Hey ,

That is a great question! It is not an easy one to answer as well. We have a lot of content here that can help you and I will link to the content in my answer.

But first, let me explain when you have PCOS or polycystic ovary syndrome.

You have PCOS when you meet at least 2 of the 3 Rotterdam criteria. These criteria are:
• Ovulatory dysfunction
• Androgen excess (This can only be measured in tests – like for example the DUTCH test)
• Polycystic ovaries (This can only be evaluated by a doctor)

Let’s dive a little deeper into the signs & symptoms of PCOS:

Androgen excess
Androgen excess can lead to symptoms like male pattern hair loss, acne, anger, irritation, mood swings and hair growth in places you wouldn’t want hair to grow.

Ovalulatory issues
These issues can be irregular cycles, but they can also present themselves as anovulation or fertility challenges.
What causes PCOS?Often excess androgen can be caused by insulin resistance. In the B Better library, we have a course on blood sugar regulation which dives a lot deeper into how insulin resistance is caused and what it is. Here is a video that explains what insulin resistance means, but with PCOS I would advise you to watch the entire course since this course also explains how to reverse insulin resistance.

Insulin resistance causes something called Sex Hormone Binding Globulin or SHBG to go down. SHBG is like a bus for sex hormones. If sex hormones are on the bus, they aren’t available for use. Since with insulin resistance, the number of busses is reduced, more testosterone swims free wreaking havoc.

Insulin resistance can also lead to anovulation and it is the ovulation that leads to progesterone production. If you would like to dive deeper into how ovulation works, we have a more detailed handout about estrogen (just click here). The first part dives deeper into how sex hormones dance with each other. For now, just remember that because progesterone isn’t made, estrogen becomes ‘dominant’, which can lead to symptoms of estrogen dominance.

Now why did I try to explain to you in this detail how androgens cause PCOS? There are 3 places where androgens are made in the female body:
• The ovaries produce roughly 25% of the body’s testosterone
• The adrenals produce 25% of the body’s testosterone as well
• The other 50% percent is made in adipose tissue from a precursor that is made in the adrenal gland (Androstenedione).

This means that in some cases, where there are PCOS symptoms, but no insulin resistance, the adrenal glands (which are responsible for producing stress hormones as well) and everything that controls the adrenals can also contribute to a possible root cause for PCOS.
How do you know what might be at play?If you are interested in finding out what causes PCOS, lab testing is something you might want to consider. Here are some tests that I usually recommend to my clients if they want to know.

Here are some options to find out if you have insulin resistance
• Fasting insulin 
• Fasting blood glucose
• A glucose tolerance test
• HbA1c

There is a video in the B Better library (just click here) that dives deeper into lab values you could use to explore if you have insulin resistance.

Often insulin resistance is a big player in PCOS. If you aren’t sure where to start in managing PCOS and testing is something you don’t want or need to do, lowering insulin is a good place to start!

The next tests are tests to find out other possible root causes that might have led to a PCOS picture but are often not considered.

Tests for a hypothyroid state
A slow thyroid can be a root cause of weight gain. The adipose tissue is a big source of testosterone. More Signs & symptoms of a slow thyroid you can find in the video here, but here are a few important ones: constipation, a hard time losing weight, feeling cold and hair loss. If these symptoms are present, you can do a full thyroid panel (just click here).

If you suspect hypothyroidism is at play, we do have a full course on this in our library as well. Just click here.

Prolactin
Prolactin is the hormone for breastfeeding. Mild elevations can be caused by stress, hypothyroidism or a lack of dopamine. When your body is unsure if you should be breastfeeding or not, this can influence the menstrual cycle. If for some other reason, acne presents itself, this can lead to a PCOS picture, while actually other things are at play. 
Addressing or Managing PCOSInsulin Resistance
Getting insulin sensitive again is something that can help greatly with PCOS. The B Better library has again some excellent videos. There are different dietary strategies that can help, but whatever strategy you choose, making clean healthy food choices play a key role in all those strategies. Here is a video describing dietary guidelines that work for many. These guidelines form the basis.

Supplements can help as well. Again, following the entire course will give you the most insight, but this video and this one as well will provide you with different supplement options depending on which stage of insulin resistance you are experiencing.

Stress & Adrenal Health
There are many signs & symptoms of stress (click here for the complete list!). But here are a few important ones: feeling wired & tired, feeling anxious all the time, feeling overly alert, feeling exhausted and having a low pulse rate are just a few of them. With managing PCOS I would also recommend you to watch the newly released course on adrenal balance entirely.

But here are the most important videos you could watch to help you going today:

Here is a video on how stress impacts the entire body. Stress can worsen or lead to estrogen-dominance symptoms. But stress can also cause hypothyroidism which is explained here.

Stress can lead to high cortisol levels (which is a stress hormone made in the adrenal glands) or low cortisol levels. Addressing high cortisol levels has a different approach than addressing low cortisol levels. It is all explained in this video and this video.

I know it is a lot! PCOS is a big topic. But I hope this can send you in the right direction!