PCOS is a remarkable syndrome when you start looking at the interconnectedness of all the symptoms and pathology.

As discussed in the last article, What is PCOS?, it is the most common hormonal disorder among people who menstruate.

The numbers are anywhere from 2-20% of the menstruating population has Polycystic Ovary Syndrome, and possibly 50% of people who have it are undiagnosed.

That is a big deal because of the health risks associated with it later in life.

When I began looking into PCOS, I was immediately surprised how connected the symptoms are to the same hormones and body systems – over and over again.

In this article, you will learn:

  • What high androgen levels do in a body (androgens are hormones found in higher amounts in male bodies like testosterone and androstenedione,)
  • How high androgens cause PCOS but also how PCOS causes high androgens, and
  • What is the process that causes anovulation and polycystic ovaries.

First Things First

The Rotterdam Criteria is the list of three symptoms of which the people with PCOS have at least two:

  • High testosterone
  • Irregular periods and cycles lasting over 35 days – with anovulation (no ovulation)
  • Polycystic ovaries found on ultrasound

When someone has a doctor diagnose them with PCOS, this is the criteria they follow.

As you will see going forward, a body with PCOS continually manifests more of the above symptoms through the other symptoms.

It’s a tangled web.

If this all feels too overwhelming, you do not need to know all of this information to begin supporting the systems that need it.

You can skip this article and go straight to the article I wrote all about recommendations for PCOS. (coming soon!)

This is for the curious folks.

I know sometimes I need a deeper explanation to something happening in my body, and sometimes I couldn’t care less.

Choose what feels right to you at this moment.

You can always come back to this article later to see how it all fits together and how it plays out in your body based on your specific symptoms.

The Interconnectedness of it All

PCOS is a real mess of interconnected symptoms and causes.

By mess I mean that I had one hell of a time untangling it all in my brain to lay it out in a way that is easy to digest.

I will go through each of the three symptoms listed above to connect them with the broader syndrome.

PCOS manifests itself differently in every body, making diagnosis and treatments from your doctor difficult 

 High Testosterone and Insulin Resistance

High testosterone levels can be found in a body with PCOS and the symptoms can further the imbalance and the syndrome itself.

This imbalance can be caused by insulin resistance.

This is when the cells in the body are no longer responding to the message that insulin carries – “Take in glucose. There is too much out here.”

The pancreas will keep secreting insulin, but blood sugar levels will remain high.

When cells no longer take in glucose from the blood, there is more circulating glucose and insulin.

Excess levels of glucose in the blood also lead to symptoms like low energy, extra hunger and/or thirst, stomach pain, shortness of breath to name a few.

The continual release of insulin will tire the pancreas which makes it harder for it to continue its job.

The bloodstream contains excess insulin, but it is not able to carry out its function. It keeps circulating, and it turns out, it does affect some tissues.

While most cells in the body can become insulin resistant, there are some that do not, namely the ovaries.

High amounts of insulin in the bloodstream trigger the ovaries to produce androgens, like testosterone.

The levels of testosterone increase.

 Testosterone and PCOS

The increased testosterone in PCOS can lead to weight gain, hair loss, acne, hirsutism (hair growth in unwanted places like upper lip, chin, breasts, low belly.)

It will also prevent the ovaries from ovulating.

The pituitary gland keeps signaling the ovaries to mature some follicles, but the increased androgens prevent ovulation.

Follicles will mature, but will not be released in ovulation.

If the follicles are not being released, where do they go?

Some naturally stop maturing and are absorbed to be used in other processes, but some stay in the ovaries, which leads to multiple cysts in the ovaries – polycystic ovaries.

Menstrual Cycles and PCOS

This is actually how a lot of people find out they have PCOS: They have been trying to get pregnant, to no avail, and so they seek professional help, and polycystic ovaries are found on an ultrasound.

The high androgen levels are the reason for the absent or inconsistent ovulation.

I always recommend charting your cycles so you know if you are ovulating or not and how often.

This is simply taking your basal body temperature and checking cervical fluid daily then recording the information on a chart.

You soon notice patterns from cycle to cycle.

There are many reasons for skipped ovulation, so it is always best to see a healthcare provider that is well versed in menstrual health.

A lot of times with PCOS, people will notice that they have long cycles followed by long and/or heavy periods.

This is because the uterine lining is building up for that much longer, and if estrogen levels are high too, this is also a symptom of estrogen dominance.

There are other factors that work cyclically with PCOS – they can interfere with PCOS and aggravate it but also PCOS can interfere with and aggravate it.

Other factors include gut health, chronic stress, inflammation, sleep issues, the pill to name a few.

The next article in this series will cover the above factors and a few more.

Insulin Resistance and the Liver

Excess insulin in the bloodstream also inhibits the liver from producing a protein that is needed to bind to excess hormones, like testosterone and estrogen, called sex-hormone binding gobulin or SHBG.

This then increases free testosterone. There is no way for the excess to leave the body.

It can be converted to other hormones through a process called aromatization, extra androgens are converted to estrogen.

Now there is excess testosterone and estrogen, which comes with its own list of problems. (Check out my article on Estrogen Dominance here.)

Final Thoughts

Over and over, the term insulin resistance has come up.

It is both the cause and effect of PCOS, which really makes this all a terrible cycle.

Insulin resistance creates higher levels of testosterone which leads to delayed or absent ovulation which then causes cysts in the ovaries.

PCOS is a complex metabolic and endocrine issue. It impacts many body systems and there are many varying symptoms.

It is because the symptoms can be so individual that a diagnosis of PCOS can take years.

Sadly, it is up to us to advocate for our own health.

If you know there is something going on with your menstrual cycles and you do have similar symptoms as listed above, take this information to your doctor and ask for tests.

Keep on them. If you feel you are not heard, try looking for a doctor who understands this stuff better. 

Your health and wellbeing is so important.

Don’t accept the idea that you need to lose weight or go on the pill.

You need actual attention and tests and treatments specific to your symptoms and pathology. 

Yours in plant love,



If you feel like you need personalized guidance from Carly…

I invite you to book a FREE Hormone Clarity Assessment by clicking on the button below!

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