Only by accurate diagnosis and addressing underlying hormone imbalances, will the condition be corrected.

The cosmetic effects on the skin are some of the more noticeable and distressing features, however, PCOS is a serious health condition that should not be ignored! The pattern of symptoms, which may also include infertility and weight gain, also carries an increased risk of heart disease, diabetes, and stroke.

The key to overcoming various health conditions is recognizing a pattern of symptoms and addressing their root cause. Unfortunately many are often too busy taking care of others that they don’t pause to consider that some of their frustrating issues, i.e. acne, dark skin patches, and infertility, can be related and ultimately treated; such is the case with PCOS.

Glancing at the list of symptoms, it is easy to see why depression, anxiety, and a poor outlook on life are frequent complaints. Note, the pattern of predominant features varies with race and age, and are also changeable within an individual.

Signs of PCOS

  • Infertility
  • Acne
  • Skin tags
  • Hair loss (alopecia)
  • Excess hair growth on face and body (hirsutism)
  • Dark skin patches (on nape of neck, underarm, thigh and under breasts)
  • Thick rough texture on elbows and knees
  • Weight gain and obesity
  • Mood changes
  • Glucose intolerance
  • Irregular or absence of menstrual periods
  • Ovarian cysts
  • Hypertension

What is PCOS?

PCOS, also called Stein-Leventhal Syndrome, affects approximately 7 million women and adolescent girls. Central to the condition is an imbalance in reproductive hormone levels. As a consequence of the imbalance, clusters of small, fluid-filled cysts develop in the ovaries, containing immature eggs. Twice the numbers of women with PCOS have cysts without the accompanying biochemical features of the condition, such as those affecting the skin.

The relevant hormone dysfunctions have been studied extensively and insulin resistance has been found to be a universal factor. Once considered as an infertility condition, PCOS is now regarded as a metabolic disorder, as are Type 2 diabetes, cardiovascular disease, and stroke.

The relationship between PCOS and these other conditions punctuates the importance of treating PCOS to avoid more serious complications. Looking more closely at insulin resistance puts it all into focus.

Insulin Resistance

Insulin is produced in the pancreas and is released when blood sugar (glucose) levels increase from eating. Its function is to reduce the concentration of glucose in the bloodstream by triggering its uptake into the cell where it can be converted to energy.

Factors such as stress and poor diet can upset the balance resulting in “insulin resistance.” In this case, the cell doesn’t respond to the insulin, causing more to be released, and ultimately creating a surplus in the bloodstream. One study estimates that 65-70% of women with PCOS are obese and have insulin resistance.

Genetics are a contributing factor as well, however, diet and lifestyle generally have greater influence. The key point moving forward is that insulin also impacts reproductive hormones, i.e. estrogens and male androgens.

PCOS: Insulin, Hormones, and Skin Conditions

  • Excess insulin in the bloodstream stimulates the ovaries to produce testosterone, leading to traits such as acne, balding, and hair growth on the face.
  • Excess male androgens set the stage for acne, while insulin and insulin growth factor (IGF) accelerate the damage. Insulin induces male androgen production, while at the same time suppressing the hormone (SHBG) that normally binds with it. This ultimately translates to an increased concentration of circulating male hormones.
  • High insulin is associated with dark skin patches, known as “acanthosis nigricans”. Excess insulin causes normal skin cells to reproduce at a rapid rate producing discoloration and is also an indicator of potential diabetes.
  • Excess insulin disrupts the hormones that mediate the menstrual cycle. The imbalance of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) leads to eggs developing into cysts rather than mature eggs. Cysts cause ovaries to produce more testosterone.

Predictive Factors

The following have also been shown to be predictive of PCOS:

  • Adolescent girls experiencing menstrual irregularities for more than 2 to 3 years after initial onset.
  • Adolescent girls with severe acne that doesn’t respond to normal treatments are found to be 40% more likely to develop PCOS.
  • Increased levels of BPA exposure, such as from plastics, trick the body into thinking there is too much estrogen which prompts the production of other hormones to balance it out.
  • Having metabolic syndrome, which is a combination of at least three risk factors for cardiovascular disease, diabetes, and stroke. Some of the factors are elevated blood sugar, high triglycerides, and obesity.

Diagnosing PCOS

Dark skin patches (acanthosis nigricans) and hair growth (hirsutism) are considered the most reliable signs of PCOS on the skin, which can be assessed via comprehensive examination. The following are also useful:

  • To measure androgen levels in order to identify excess, the free testosterone (T) test is the most sensitive (ideally via equilibrium dialysis technique).
  • An ultrasound of the uterus and ovaries can identify abnormalities including the thickness of the uterine lining and cysts.
  • Blood work can readily identify signs of insulin resistance and other metabolic syndrome markers.


Standard treatments for PCOS manifested skin conditions may offer some improvements in the short-term, but they haven’t demonstrated long-term success and maybe masking the seriousness of the condition. When a normally effective treatment isn’t working, it can also be a clue that PCOS is the real issue.

Broadening the therapeutic scope towards a comprehensive program balances the insulin and hormone levels through long-term lifestyle changes offering a better chance of resolution. A qualified medical practitioner can assist with finding the best approach for an individual’s case, including a select combination of the following:

  • The drug Metformin, commonly prescribed for diabetes, is a common “go-to” for PCOS. However, evidence as to its effectiveness is conflicting.
  • Avoid sugars, processed carbohydrates, trans fats, dairy, hormone disruptors (BPAs), and growth hormones (found in non-organic meat and dairy products).
  • Green Tea, plus other herbs that are clinically showing promise include: Paeonia lactiflora (White peony), Vitex agnus-castus (Chaste berry) Cimicifuga racemosa (black cohosh), and Glycyrrhiza spp. (licorice).
  • Diet, exercise and stress management must be implemented as a lifestyle change, not as a temporary corrective measure.
  • Losing 5-10% of total body weight can offer significant improvements in restoring insulin sensitivity and reducing male androgens.
  • Anti-androgen drug therapy ie. Spironolactone (Aldactone), Cyproterone acetate, Flutamide (Eulexin), and Finasteride (Propecia, Proscar) act to improve hirsutism, each drug having pros and cons.
  • Bioidentical hormone replacement therapy is a means of naturally and effectively complementing diet and lifestyle modifications towards reversing PCOS, as well as minimizing metabolic disease potential.

Doctors here at Holtorf Medical Group are specially trained to diagnose and treat PCOS. If you believe you are suffering from PCOS, contact us to speak with a patient representative and see how we can help you.

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