There is significant variability in the severity and mix of PCOS symptoms across individuals with PCOS and across their lifetime.  Environmental factors are therefore believed to have a significant effect on how the condition manifests.  This article explores PCOS and Environmental Factors.

The underlying cause of PCOS is a result of a complex interaction of genetic, epigenetic and environmental factors.[1]  Genetic factors relate to how individual or groups of genes are implicated in health and disease.[2]  Epigenetic factors relate to how genes are expressed or function, in response to the environmental factors within the womb or later in life.[3]  Environmental factors include lifestyle, diet, stress/trauma and exposure to endocrine-disrupting chemicals (EDCs),[4] natural or man-made chemicals that may mimic, block or interfere with the body’s hormones.[5]

Many clinicians recommend lifestyle modifications, including high impact exercise and a low carbohydrate diet, for individuals with PCOS to reduce BMI and manage symptoms.[6],[7]  Having a high body mass index (BMI) is believed to exacerbate the symptoms of PCOS as it contributes to increased insulin resistance. 

The evidence on the effectiveness of diet and exercise on managing symptoms is relatively week overall.[8],[9],[10]  Preliminary evidence suggests that lifestyle modifications can benefit individuals with PCOS through improved reproductive function.[11],[12]  This research indicates that the combination of a calorie-restricted/high protein diet with resistance exercise to increase muscle mass is likely to offer the greatest benefit.[13]

The relationship between PCOS and BMI is not straightforward.  For individuals with metabolic type PCOS, insulin resistance can lead to weight gain.  However, dysfunction in adipose tissue (AT), the connective tissue or fat that extends throughout your body,[14] is implicated in PCOS even in individuals who do not have an excess of body fat.[15]

The expression of PCOS symptoms is likely exacerbated by stress due to the release of cortisol, the body’s main stress hormone.[16]  Elevated cortisol levels has a number of effects on the metabolism including contributing to insulin resistance.[17]

PCOS has been linked with a variety of forms of stress/trauma beyond the scope of managing a chronic condition and its associated symptoms and health complications:

• Experience of childhood emotional abuse is >5x more common in individuals with PCOS;[18]

• Experience of childhood physical abuse is >4x more common in individuals with PCOS;[19]

• Individuals with PCOS are 3-8x more likely to experience depression,[20] with particularly high rates amongst young women;[21]

• Individuals with PCOS are almost 5x more likely to experience anxiety;[22] 

• Individuals with PCOS are 4x more likely to have an eating disorder;[23] and

• Individuals with PCOS are 2x more likely to develop post-traumatic stress disorder (PTSD).[24]

  
  

EDCs are chemicals that interfere with the endocrine system, the network of glands that produce all of our hormones, the chemical messengers that help cells talk to each other.[25],[26]  These hormones control all of our cellular processes including reproduction, metabolism and stress response.

EDCs span a huge number of different chemicals that we are exposed to through a range of sources including the foods we consume, medications, cosmetics, household chemicals, plastic packaging and air-borne industrial pollutants.[27] 

Reviewed by Dr. Elisabet Stener-Victorin, principal investigator of the Reproductive Endocrinology and Metabolism research group at the Department of Physiology and Pharmacology at Karolinska Institutet, Stockholm, Sweden and Chief Scientific Officer of the AE-PCOS Society

Sources

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883751/

[2] https://www.cdc.gov/genomics/about/basics.htm

[3] https://www.cdc.gov/genomics/disease/epigenetics.htm

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9864804/

[5] https://www.niehs.nih.gov/health/topics/agents/endocrine

[6] https://www.hopkinsmedicine.org/health/wellness-and-prevention/pcos-diet

[7] https://nyulangone.org/conditions/polycystic-ovary-syndrome/treatments/lifestyle-changes-for-polycystic-ovary-syndrome

[8] https://www.elsevier.es/es-revista-medicina-familia-semergen-40-articulo-lifestyle-interventions-in-women-with-S1138359321003488

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438659/

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876590/

[11] https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.808898/full

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876590/

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876590/

[14] https://my.clevelandclinic.org/health/body/24052-adipose-tissue-body-fat

[15] https://academic.oup.com/jcem/article-abstract/109/1/10/7199845?redirectedFrom=fulltext

[16] https://carespace.health/post/is-pcos-triggered-by-trauma/

[17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9331414/

[18] https://pubmed.ncbi.nlm.nih.gov/35985071/

[19] https://pubmed.ncbi.nlm.nih.gov/35985071/

[20] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9470949/

[21] https://pubmed.ncbi.nlm.nih.gov/29962792/

[22] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9319705/

[23] https://pubmed.ncbi.nlm.nih.gov/28104244/

[24] https://www.imrpress.com/journal/CEOG/50/9/10.31083/j.ceog5009193/htm

[25] https://www.webmd.com/children/what-are-endocrine-disruptors

[26] https://www.webmd.com/diabetes/endocrine-system-facts

[27] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9864804/