Polycystic ovarian syndrome (PCOS) is a very common endocrine disorder often associated with symptoms such as irregular menstrual cycles, weight gain, hair loss, acne, hair growth in places women don't want (upper lip, belly, etc.), and infertility. It can take a long time to diagnose because some associated symptoms are usually chalked up to 'typical' of girls in their teenage years such as acne or irregular cycles.
To truly diagnose PCOS, most practitioners follow the 2003 Rotterdam Criteria in which a woman must have 2 out of 3: multiple small cysts on her ovaries (hence the name PCOS), elevated androgen hormones and associated symptoms and/or anovulatory/irregular cycles.
Androgens are hormones such as testosterone and DHEA. When elevated and/or if they go down a pathway driven by the 5a-reductase enzyme, the common symptoms include cystic acne, the unwanted hair growth (hirsutism), hair loss on the head, and mood swings such as anger or irritation.
Where are androgens made?
Interestingly enough, they are made both in the ovaries and in the adrenal gland. Testosterone can also be made in fat tissue. Typically, PCOS women have insulin problems or insulin resistance and this causes testosterone to increase out of the ovary. However, if insulin is not the problem, it's possible the elevated androgen hormones are because her ADRENAL GLANDS are over-producing it.
Keep in mind, the adrenals also produce stress hormones such as cortisol, norepinephrine (noradrenaline) and epinephrine (adrenaline). How many women have gotten into high stress situations and found they have irregular cycles as a result or trouble with fertility?
Understanding and testing the hormones produced by the ovaries and adrenal glands coupled with insulin testing can actually reveal a lot more about the cause of someone's PCOS and provide more direction with treatment.