Polycystic ovarian syndrome (PCOS) is a diagnosis that used to be called a “syndrome.” Syndromes are a compilation of symptoms with the absence of absolute diagnostic criteria. The syndrome predominantly revolved around infertility with the presence of cystic ovaries. Along with these criteria were obesity, acne, facial hair, depression, fatigue, etc.
This “syndrome” needs to be renamed, as physicians know that the primary defect is NOT in the ovaries and in fact has absolute diagnostic laboratory findings. PCOS is simply insulin resistance diagnosed when women’s FSH/LH levels (blood work) have a shifted ratio. In non-PCOS women, the ratio is 2:1. In PCOS women it is less than this and often shifted to a 1:2 ratio or worse.
Today we know that cysts do NOT have to be present to be accurately diagnosed with PCOS. In fact, women who have had their ovaries removed are frequently diagnosed with PCOS. Understanding why some women will get cysts on their ovaries and others do not identifies why the name is not reflective of the underlying condition anymore.
The culprit in PCOS is how insulin interacts with the receptor site on cells – nothing more, nothing less. The reason many more symptoms than the ones listed above exist is because insulin interacts with every cell in the body. Insulin is required to carry glucose (sugar) into cells. Insulin levels will increase either immediately or years after receptors become damaged. Stress is a main cause of receptor site changes. Once receptor site changes have occurred long enough, insulin levels will begin to increase. Not all people with insulin resistance have elevated insulin levels. It depends on when the condition is diagnosed.
Insulin increases an enzyme in the ovary (P450c17 alpha), which can cause cysts. We all have a unique metabolic response. 50 percent of women will make more insulin in response to the receptor site changes and 50 percent will not. This is why we have missed more than 50 percent of insulin-resistant women who simply don’t have cysts on their ovaries.
One hormone change triggers another, which changes another. This makes a vicious cycle of out-of-balance hormones.