4 Types of PCOS - and How to Know Which One You Have
PCOS (Polycystic Ovarian Syndrome) is a complex hormonal disorder affecting around 10% of women. If you’ve recently been diagnosed, please know that 1) you’re not alone, and 2) you’ve come to the right place for all the info you need to help reverse your symptoms naturally.
Firstly, what is PCOS?
Put simply, PCOS is a hormonal disorder which can cause irregular periods as well as unwanted physical symptoms. Common signs and symptoms of PCOS include:
Acne
Oily skin and hair
Excess hair growth on the face and body
Hair thinning or loss on the head
Weight gain or trouble losing weight
Darkened skin patches
Irregular periods or no periods
Difficulty falling pregnant
PCOS symptoms are caused by an imbalance in hormones, particularly high levels of androgens (‘male’ hormones in the body) such as testosterone and DHT. When these hormones are higher than they should be, this can lead to common signs like acne and excess hair growth as well as issues with ovulation, irregular periods and infertility.
What about the cysts on my ovaries?!
Great question! Regardless of the name, it’s important to know that these ‘cysts’ seen in PCOS are really not cysts at all. They are actually just an increased number of follicles which in some cases can be quite normal and can be seen in women even without PCOS. The term ‘polycystic’ is therefore pretty misleading, and one of the main reasons why there is so much debate about changing the name ‘PCOS’ to something more accurate. Repeat after me: PCOS cannot be diagnosed by ultrasound alone. If it has, it’s time to get a second opinion.
How to treat PCOS
When it comes to PCOS, medical treatment is often a one sized fits all approach. The amount of times my clients have been told to just “lose weight” or “go on the pill” to “regulate” their cycle, really bothers me. Why?
Weight loss in PCOS can be extremely hard (without the right tools), because one of the symptoms alone is weight gain!
The pill doesn’t treat the underlying cause of PCOS. It just provides the body with synthetic hormones which masks symptoms temporarily. This in particular can be really problematic when women come off the pill later on - especially if they are trying to conceive - only for their symptoms to return. And, importantly:
There are 4 different types of PCOS. PCOS can affect everyone differently, and knowing what type of PCOS you have is an important step to treat your symptoms and heal PCOS successfully.
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So, what type of PCOS do I have?
In order to effectively treat PCOS and reverse symptoms naturally, you need to know the type of PCOS you’re dealing with. The 4 types of PCOS include:
1. Insulin resistant PCOS
This is the most common type of PCOS, affecting around 70% of people. Insulin resistance is basically where there are higher levels of insulin than normal in the body - also known as hyperinsulinemia. This happens when our cells become a bit “numb” to the effects of insulin, which causes the pancreas to pump out more and more insulin until the cells get the message. In this type of PCOS, you may be struggling with your weight, holding weight around the stomach/abdomen, have sugar cravings as well as symptoms like fatigue or brain fog. It’s high levels of insulin that drives up androgen levels which cause issues like excess hair, male pattern hair loss and acne.
Often doctors will just test HbA1c or glucose levels, which while gives us some information about your blood sugar levels, doesn’t give us the full picture. To rule out insulin resistance, you NEED to have your fasting insulin tested. Normal fasting insulin levels are less than 10 mIU/L (60 pmol/L).
To help treat insulin resistant PCOS, the key is down to improving your insulin sensitivity. You can work on this through:
Regular exercise and movement throughout the day helps your body to burn sugar, build muscle and improve your sensitivity to insulin.
Avoiding high sugar foods and having a lower carbohydrate diet that is also rich in protein and fat to balance blood sugar levels.
Prioritising sleep and reducing stress can also help to manage blood sugar and insulin levels.
Supplementation of key nutrients such as magnesium, chromium, NAC, inositol and berberine can also be extremely helpful. I strongly advise working with a nutritionist or naturopath to find out what is best for you at what dosage, as this will vary from person to person and is key to getting results.
