How PCOS often starts is in the hypothalamus, a structure


in your brain. Specifically, the application of a wide variety of stressors will initiate the process. “Stress” in this context means a variety of different things.


Chronic, uncompensated emotional and mental stress,


physical stress from over-exercising, over-dieting and under- sleeping; environmental stress from exposure to hormone-dis- rupting compounds, estrogens, plasticizers and certain classes of pesticides and/or any combination of the preceding factors will increase catecholamines. This, in turn, is noted by the hypothalamus, which will start


releasing increased amounts of CRF (corticotropin-releasing fac- tor).


CRF, in turn, increases cortisol production from the adrenals, increases the production of androgens, and can cause symptoms of depression. Elevated, uncompensated cortisol will increase blood sugar. Increased blood sugar will lead to increased insulin release.With chronic high blood sugar and high insulin, you tip towards insulin resistance. In an attempt to make your body “hear” insulin’s message, the pancreas will make even more insulin. The ovaries are spurred on to make androgens (estrogen and testosterone) via insulin or IGF-1 (insulin like growth factor) receptors on their surface. The extra insulin and cortisol can create central obesity, typical in metabolic syndrome and PCOS, but there are plenty of lean women with PCOS. The extra androgens, pumped out by the ovaries, are con-


verted to estrone, by the process of aromatization. This process is accelerated when someone is overweight, as the fat cells are hot beds of aromatization. Estrone is an estrogen fraction. Estrogen dominance is com-


mon in women with PCOS, who often have low absolute levels of progesterone or low relative progesterone in relationship to estrogens. Estrone, in high amounts, is capable of disrupting another hormone, GnRH (gonadotropin-releasing hormone). The disruption in GnRH in turn leads to a skewing of the release of two other hormones important in the PCOS conversation, LH (luteinizing hormone) and FSH (follicle stimulating hormone). Too much LH is produced, and too little FSH. Excess LH will


drive even more androgen production, which will lead that cycle churning forward and assisted by high insulin. Too little FSH means follicles never fully develop, so they swell a bit and turn cystic, unable to complete their cycle of maturation and thus ovulation. High insulin, excessive androgens, elevated estrone and LH/


FSH disruption lead to the classic symptoms of PCOS: irregular periods, absent period, infertility, acne, hair growth on the chin, above the lip, around the nipples and under the bellybutton. Tests and imaging studies may determine you are not ovulating, even though there are multiple swollen follicles/cysts on your ovaries. Interestingly, these swellings/cysts are not always present in


all women with PCOS. Excess androgens are also not always found, leading clinicians and researchers to think of PCOS as a wide presentation of symptoms, along the lines of a spectrum. What appears to be a consistent theme in all women with PCOS is GnRH disruption, leading to alteration of LH and FSH. This skewed ratio of high LH and low(er) FSH is responsible for ir- regular menses and infertility. Therefore, it is important for all women, who are to be worked up for PCOS to not only have their androgens and fasting


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Ends 3/31/17


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