PCOS and the Menstrual Cycle

If you have read my earlier posts, particularly the one where I explain how I got diagnosed with PCOS you will recall that I mentioned a doctor who didn't believe I could possibly have PCOS until she reluctantly did a scan. What I failed to also mention is that she did ask me to get a blood test done to see what my hormone levels were, (after the scan was done), in particular Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Estrogen, Progesterone and Testosterone.

You see, Insulin Resistance is not a sole factor that causes PCOS. There is a relationship of hormones, particularly the LH and FSH, that we need to understand. Women's bodies are complex and the way our hormones work to manage the menstrual cycle is a beautiful balance and yet it is so complicated to understand. I will try my best to explain this intricate process so that we can further understand what is NOT happening during the Menstrual cycle in women with PCOS.

The Menstrual Cycle

(In women who do not have PCOS)

As Women, it is extremely important to know how our menstrual cycle works in order to know why are hormones behave the way they do, or simply how we get a period every month. Below is an image of the menstrual cycle in women who do not have PCOS.

Menstrual Cycle in Women Without PCOS

• All the hormones at the beginning of the cycle are at low levels.

• As you can see at around "Day 5" there is a slight surge in the purple line, this means that a signal has been sent by the hormone FSH.

• The rise in FSH stimulates the follicles in your ovaries (fluid filled cavities that each contain one undeveloped egg) to develop and to start to produce another hormone called estrogen.

• However, only one follicle will begin to mature, this is the Dominant follicle so that only one egg will be produced so to speak.

• At the same time we see a rise in Estrogen, which starts to prepare the womb by thickening the lining and preparing nutrients.

• The level of estrogen in your body will continue to increase and at a certain level it causes a rapid rise in LH (LH 'surge'). This LH surge triggers ovulation, where an egg is released from the ovary. Although many women think they ovulate on day 14, every woman is different and this day can vary. Remember this, every woman's cycle is different. We can't all have a 28 day cycle. That is just absurd.

• The rise in estrogen will also cause FSH to drop so that no more eggs are stimulated.

• Once the egg has been released it moves along the Fallopian tube towards your womb.

• At the same time we see a surge in Progesterone which helps prepare the womb for egg implantation, if implantation does not happen then the hormones begin to drop, which stimulates a period.

• Everything resets, and the cycle starts again.

The Menstrual Cycle with PCOS

So as we have seen above in the Normal Menstrual cycle we have the brain send out LH and FSH to stimulate egg production and to start ovulation. However, in PCOS this is a different story.

• With PCOS, LH levels are often high when the menstrual cycle starts.

• The levels of LH are also higher than FSH levels. (Normally 2 to 3 times higher).

• Because the LH levels are already quite high, there is no LH surge. Without this LH surge, ovulation does not occur, and periods are irregular.

This pathway is A LOT more complicated but all we need to understand is that LH is normally higher in women with PCOS than in women without PCOS. Generally 2 to 3 times higher, which causes havoc in the system and prevents 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.

So back when I first got diagnosed with PCOS, my LH levels were three times that of FSH levels. My testosterone was slightly elevated and my progesterone was low. So of course the Doctor relied ONLY on the hormone levels and did not see a need to check for INSULIN RESISTANCE.

That was SUCH an easy diagnosis for this doctor right? Think about it. She had a patient who already knew what to look for, she had already run the hormone tests and prescribed the pill. So who cares about the exact cause at this point right? The pill will sort out the period and this overly clever patient will be happy..... (This makes me so angry). Yes the pill helped with my period, and because I was young and never had babies on my mind, I never once thought that there could be an underlying issue. I had trusted a professional who I thought knew what they were doing. I wish I had known then what I know now, but hindsight is always 20/20 I guess..... C'est la Vie!

Anyways, so while researching for this post, I stumbled upon the image below and found it funny so I thought I would share it as I feel like it is easier to see what is going on, right?

Reference:https://medcomic.com/medcomic/the-menstrual-cycle/

The image might look a little violent (I think it is hilarious), but you can clearly see that once FSH is released, it causes a follicle to mature which contains one egg. Estrogen makes sure that this maturation happens after which LH comes along and tells the Follicle to let go of the mature egg inside. This is Ovulation!

At this point, progesterone is released to prepare the womb for implantation. If this does not happen the egg breaks down and a period starts! After which all the hormones then lower down in readiness for the next cycle. Yay for women who are NORMAL!

With PCOS, the LH surge does not occur, so the egg does not get released, then progesterone does not surge either so it remains low. Without a surge in Progesterone, there will be no drop in Progesterone either, which means no period.

In PCOS, Progesterone levels will remain low, because if you notice in the first image, when LH is high, Progesterone is low. So as long as you have high levels of LH floating around, Progesterone feels like it needs to lay low.

The reason for the LH levels remaining high in women with PCOS is a complicated mechanism, but I do know that it is also related to high levels of Testosterone. With high levels of Testosterone, the LH will remain high. We now know that Insulin resistance causes androgens like Testosterone to rise, so it makes sense then that the LH levels will also be higher than normal. The other factor here also remains that if you have High Testosterone, then it is also likely that you will have High Estrogen. This is because the two hormones are closely related in structure, so the body tends to convert some of that testosterone into estrogen when it thinks it is running low. Amazing things, our bodies. So amazing, it keeps compensating when things are not in balance.

So what do we get from all this?

All I know is that if I do not make sure that my Insulin levels stay down, then the LH will not balance out with FSH, I will not Ovulate and will not get a period.

Now this is important: The only way to keep Insulin down is through Diet and Exercise. Always remember that 80% of your weight loss plan comes down to how and what you eat. The other 20% is exercise. Once I figured out the perfect balance for me, my period came back within a month and after that, without me even knowing, I conceived! It was amazing how fast it happened and I am sure it can happen for you too. Be Positive. Be informed and research as much as you can so you know where you are going wrong and how you can improve. You are the only one who knows your body.

I hope that this has been an easier way to understand hormones and how they are related to the Menstrual Cycle because the next posts will be about Diet, Medicines and Lifestyle changes that worked for me and having this background information will make it easier to explain certain concepts.

So happy to hear that people are reading and are interested in receiving more information! I will try to post as often as I can but until next time my PCOS Warriors, Be strong and Keep on fighting!

Medical Disclaimer: I have oversimplified the hormone mechanisms to make it easier to understand what happens with the hormones when we have PCOS. It is A LOT more complicated than this and because I have oversimplified, I may have not explained other complicated pathways that are involved. Furthermore, the information provided in this blog is formed from personal experiences and are general in nature. If further medical advice is needed, kindly consult your doctor for advice and tests.