what they mean for your daily life.
PCOS affects up to 15% of women of reproductive age, making it one of the most common hormonal disorders we see. Yet despite its prevalence, many women feel confused about which hormones are actually involved and how these imbalances create the symptoms they’re experiencing.
The truth is, PCOS isn’t just about your ovaries. It’s a complex condition involving multiple hormone systems throughout your body. When these systems fall out of balance, they create a cascade of effects that can impact everything from your menstrual cycle to your energy levels, weight, and even your mood.
Understanding which hormones are affected by PCOS is the first step toward taking control of your health. When you know what’s happening in your body, you can make informed decisions about treatment options and lifestyle changes that address the root causes of your symptoms.
The Primary Players: Androgens in PCOS
Let’s start with the hormones that often take center stage in PCOS: androgens. These are typically thought of as “male hormones,” but women naturally produce them too, just in smaller amounts. In PCOS, however, androgen levels become elevated, creating many of the condition’s most recognizable symptoms.
Testosterone: The Most Common Culprit
Testosterone is probably the androgen you’ve heard most about. In women with PCOS, testosterone levels can be significantly higher than normal. According to the Cleveland Clinic, elevated androgens prevent the ovaries from releasing eggs normally, which disrupts your menstrual cycle and can cause those characteristic small cysts on your ovaries.
When testosterone levels are high, you might notice excess hair growth on your face, chest, or back (called hirsutism), which affects up to 70% of women with PCOS. You may also experience male-pattern hair loss, where your hairline recedes or you develop thinning on the crown of your head. Additionally, elevated testosterone often contributes to stubborn acne, particularly along the jawline and chin.
DHEA-S: The Supporting Actor
Dehydroepiandrosterone sulfate (DHEA-S) is another androgen that’s frequently elevated in PCOS. This hormone is produced primarily by your adrenal glands, which sit on top of your kidneys. DHEA-S works alongside testosterone to contribute to many of the same symptoms, including excess hair growth and acne.
What makes DHEA-S particularly interesting is that it can help your healthcare provider understand whether your PCOS symptoms are coming primarily from your ovaries or your adrenal glands. This distinction can be important for determining the most effective treatment approach.
The Insulin Connection: A Key Driver of Hormonal Chaos
One of the most important discoveries in PCOS research has been understanding the role of insulin resistance. Many women with PCOS have difficulty processing insulin effectively, and this creates a domino effect throughout their hormone systems.
How Insulin Resistance Develops
Insulin is the hormone responsible for helping your cells use glucose (sugar) for energy. When you have insulin resistance, your cells don’t respond properly to insulin’s signals. Your pancreas tries to compensate by producing more insulin, leading to chronically elevated insulin levels in your bloodstream.
The problem is that high insulin levels trigger your ovaries to produce even more androgens. This creates a vicious cycle: insulin resistance leads to higher androgen levels, which can worsen insulin resistance, which leads to even higher insulin levels, and so on.
The Wide-Reaching Effects
Insulin resistance doesn’t just affect your blood sugar. It can contribute to weight gain, particularly around your midsection, and make it incredibly difficult to lose weight even when you’re eating well and exercising regularly. The frustration many of my patients feel about their weight isn’t just about appearance—it’s about feeling like their body isn’t responding to their efforts the way it should.
Insulin resistance can also contribute to those dark, velvety patches of skin you might notice around your neck, armpits, or groin area. This condition, called acanthosis nigricans, is often one of the first visible signs that insulin levels are elevated.
The Reproductive Hormone Imbalance: Estrogen and Progesterone
PCOS significantly disrupts the delicate balance between estrogen and progesterone, the two primary female reproductive hormones. Understanding this disruption helps explain why your menstrual cycles might be so unpredictable.
Estrogen: Too Much of a Good Thing
In a typical menstrual cycle, estrogen levels rise and fall in a predictable pattern. With PCOS, this pattern becomes chaotic. Because ovulation happens irregularly or not at all, estrogen levels can remain elevated for extended periods without the balancing effect of progesterone.
This estrogen dominance can contribute to several concerning health risks. The Cleveland Clinic notes that women with PCOS have an increased risk of endometrial hyperplasia and endometrial cancer, largely due to prolonged estrogen exposure without adequate progesterone to balance it.
Progesterone: The Missing Piece
Progesterone is produced primarily after ovulation occurs. Since women with PCOS often don’t ovulate regularly, progesterone levels tend to be chronically low. This creates an imbalance that affects far more than just your menstrual cycle.
Low progesterone can contribute to mood changes, anxiety, and difficulty sleeping. It can also affect your body’s ability to use fat for fuel, making weight management even more challenging. Many of my patients notice that they feel more emotionally balanced and sleep better when we work to support healthy progesterone levels.
The Control Center: LH and FSH Disruption
Two hormones produced by your pituitary gland—luteinizing hormone (LH) and follicle-stimulating hormone (FSH)—play crucial roles in regulating your menstrual cycle. PCOS significantly disrupts the normal relationship between these hormones.
The LH to FSH Ratio
In women with PCOS, LH levels are often elevated relative to FSH levels. Normally, these hormones work together in a carefully choreographed dance throughout your menstrual cycle. LH surges to trigger ovulation, while FSH helps your eggs mature in preparation.
When this ratio is disrupted, it contributes to the irregular ovulation that’s characteristic of PCOS. The elevated LH also stimulates your ovaries to produce more androgens, adding to the hormonal imbalance.
What This Means for Your Cycles
This disruption in LH and FSH helps explain why your periods might be so unpredictable. You might go months without a period, have very light periods when they do occur, or experience heavy, prolonged bleeding. Understanding that this isn’t just “irregular periods” but rather a complex hormonal disruption can help you feel more empowered to seek appropriate treatment.
