PCOS Knowledge BankWomen's Health

PCOS And Hormones – A Guide To PCOS Hormonal Imbalances

7 Mins read

PCOS is caused by an imbalance of hormones in females of reproductive age. There’s no single test that, by itself, shows whether you have polycystic ovary syndrome. Your doctor will ask you about your symptoms and give you a physical exam and blood tests to help find out if you have this condition. Most often, the levels of the following hormones are measured while considering a PCOS diagnosis:

1. Luteinising hormone (LH)

One of the hormones that is often screened when diagnosing PCOS is luteinising hormone. LH tends to be high in women with PCOS and it tends to be 3-4 times as high as Follicle Stimulating Hormone (FSH) levels. In females, this “LH surge” triggers ovulation and development of the corpus lutetium.

LH hormone is known as a gonadotropin. Normally,”LH surge” triggers ovulation, thereby not only releasing the egg from the follicle but also initiating the conversion of the residual follicle into a corpus lutetium.

But with PCOS the levels of LH are already very high. This, there is no surge and this results in irregular ovulation. Moreover, LH causes the ovaries to release androgens. These male hormones that are the cause of some of the unpleasant symptoms like hirsutism and acne.

Regulating LH levels

  1.  High insulin levels will result in high levels of LH. There are a number of ways to reduce insulin levels – exercise, eating foods with a low GI, Improving inflammation, and taking supplements like Inositol
  2. Consuming the following foods can help PCOS patients regulate LH levels – avocados, almonds, cashews, monounsaturated fats and omega 3 sources such as chia seeds, flaxseeds, and walnuts 


2. Follicle-stimulating hormone (FSH)

Follicle-stimulating hormone, or FSH, is a hormone released from the pituitary gland in the brain that stimulates the growth of ovarian follicles before the release of an egg from one follicle at ovulation. It also increases oestradiol production. Women without PCOS ovulate on a regular basis unlike women with PCOS.

Similar to high LH levels in PCOS, women with PCOS have low FSH levels that lead to irregular ovulation. Low levels of FSH contributes to poor egg development and an inability to ovulate.

The elevated LH to FSH ratio (a ratio of 3:1) is enough to disrupt ovulation. While this used to be considered an important aspect in diagnosing PCOS, it is now considered less useful in diagnosing PCOS but is still helpful when looking at the overall picture.

Regulating FSH levels

  1. Dietary changes such as cutting wheat products and cold foods out of your diet
  2. Taking certain herbal supplements
  3. Reducing stress
  4. Regular exercise
  5. Alternative medical treatments such as acupuncture
  6. Eating fats that are pressed naturally from whole-plant foods such as coconuts, nuts, seeds, avocado, and olives help in regulating FSH levels


3. Progesterone

Progesterone is a hormone that affects almost every tissue in the female body. Progesterone helps to regulate the menstrual cycle. But its main job is to get the uterus ready for pregnancy. Normally progesterone helps thicken the lining of the uterus to prepare for a fertilised egg, after ovulation each month.

In women with PCOS, irregular ovulation leads to low progesterone levels. This results in a variety of problems including highly irregular periods and difficulty in getting pregnant. Doctors often prescribe progesterone hormones to regulate irregular periods. They mimic the changes that the woman undergoes naturally to become pregnant.

Regulating progesterone levels

  1. A diet full of nutrients and omega 3 fatty acids, such as cold-water fish or flax seed, improves the ability of the body to produce progesterone
  2. Take in Vitamin B and C rich foods every day, as the body does not store them. They help reduce estrogen in order to balance progesterone


4. Dehydroepiandrosterone sulfate (DHEAS)

DHEAS is secreted by the adrenal glands and is the most abundant circulating steroid hormone in humans. It is converted into either estrogen or testosterone in the body. Your natural DHEA levels are highest when you’re a young adult. Since DHEAS levels naturally decline with age, some women take DHEA supplements as they start to grow older.

Age-wise normal DHEAS levels – 
  • 18-19 year olds – 145 to 395 mcg/dL
  • 20s – 65 and 380 mcg/dL
  • 30s – 45 to 270 mcg/dL
  • 40s – 32 to 240 mcg/dL

However, women with PCOS have elevated DHEAS levels. Throughout the course of treatment for PCOS, the doctor may order blood work to test your DHEAS and other hormones. Doctors will measure a woman’s serum (blood) levels of this steroid to rule out other medical conditions that have similar symptoms to PCOS. Having too much DHEA in your system may be associated with hyperandrogenic effects.

Regulating DHEAS levels

  1. Regular exercise
  2. Getting the right amount of sleep
  3. Zinc rich foods like meat (especially lamb and the dark meat on chicken), nuts, beans, whole grains, yeast


5. Prolactin

Prolactin is a hormone whose primary function is to initiate lactation. It’s also known as PRL or lactogenic hormone and is released by the pituitary gland. Prolactin is mainly used to help women produce milk after childbirth. When women are pregnant or have just given birth, their prolactin levels increase so they can make breast milk. But it is possible to have high prolactin levels even if you’re not pregnant.

Patients with PCOS can have mildly elevated prolactin; this condition is known as  Hyperprolactinemia. This can lead to other harmful conditions such as infertility, Amenorrhea (absence of periods) and galactorrhea (inappropriate lactation). The exact mechanism of hyperprolactinemia in PCOS is unknown.

Higher prolactin levels (50-100 ng/mL) may cause irregular periods and significantly decrease a woman’s fertility. Prolactin levels over 100 ng/mL can alter the normal function of a woman’s reproductive system, causing symptoms of menopause (absence of menstrual periods, hot flashes, vaginal dryness) and infertility.