2. Post-pill PCOS
Post-pill PCOS occurs in some people after they stop taking the oral contraceptive pill. In this type, symptoms like acne, irregular periods and excess hair growth were not present prior to starting the pill at all. Oral contraceptives such as Ginet, Yasmin and Yaz are often involved in this type of PCOS due to the type of synthetic progestins used. After coming off the pill, your ovaries basically throw a party and there is a natural surge in androgens which can cause typical PCOS symptoms, however in this type there is no insulin resistance. I typically see this in clients in 3-6 months after stopping the pill. Keep in mind that this type can take time to heal on its own, but can be addressed more quickly with the right nutrition, lifestyle changes and supplementation or herbal medicine support.
To help treat post-pill PCOS:
Be patient. This type can take some time to reverse, but remember it is a temporary situation.
Speak to a practitioner about supplementation. Nutrients such as magnesium, vitamin E, vitamin B6, zinc as well as specific herbs like chaste tree and peony can be helpful to support ovulation and lower excess androgens.
Prioritise sleep and stress management. Like insulin resistance PCOS, it is important to get a good quality sleep and reduce stress levels to support overall hormonal balance.
3. Adrenal PCOS
This type of PCOS is due to an abnormal stress response and affects around 10% of those diagnosed. Typically DHEA-S (another type of androgen from the adrenal glands) will be elevated alone, and high levels of testosterone and androstenedione are not seen. This type of androgen unfortunately isn’t often tested, unless you go through an endocrinologist or other specialist.
To help treat adrenal PCOS:
Manage stress. Reducing stress levels through activities like yoga, meditation, mindfulness and journalling will help to support your nervous system and your hormones.
Get enough sleep each night. Make sure you’re getting at least 8 hours of sleep each night to support your stress levels and recovery.
Avoid high intensity exercise. Limit excessive and high intensity training as this can further put a stress on your adrenals.
Avoid caffeine from coffee, tea and fizzy drinks.
Speak to a practitioner about herbs and supplements. Specific herbs like withania, rhodiola and liquorice can help the body adapt and recover from stress. Nutrients like magnesium, vitamin B5 and vitamin C are also important to support the adrenal glands and nervous system. You’ll need to speak to a professional about correct dosages and which supplements to take, especially when it comes to herbs as they may not be right for you.
4. Inflammatory PCOS
In inflammatory PCOS, chronic inflammation causes the ovaries to make excess testosterone, resulting in physical symptoms and issues with ovulation. Signs of inflammation in this type of PCOS include headaches, joint pain, unexplained fatigue, skin issues like eczema and bowel issues like IBS. Typically, you will see raised inflammatory markers on a blood test, such as a high CRP (C reactive protein) above 5. Other tests such as fasting glucose and insulin are in the normal range, but can sometimes be affected as inflammation can affect these numbers.
To help treat inflammatory PCOS:
Address gut health. Repairing leaky gut tissue, balancing gut bacteria, improving digestive enzymes and eliminating pathogenic bacteria are all important steps to reduce overall inflammation.
Remove food triggers. Addressing potential food sensitivities and removal of inflammatory foods is a vital step to help address inflammation. It can sometimes be quite difficult to figure out what foods might be driving your inflammation, so it’s best to work with a nutritionist on this who can help you.
Natural anti-inflammatories such as turmeric , omega 3 fatty acids as well as antioxidants like NAC can help to support this type of PCOS. Always speak to a practitioner first to see if these are right for you, and in what dosages to take them for them to be effective.
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Could it be something else?
PCOS can often be misdiagnosed for something else called Hypothalamic Amenorrhoea. In hypothalamic amenorrhoea (HA), your period can stop due to under-eating and/or overexercising, and similarly to PCOS can present itself with mild acne, excess hair growth and a polycystic ovary appearance on an ultrasound. This misdiagnoses is problematic as treatment of the two conditions are very different.
The main difference when in comes to PCOS vs hypothalamic amenorrhoea is what is known as the LH:FSH ratio. In PCOS, luteinising hormone (LH) can be 2-3 times higher than follicle stimulating hormone (FSH) when they should be at about a 1:1 ratio. In hypothalamic amenorrhoea however, the opposite is true, and LH can be much lower than FSH.
Still unsure?
PCOS can be difficult to navigate alone. Remember that it is a complex hormonal disorder that can take time to resolve. If you’re tired of being on hormonal contraception, are looking to start a family, or would just like to manage your PCOS symptoms naturally, find out more how I can help you with our Exclusive PCOS Repair Program.