The Supporting Cast: Other Hormones Affected by PCOS
While androgens, insulin, and reproductive hormones get most of the attention in PCOS, several other hormones can also be affected, contributing to the wide range of symptoms women experience.
Cortisol: The Stress Hormone Connection
Cortisol, your primary stress hormone, is often elevated in women with PCOS. Chronic stress can worsen insulin resistance and increase androgen production, creating another layer of hormonal disruption.
Many women with PCOS find themselves in a frustrating cycle where the condition itself creates stress (about symptoms, fertility concerns, or weight management), which then elevates cortisol and worsens their PCOS symptoms. This is why stress management becomes such an important part of comprehensive PCOS care.
Thyroid Hormones: The Metabolism Connection
Thyroid disorders are more common in women with PCOS than in the general population. Your thyroid hormones regulate your metabolism, and when they’re out of balance, it can worsen many PCOS symptoms, particularly weight gain and fatigue.
Even subclinical thyroid dysfunction—where your levels are technically “normal” but not optimal—can contribute to the challenges of managing PCOS. This is why I always recommend comprehensive thyroid testing for my PCOS patients, not just the basic TSH that’s often ordered.
Appetite Hormones: Ghrelin and Leptin
PCOS can also disrupt the hormones that regulate hunger and satiety. Ghrelin, which signals hunger, and leptin, which signals fullness, can both be affected. This disruption might help explain why you feel hungry more often than you think you should, or why you don’t feel satisfied after eating.
Understanding that these appetite changes have a hormonal basis can help reduce the shame and frustration many women feel about their relationship with food when they have PCOS.
Managing Hormonal Imbalances Through Diet and Exercise
While hormones and PCOS might seem like an overwhelming medical puzzle, there’s actually quite a bit you can do through lifestyle modifications to help restore balance. The key is understanding which approaches actually address the underlying hormonal disruptions rather than just treating symptoms.
The Power of Anti-Inflammatory Eating
Chronic inflammation plays a significant role in PCOS, contributing to insulin resistance and elevated androgen levels. An anti-inflammatory diet rich in whole foods, healthy fats, and plenty of vegetables can help reduce this inflammation and support better hormonal balance.
Focus on foods that help stabilize blood sugar, such as lean proteins, fiber-rich vegetables, and healthy fats from sources like avocados, nuts, and olive oil. Many of my patients find that reducing processed foods and refined sugars makes a noticeable difference in their energy levels and PCOS symptoms.
Exercise: More Than Just Weight Management
Regular physical activity is one of the most powerful tools for improving insulin sensitivity and reducing androgen levels. Both aerobic exercise and strength training can be beneficial, but you don’t need to spend hours at the gym to see results.
Even moderate exercise, like a 30-minute walk after meals, can help improve insulin sensitivity. Strength training is particularly beneficial because muscle tissue is very metabolically active and helps your body process glucose more effectively.
Medical Treatments for Hormonal Regulation
While lifestyle changes form the foundation of PCOS management, medical treatments can be invaluable for addressing specific hormonal imbalances. The key is finding approaches that work with your body’s natural processes rather than simply suppressing symptoms.
Addressing Insulin Resistance
Medications like metformin can help improve insulin sensitivity, which often leads to improvements in other hormonal imbalances as well. When insulin levels come down, androgen levels often follow suit, leading to improvements in hair growth, acne, and menstrual regularity.
Supporting Ovulation
For women trying to conceive, medications that support ovulation can be life-changing. These work by helping to restore the normal hormonal patterns needed for regular ovulation to occur.
Hormonal Balance Support
Hormonal contraceptives can help regulate cycles and reduce androgen effects, but they work best when combined with lifestyle approaches that address underlying imbalances like insulin resistance.
Lifestyle Adjustments and Stress Management
Managing the stress that often accompanies PCOS is crucial for hormonal balance. Chronic stress elevates cortisol, which can worsen insulin resistance and increase androgen production.
Mind-Body Approaches
Practices like yoga, meditation, and deep breathing exercises can help regulate your stress response and support better hormonal balance. Many of my patients find that even 10-15 minutes of daily stress management practice makes a noticeable difference in how they feel.
Sleep: The Foundation of Hormonal Health
Quality sleep is essential for hormonal balance. Poor sleep can worsen insulin resistance, increase cortisol levels, and disrupt the hormones that regulate appetite. Prioritizing good sleep hygiene—like maintaining consistent sleep and wake times, creating a relaxing bedtime routine, and limiting screen time before bed—can significantly support your PCOS management efforts.
Taking Control of Your Hormonal Health
PCOS involves a complex web of hormonal imbalances, but understanding these connections empowers you to make informed decisions about your health. The hormones affected by PCOS—from androgens and insulin to reproductive hormones and stress hormones—all influence each other, which is why comprehensive care that addresses multiple systems tends to be most effective.
Remember that PCOS looks different for every woman. Your specific pattern of hormonal imbalances might be different from someone else’s, which is why personalized care is so important. Working with a healthcare provider who understands the complexity of PCOS and takes time to understand your unique situation can make all the difference in developing an effective treatment plan.
The most important thing to remember is that you’re not powerless against these hormonal imbalances. While PCOS is a chronic condition that requires ongoing management, many women find that with the right combination of lifestyle approaches and medical support, they can achieve significant improvements in their symptoms and overall quality of life.
Medical Disclaimer: If you have been recently diagnosed with PCOS, consult with your naturopathic medical provider for guidance. Never start a new therapy or regimen without consulting with your medical provider.
Struggling with PCOS? You don’t have to navigate this alone. Reach out for a free 15-minute discovery call to learn how personalized naturopathic care can help you achieve better hormonal balance and reclaim your vitality.