Regulating prolactin levels

  1. Consume foods high in B6 and zinc like potatoes, bananas, wild salmon, shellfish, beef, and beans
  2. Foods rich in vitamin E may also help in lowering prolactin levels


6. Anti-Mullerian hormone (AMH)

AMH or anti-mullerian hormone is produced by cells from the small follicles in a woman’s ovaries. It is used as a marker of oocyte quantity (woman’s egg count). In a normal ovary, AMH works by preventing the premature development of a follicle and, in turn, the release of an immature egg during ovulation.

When diagnosing PCOS, AMH levels will be high. There will be a lot of follicles that do not develop into eggs. Thus, they halt the maturation of an egg. Also, the buildup of follicles in the ovaries increase AMH levels and create potential cysts. Results of metformin administration for ovarian AMH levels in patients with PCOS may vary based on ovulatory response.

Regulating AMH levels

  1. By eating a healthy diet that’s low in carbohydrates and sugars and high in fibre, fresh fruits, and vegetables, you’ll have the ability to control your AMH levels
  2. Choose foods that are full of antioxidants, healthy fats (such as omega-3s), lean protein, and vitamins

7. Estrogen

Estrogens are a group of hormones that play a key role in the development of female physical features and reproductive functions, including the growth of breasts and the uterus, and regulation of the menstrual cycle. It is secreted by the developing egg follicle and aids in thickening the endometrium for ovulation and possible pregnancy.

High levels of estrogen (estrogen dominance) can occur in women with PCOS. This causes irregular periods, unwanted hair growth, and acne. It is believed that estrogen dominance also results in irregular ovulation. Lack of ovulation results in continuous high levels of estrogen and insufficient progesterone. This constant estrogen exposure may cause the endometrium to become excessively thickened, which can lead to heavy and irregular bleeding.

Regulating estrogen levels

  1. A diet rich in antioxidants can also help to protect your estrogen receptors from environmental damage
  2. Cruciferous vegetables, such as broccoli, cabbage, cauliflower, and kale, mushrooms, red grapes, flax seeds, whole grains will help regulate estrogen levels in the body


8. Sex hormone-binding globulin (SHBG)

Sex hormone-binding globulin (SHBG) is a protein produced by the liver that transports the hormones testosterone, dihydrotestosterone, and estradiol and carries these hormones throughout the blood. SHBG is an important biomarker. It has a stronger affinity for DHT and testosterone (which are androgens), as compared to estrogens. Therefore, it plays a significant role in maintaining the delicate balance between estrogen and testosterone in a woman’s body.

Normally, small amounts of testosterone are produced by the ovaries and the adrenal glands. With PCOS, an increase in testosterone production disrupts the balance of hormones. This causes symptoms such as irregular or missed menstrual periods, infertility, acne, and excess facial and body hair (hirsutism).

Women with polycystic ovary syndrome (PCOS) may have low SHBG levels and tend to have insulin resistance, obesity, and excess androgen production. Research also suggests that low SHBG levels in adult women may be a marker for predicting the development of type 2 diabetes.

Regulating SHBG levels

  1. Lignan rich foods like wheat, pumpkin, barley, yams, eggplant, chickpeas, kidney beans, and carrots
  2. Following a low glycemic diet
  3. Increasing protein consumption
  4. Reducing simple sugars, alcohol, and caffeine intake are few dietary changes that you can make


9. Testosterone

Testosterone is a hormone produced by the human body. It’s mainly a male hormone that produced in men and plays a role in shaping a man’s appearance and sexual development. In females, the ovaries also produce testosterone in small quantities.

Women with PCOS often have an increased level of both total testosterone and free testosterone. Furthermore, even a slight increase in testosterone in a woman’s body can suppress normal menstruation and ovulation. Too much testosterone can cause symptoms that affect a woman’s physical appearance including excess body and facial hair, balding, acne, increased muscle mass, low libido and changes in mood. In more severe cases of testosterone imbalances in women, infertility and obesity are common.

Regulating testosterone levels

  1. Eating soy and soy-based products like edamame, tofu, and soy milk may cause a drop in testosterone levels.
  2. Mint, liquorice root, vegetable oil, flax seeds, nuts have also been shown to decrease testosterone levels


10. Human chorionic gonadotropin (hCG)

Human chorionic gonadotropin (hCG) is a hormone that supports the normal development of an egg in a woman’s ovary and stimulates the release of the egg during ovulation. It can be used to cause ovulation and to treat infertility in women, and to increase sperm count in men.

After conceiving (when the sperm fertilises the egg), the developing placenta begins to produce and releases hCG. It takes about 2 weeks for the hCG levels to be high enough to be detected in urine using a home pregnancy test. A positive home test result is almost certainly correct, but a negative result is less reliable.

PCOS false negative tests and hCG

A woman with PCOS who is trying to get pregnant could face the problem of not knowing if she was pregnant or not. This causes a false negative pregnancy test. Most false-negative results to occur when levels of hCG in the urine are too low for the test to detect pregnancy. This can happen if you take the pregnancy test too early, especially if you ovulated late in the month. It can also happen if your levels of hCG become diluted by high fluid intake before the test.

Regulating HcG levels

  1. It’s all about whole foods. Balance in carbohydrates and protein intake and eat soy products.
  2. Make sure you up your iron and magnesium intake.

Maintenance of pregnancy is complicated by a higher rate of premature spontaneous abortions and high risk of gestational diabetes, hypertension, and preeclampsia. However, with careful monitoring and treatment, the outcome of pregnancy in most women with PCOS is excellent.


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