The 4 Types Of PCOS & Getting To The Root Cause

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, affecting 8-13% of women. 

It is believed that genetics, hormones and lifestyle play a significant role in the development of PCOS. In terms of genetics and family history, women with PCOS are 50% more likely to have a relative who also has PCOS such as a mother or sister.

So what are the common signs and symptoms of PCOS?

• Irregular or absent period
• Hirsutism (male pattern hair growth on face, stomach, back)
• Jawline acne
• Weight gain
• Darkened skin patches
• Thinning of hair on scalp and/or hair loss
• Increased susceptibility to mental health issues including anxiety, depression
• Fertility concerns and difficulties falling pregnant
• Insulin resistance
• ‘Cysts on the ovaries’ 

Just quickly while we are on the cysts… they are not actually cysts but rather an increased number of follicles (which creates a lot of confusion with the name). PCOS cannot, and should not be diagnosed by ultrasound alone.

To get to the bottom of your PCOS symptoms, it is important to identify the root cause or what is driving your PCOS. To determine this, it is important proper testing is completed including extensive blood work and pelvic ultrasound with consideration of symptoms. This will help identify what type of PCOS you have and therefore an appropriate management plan. Unfortunately if you are on the pill (which many women with PCOS are) this will be masking your symptoms.

So what are the 4 types of PCOS?

1. Insulin resistant PCOS
2. Inflammatory PCOS
3. Adrenal PCOS 
4. Post pill PCOS

Now, lets break things down and delve into the different types of PCOS. 

1. Insulin resistant PCOS

This is the most common type of PCOS affecting an estimated 70% of women with PCOS. 

Insulin resistance occurs when the body is unable to utilise insulin properly, resulting in elevated glucose levels. As a result, the body tries to regulate glucose levels by producing more insulin, which in turn can lead to increased production of male sex hormones e.g testosterone (hello pesky chin hair).

So how do you know if you have this type of PCOS? Bloodwork and symptoms. In particularly, HbA1c, glucose levels and fasting insulin. GTT can also be considered but is not necessary often if the other bloods listed have been complete. Lets face it, that GTT drink is horrid. I also would highly recommend doing a 2 week stint of continuous glucose monitoring. You can read my blog here to find out how this provides invaluable insight into your body's response to food as well as lifestyle choices.

2. Inflammatory PCOS

Chronic inflammation is harmful to our body and is detrimental to normal bodily functions including ovulation. Inflammation can lead to an imbalance of hormones e.g testosterone. Individuals with inflammatory PCOS will usually have elevated inflammatory markers with blood work e.g CRP, ESR, PV.

If you have symptoms of systemic inflammation e.g fatigue, skin allergies such as eczema or psoriasis, joint pain, migraines etc this could indicate that you have inflammatory PCOS.

3. Adrenal PCOS

This is one of the least common types of PCOS, accounting for only 10% of cases. Adrenal PCOS is characterised by chronic stress and/or an abnormal stress response which consequently results in elevated androgens such as DHEAS. With this type of PCOS we would normally see elevated DHEAS (but normal testosterone and androstenedione). This is why blood work is so important. Unfortunately, DHEAS is not typically tested unless you go to an integrative GP or naturopath/nutritionist.

4. Post pill PCOS

Unfortunately there are many side effects of the pill, one of which is suppressing ovulation. Once you stop taking the pill your ovaries should start communicating again without the huge influx of hormones present in your body from the pill. The problem is, once you stop the pill there will be a natural surge in the production of androgens (male sex hormones).

Some individuals may not get on top of the effects of the pill for an extended period- this can often be months to as long as a year depending on the individual.

If your periods were considered ‘regular’ before commencing the pill and are now irregular this could be a sign of post pill PCOS. Another sign is increased levels of luteinizing hormones (LH) in your blood. This is why getting comprehensively tested is so important. 

It is important to note: PCOS can sometimes be misdiagnosed for Hypothalamic Amenorrhoea (HA). In HA, your period may stop due to over exercising and/or under eating. HA can present itself similarly to PCOS however the main difference when in comes to PCOS vs hypothalamic amenorrhoea is what is known as the LH:FSH ratio. This is why we test not guess.

PCOS Management:

Supplements and lifestyle:

• Myo-Inositol: Effective for insulin resistance, normalising ovarian function,  improving egg quality + so much more. You can read more about Myo-Inositol on our blog here. 
• Other helpful supplements include: Magnesium, chromium, NAC and berberine. It is important to work with a nutritionist or naturopath to find out what supplements will work best for you as recommendations will vary for each individual.
• Green tea, spearmint tea, liquorice and peony can also be helpful - again working with a health professional is essential as liquorice and peony are strong herbs which can have side effects. Liquorice for example, is not suitable for those with hypertension (high blood pressure).
• Reducing toxins: This is extremely important and often overlooked. Toxins have been linked to inflammation, reproductive concerns, skin issues, respiratory issues, hormonal imbalances + so much more. In fact, fragrance and perfume have been banned from a number of IVF clinics as research has shown it leads to reduced pregnancy rates. If you would like to learn more, our best-selling eBook: 'Your Complete guide: Going Low Tox' is a great resource and provides over 300+ low tox recommendations. You can click here to learn more.
• Invest in a water filter: This will reduce your exposure to heavy metals, chemicals etc and will do your hormones, thyroid and skin the world of good. My first recommendation is this one here. You can use TPC5 for 10% off. Otherwise Watersco do really good filters too - you can buy a jug for $99 which is a great place to start. You can find that here.

Nutrition, exercise and blood sugar levels:

• Balance meals: What I mean by this is to ensure you have a source of high quality fats, proteins and carbohydrates with each meal. This will help stabilise blood sugar levels, prevent afternoon energy slumps and help you feel full for longer periods of time.
• Minimise refined sugar: Ingredient labels should be checked, as sugar hides in many foods under various names, including: Brown sugar, cane sugar, corn syrup, golden sugar, high-fructose corn syrup (HFCS), icing sugar, sucrose. Sugar should not be replaced with artificial sweeteners. Stevia or monk fruit are natural sweeteners that do not raise blood sugar levels. 
• The order you eat your meals matters: If possible, vegetables first, proteins and fats following and starches and sugars (carbohydrates) last. This will lead to smaller glucose peaks and you'll feel better, have more energy and fewer cravings. 
• Small frequent meals: Having small, frequent meals throughout the day are important for blood sugar control. It is important to no go too long without eating! 
• Add cinnamon: Cinnamon can assist in balancing blood sugar and has been shown to help change how the body responds to insulin- can add to pancakes, smoothies etc.
• Collagen is also a great addition for high quality protein and easy to add to meals. This will ensure your meal is well balanced, high in protein and help stabilise blood sugar levels. Click here to shop our hydrolysed collagen range.
• Pseudo-grains contain more protein than cereal grains which help to stabilise blood glucose levels. Amaranth, buckwheat, and quinoa are examples of these grains.
• Moderate exercise improves the body's ability to process glucose and keep blood sugar levels stable. Walking after meals has been shown to reduce blood sugar levels significantly. We would suggest trying to aim for 30 minutes of aerobic activity each day e.g walking, yoga, pilates, swimming (whatever you enjoy).
• Manage stress: Increased levels of serum cortisol can interrupt the insulin signalling pathway and can lead to insulin resistance during normal pregnancy. Try to tune into stress levels and put some strategies in place eg deep breathing, talking to a friend or loved one, listening to some music, meditation etc.