August 25, 2022

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Knowing your PCOS Driver


Polycystic Ovarian Syndrome

PCOS, or Polycystic Ovarian Syndrome, is a hormonal condition associated with irregular/absent cycles and a myriad of seemingly unrelated symptoms that can really impact a woman's quality of life. From hair loss, weight gain, brain fog, fatigue to irregular cycles, infertility, acne, heavy painful bleeds, the list goes on. 

As a Naturopath specializing in Women’s Hormones, PCOS is a condition I see time and time again where the individual sitting in front of me has just received their diagnosis with a very grim set of expectations surrounding it. Phrases like ‘you might want to look into IVF because it won’t be possible to fall pregnant on your own’, or even ‘you have polycystic ovaries, here’s some metformin’ (the standard prescription for PCOS). 


Few bones to pick with each of those sentiments:

  • PCOS is a hormonal condition
  • If left untreated, you may have issues conceiving without getting your hormones back into balance.

But that’s the key - YOU CAN BALANCE YOUR HORMONES. While IVF can be an absolute lifeline for some, it should never be the first line of treatment. And secondly, yes metformin can improve insulin sensitivity which is one driving factor of PCOS, but did you know there are 3 other driving factors that contribute to PCOS?

Knowing your driver can be game changing when it comes to treating the underlying imbalances exacerbating your hormonal symptoms. 

Before we get into the nitty gritty of PCOS drivers, let’s first define what PCOS is, and more importantly, what it is not.


What is PCOS?

PCOS is a hormonal condition which must be characterized by 2 out of 3 of the following criteria to be accurately diagnosed: 

  1. Anovulatory/irregular cycles 
  2. High androgens: evident on a blood test OR clinically (jawline acne, abnormal hair growth, male pattern baldness) 
  3. Polycystic ovaries on an ultrasound.

As you can see, you don’t need to have polycystic ovaries to have PCOS. And if you ONLY have polycystic ovaries and don’t meet either of the other two criteria, you cannot be diagnosed with PCOS. You simply have polycystic ovaries which is an entirely different condition.


Uncovering your PCOS Driver

Driver 1: Insulin Resistant PCOS 

Insulin resistance is the most common cause of PCOS. This is because poor insulin sensitivity drives androgen production which results in anovulatory cycles. When we don’t ovulate we tend to have higher levels of unopposed estrogen in the system, and not enough progesterone resulting in painful, heavy, irregular bleeds.

If insulin resistance is your driver, some clues you might notice are weight gain around the abdomen (typical apple shape), blood sugar imbalances (dizziness, fatigue and brain fog in the hours following a high carbohydrate meal), skin tags and acanthosis nigricans (where the skin becomes thick and discolored commonly seen in the neck, groin, and armpits). 

Tests to consider: Fasting Insulin, Fasting Blood Glucose


Driver 2: Post Pill PCOS 

Clinically, this is the second most common driver I see with the women I work with. Picture this, you’ve decided to come off the pill, perhaps you’ve experienced some negative symptoms, or maybe you’ve decided to try for a baby. Months are going by and yet your period still hasn’t returned, your acne is worse than ever and all of a sudden you meet the criteria for PCOS (see above). 

This is one of the easiest PCOS drivers to correct. The pill depletes key nutrients needed to produce your sex hormones AND your mood balancing neurotransmitters. It also cuts off communication between the brain and reproductive organs. It's all about restoring the communication pathways + repleting your nutrients.

Tests to consider: Iron, Zinc, LH, FSH, Female hormone profile.


Driver 3: Adrenal PCOS 

Now this one’s interesting because a key marker of PCOS is high androgens, and where are our androgens produced? 

80% of DHEA, 98-99% of DHEA-S and 66% of Testosterone is produced in the adrenals. When our body is under stress (physical, mental OR emotional) we enter into our sympathetic nervous system state which fires up the adrenals to produce cortisol and adrenaline. Because androgens are also produced in the adrenals, their production is also increased leading to hormonal imbalances driving PCOS. If you’re feeling constantly fatigued, brain fog, anxiety, restlessness and insomnia, this is most likely your driver. 

Many different methods can be used to improve your adaptation to stress. I love herbal medicine for this because I can get very specific with the herbs I want to use to address how stress is impacting your hormones. 

Tests to consider: DHEA, Cortisol


Driver 4: Inflammatory PCOS

Lastly, and probably the most complex of the drivers, is Inflammatory PCOS. Usually this presents with skin conditions such as eczema, red/inflamed acne, multiple food sensitivities, rashes, and even endometriosis.

The biggest thing to consider here is that inflammation is a symptom not a cause. I want to know where this inflammation is coming from, and 9 times out of 10 it’s being driven by gut dysbiosis, intestinal permeability or poor dietary patterns. 

Tests to consider: CRP HS, ESR, FBC, Vit D.


It's important to understand and treat the root cause of your PCOS, rather than a quick fix. Nutrition, herbal medicine and lifestyle strategies are key in regulating these systems. Reach out to your health practitioner or Naturopath for a holistic, specific treatment strategy to bring you back to balance.



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Written by KRISTY KNIGHT

Kristy is a degree qualified Naturopath who believes in a holistic, evidence-based approach to health and healing. She believes in treating the cause, rather than simply masking symptoms with quick fixes.

Her practice is rooted in science, evident through her health science background, yet weaved in nature believing the body has the innate ability to heal itself (given the right environment). She utilizes herbal medicine, nutraceuticals, diet and lifestyle to achieve optimal functioning of the human body.


She’s passionate about helping people feel themselves again by working on the foundations to good health: restorative sleep, good gut health, stress management, nutrition and a balanced lifestyle. She's had extensive experience in supporting women with PCOS, PMS, painful/heavy periods, perimenopause, endometriosis, thyroid conditions, anxiety, depression and insomnia + much more!

You can find out more and follow Kristy on Instagram - here.


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