The imbalanced hormones involved in PCOS may affect a regular menstrual cycle, cause PCOS related weight gain, infertility, PCOS pregnancy complications such as miscarriage, recurrent miscarriage, pre-eclampsia, NICU babies and reduce breastfeeding ability.
But which hormones are involved??
Let’s first take a quick look at the hormonal fluctuations in a healthy menstrual cycle:
Picture: Normal Menstrual Cycle Changes (Credit)
Now let’s take a look at some of the hormones important in PCOS:
High Levels of Luteinising Hormone (LH)
Luteinising Hormone helps in the final maturation of the egg, and the LH surge triggers ovulation. Women with PCOS typically have high levels of LH, but often don’t experience the all-important surge.
“Inappropriately raised LH levels may have adverse effects on the developing oocyte (egg) or endometrium either directly, or indirectly by causing an elevation in testosterone and oestrogen levels.”
High LH levels contribute to the lack of an egg being released from the ovary (anovulation). This sustained high level of LH is different from the “LH surge” that occurs just before ovulation, which serves to ‘push’ the egg through the ovarian wall. When eggs aren’t released for fertilisation, infertility is unavoidable.
Abnormal LH to Follicle Stimulating Hormone (FSH) Ratio
An abnormal LH to Follicle Stimulating Hormone (FSH) ratio has been postulated as a factor in PCOS. Although some research suggests that examining this ratio is of limited use, and may be less of a factor than originally thought. FSH triggers a follicle to develop into a mature egg. A typical LH to FSH ratio is 1:1. Some health professionals consider ratios of 2:1 or 3:1 to indicate possible PCOS.
High Insulin Levels
Most women with PCOS have high insulin levels and can have insulin resistance. Their body has trouble using the hormone insulin correctly, and so they produce more insulin to compensate. With increasing insulin levels, the cells effectiveness in responding to insulin is reduced. This can result in insulin resistance.
Signs and symptoms of insulin resistance include:
- Weight gain, and difficulty losing weight
- Foggy brain
- Skin tags
- Darkening of the skin (acanthosis nigricans)
- Fatty liver
- Irregular periodsThese high insulin levels increase the production of androgens (male hormones), which can also contribute to infertility.
Signs and symptoms of androgen overproduction include:
- Excessive hair growth
- Weight gain
- Problems with ovulation
Inflammation may be a factor in the development of PCOS.
There is evidence that inflammation causes reduced insulin sensitivity, which can increase insulin levels, and subsequently androgen levels. This can cause anovulation and infertility.
One 2004 study concluded that PCOS and inflammation were not necessarily correlated. This study compared inflammatory markers; substances found in the blood indicating inflammation to a control group.
However, research published in 2005 examining insulin resistance and inflammatory markers in obese and non-obese women with PCOS did show that all women with PCOS had elevated levels of inflammatory markers.
Some suggest that weight and obesity may be the cause of the high levels of inflammatory markers and problems often associated with women that have PCOS, like heart disease and diabetes.
What does this mean?
It is likely that women with PCOS have higher levels of inflammation, whether due to PCOS or the common incidence of overweight and obesity in women with PCOS. It also indicates that following a food plan and lifestyle choices that reduce inflammation will be beneficial.
Low Progesterone Levels
Low progesterone levels are common in women with PCOS.
A 2004 study of 19 women with PCOS concluded that insulin resistance may be responsible for low progesterone levels during the luteal phase (the second half of the menstrual cycle, from ovulation to the first day of the bleed).
Of course, there are many other hormones involved in health, and in PCOS… Higher testosterone levels and lower Sex Hormone Binding Globule (SHBG) for example.
If you are looking to lose weight and boost your fertility and reduce your pregnancy complications, it is important these above hormones, and any imbalances which may occur is addressed.
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