The Underlying Causes of PCOS and How to Treat It


If you struggle with chronic acne, an underlying syndrome you may have is something called PCOS, or Polycystic Ovarian Syndrome.

PCOS is a very common hormonal syndrome, allegedly affecting 5 to 10% of women. One of the common symptoms is acne.

So what the heck is PCOS and why does it seem to cause acne? And more importantly what DO YOU DO ABOUT IT so that you can stop struggling with your skin?

Is PCOS What’s Causing Your Acne Breakouts?

So despite the fact that it’s right there in the name — ie ‘poly cystic ovaries’, having cystic ovaries is not actually a defining feature of the syndrome, nor do you have to have cysts on your ovaries to have PCOS.

Yes, this is really dumb. There is currently a push to change the name so it can stop confusing the heck out of everyone as to what this actually is.

So there are only two things that are required for you to have PCOS. Those two things are:

  • High androgen levels (aka male hormones). Eg. testosterone, DHEA-S, or adrostenedione. Diagnosed through a blood or saliva test.
  • You don’t ovulate because of the high androgens. So you have irregular periods.

The possible side effects of having high androgen levels include oily skin and acne, hirsutism (excess hair on places like the beard area or chest), hair loss, mood swings, and weight gain.

Possible side effects of not ovulating are, well, infertility, low progesterone (causing its own host of symptoms including bad PMS), and cysts on the ovaries.

Types of PCOS Acne & Underlying CausesSo, yes… — the cysts on the ovaries thing… Sometimes when you don’t ovulate, the eggs that were going to leave the ovaries start swelling and become cysts. Despite popular belief, the cysts don’t CAUSE the high androgens or lack of ovulation. It’s just another symptom.

Not everyone with PCOS has all of the classic symptoms. Remember, the only defining features are high androgens and lack of ovulation. How that actually translates into symptoms will be different for everyone.

The good news is that despite popular belief, you can definitely reverse your PCOS and the accompanying acne. All it is is a set of symptoms. It’s not a permanent condition.

So What DOES cause the high androgens in PCOS?

What is Causing Your PCOS and Acne?

Well this is very important to understand. Just knowing you have PCOS doesn’t tell you all that much in terms of how to actually treat it because there are many possible causes for it.

If you want to successfully put your PCOS into remission (and your acne), you will want to be barking up the right tree with your unique cause.

The Five Different PCOS Acne Profiles

Thanks to my gal Lara Briden, she has defined five different PCOS profiles.

Note that if you have acne and have shown high androgens on a blood or saliva test, but you do have regular periods and ovulation, read on. The following guide is still super helpful in sleuthing why your body may be over-producing those androgens.

Insulin Resistant PCOS Acne Profile

Types of PCOS Acne & Underlying Causes

PCOS primarily caused by insulin resistance is by far the most common type of PCOS, and the only one doctors tend to know about. It accounts for about 80% of those with PCOS.

Insulin resistance is when your body just doesn’t respond to insulin very well anymore. This results in your body pumping out a ton of insulin when you eat, which prompts the ovaries to over-produce androgens, particularly testosterone and androstenedione. This leads to the shutting down of ovulation.

This person will typically have trouble with their weight, and break out easily from simple carbs and sugar (which spike insulin more than other foods). Note that you can also be normal weight and have insulin resistance, especially if you have a history of dieting or disordered eating.

A doctor can confirm you are insulin resistant with a glucose tolerance test. Although his probable solution if you are is to put you on birth control, the drug Metformin, and tell you to lose weight.

The treatment for this type of PCOS is generally a healthy low carb diet (in particular quitting sugar), strength training, supplements like Inositol to support your blood sugar, and yes, losing some excess weight. Sleep, stress reduction, and all the basics will help.

There is also some evidence that chronic inflammation is a major cause of insulin resistance, so inflammation will also need to be addressed if you have this type of acne. See inflammatory PCOS below.

Adrenal PCOS Acne Profile

Types of PCOS Acne & Underlying Causes

Androgens aren’t all produced in the ovaries. A significant portion of androgens are made in the adrenal glands (aka the stress glands!)

Stressed out? Stress stimulates the adrenal glands to produce the androgen DHEA-S, so high levels of this hormone is something to look for on a saliva or blood test.

This stress is most often mental/emotional stress (like from a demanding job or a constant barrage of self criticism), but could also be excessive physical stress like over-exercising, under-eating, or lack of sleep.

Signs your adrenals are getting burnt out and may be the cause of your PCOS are feeling tired all the time (except maybe at night), not dealing with stress well, disturbed sleep patterns, and feeling worse after exercising. Not to mention chronic anxiety or feelings of mental burnout.

Treatment? Work on that stress. Learn to be kinder to yourself, reassess your life’s stressors, get some sleep, knock down the training if you are a chronic over-exerciser, and make sure you are eating enough calories.

Supplements to support your adrenals and HPA axis include adaptogens like rhodiola and nutrients like magnesium.

Inflammatory PCOS Acne Profile

Types of PCOS Acne & Underlying Causes

A chronically activated immune system creates inflammation in the body. If you have PCOS but without the insulin resistance, then you may be an inflammatory type.

Mental and physical stress can increase inflammation, as can poor gut health. You may also be affected by environmental toxins or food intolerances.

Clues you have chronic inflammation include getting sick all the time or experiencing chronic infections. Also look for things like chronic digestive problems like bloat, diarrhea or constipation, autoimmune disorders, eczema, sore joints, or asthma.

You may also show inflammatory markers on a blood test such as Vitamin D deficiency, abnormal blood count, elevated C-RP, thyroid or autoimmune or gluten antibodies. High DHEA and/or androstenedione may have showed up on your tests.

Treatment — work on fixing your gut. Use probiotics and treat any possible infections like parasites, bacteria, or fungus. Reduce exposure to chemicals and plastics. Avoid inflammatory foods like A1 dairy, gluten, and sugar. Work on reducing mental stress as well.

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