PCOS & Metabolic Syndrome

So the missing piece of the puzzle is that the Rotterdam criteria does not address the metabolic issue of pcos. At the core, PCOS is an issue with insulin resistance and blood sugar elevation. So what we see is this vicious cycle that women get stuck, stuck in. And we don't know what came first, the elevated androgens or the insulin resistance. But we know that the two drive this cycle to continue and to worsen. So in your brain you have the hypothalamus, which secretes gonadotropin releasing hormone, GnRH, that talks to the pituitary gland and tells it to produce FSH or lh. Those hormones suck to the ovaries and tell it to produce estrogen or progesterone. What we see is that in pcos, you get too much gonadotropin releasing hormone, which causes too much luteinizing hormone, which causes lower estrogen and no ovulation. When you don't ovulate, then you don't get the progesterone that low progesterone can continues that cycle. The other piece of it is that you make too many too much testosterone in your ovary. So the low progesterone goes back and tells gonadotropin releasing hormone to release some more. And you get stuck in this vicious cycle of anovulation or not ovulating, not making progesterone. So you have a sex hormone imbalance of too much testosterone, not enough progesterone. And then you pull into the picture this insulin resistance issue. Insulin normally is made in the pancreas and pushed out every time there's sugar in the bloodstream that needs to be taken up. When you eat a meal of almost any kind, you're going to elevate your blood sugar. You need insulin to go out and get that and take it into the cells to be utilized as energy or stored as fat. What happens when you eat all of the time is that you are making insulin more and more and more and your cells stop listening to the signal. They get really tired of insulin, knocking on the door all the time, asking them to take in the blood sugar. So you get this insulin resistance at the cellular level. So what happens is your pancreas has to make more insulin to send the same cell signal. It's like it's yelling. And so over time, if you keep eating frequent meals, even if they're small, healthy meals like almonds, you know, cheese sticks, whatever, you're still making more insulin than you should. And you develop this insulin resistance. Insulin resistance drives testosterone production and drives dihydrotestosterone production, which further suppresses the cycle of estrogen and progesterone. And so you are stuck in a cycle where you're making too many androgens, you're not ovulating, you're creating this insulin resistance, and that drives inflammation. And so all of this is happening at the level of the ovary. And the ovary is inflamed, it can't function. And then your mitochondria, which are the little powerhouses inside your cells of your ovaries, they downregulate and they no longer want to produce energy, they go in defense mode. And so then your egg quality starts to diminish, and your anti mullerian hormone level starts to diminish, and this all worsens your fertility issues. So it's really important to realize at the heart of PCOS is a metabolic issue. It's an insulin and blood sugar and inflammation issue more than anything.