The 4 Types of PCOS

PCOS also known Polycystic ovarian syndrome is an increasingly common hormone condition that causes ovarian cysts to form on a woman’s ovaries. It affects from 12-20% of women in Australia and worldwide that are in the reproductive age group. PCOS is caused by an imbalance of female hormones and can cause a range of symptoms including irregular periods, excess hair growth, hair loss, mental health issues, obesity and acne.  It is associated with insulin resistance and androgen dominance.

If you’ve recently been diagnosed with or think you may have PCOS please know that you’re not alone, and you’ve come to the right place to find the information you need to help reverse your symptoms naturally. We can help assist you with uncovering the root cause of your PCOS and help tailor a plan to reverse and manage your symptoms.

Firstly, what is PCOS

Polycystic ovary syndrome (PCOS) is not one disease. Instead, it’s “a heterogeneous disorder with different underlying biological mechanisms.” [1] In other words, it’s a set of symptoms (androgen excess and anovulatory cycles{egg not being released in the female cycle}) caused and/or driven by several underlying factors. To successfully treat PCOS, you need to identify which factor or factors are driving your symptoms. Simply, you need to know what type of PCOS you have. [2] The four types of PCOS include insulin-resistant PCOS, post-pill PCOS (which is temporary), inflammatory PCOS, and the least common adrenal PCOS.

Signs & symptoms

• Functional cysts: usually asymptomatic but may cause late or painful periods. If very large, may also cause abdominal bloating and discomfort, and painful defecation or intercourse.
• Irregular menstrual cycle, especially irregular menstruation, amenorrhoea, breakthrough bleeding
• Infertility – due to lack of ovulation
• Hair loss
• Acne
• Obesity: occurs in 50% of PCOS patients
• Prolonged periods of PMS-like symptoms
• Chronic pelvic pain
• Hypoglycemic episodes / diabetes
• Hypothyroidism

PCOS symptoms are caused by an imbalance in hormones, particularly high levels of androgens such as testosterone and DHT (The “male” hormones in the body). 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.

The 4 types of PCOS include:

Insulin resistant PCOS

This is the most common type of PCOS, affecting around 70% of PCOS sufferers [3]. 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 somewhat “numb” to the effects of insulin, which causes the pancreas to pump out more and more insulin until the cells get the message and uptake the blood glucose. [4]

Signs & Symptoms

• you may be struggling with your weight
• holding weight around the stomach/abdomen
• have sugar cravings
• fatigue
• brain fog
• excess hair growth
• male pattern hair loss
• 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).

Treatment

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.
Supplements: These key nutrients can be extremely helpful

• magnesium
• chromium
• NAC
• inositol
• berberine

We advise working with a functional medicine practitioner to find out what is the best dosage for you as dosages will vary from person to person and this is key to getting the best results.

Post-pill PCOS

Post-pill PCOS occurs in some people after they stop taking the oral contraceptive pill. Oral contraceptives such as Ginet, Yasmin and Yaz are often involved in this type of PCOS due to the type of synthetic progestins used. [5]

Signs & Symptoms that were not present prior to starting the pill

• Acne,
• Irregular periods
• Excess hair growth

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. It’s typically seen in individuals 3-6 months after stopping the pill. This type can take time to heal on its own, but can be addressed more quickly with the right nutrition, healthy lifestyle changes and supplements.

Treatment

Be patient: This type can take some time to reverse, but remember it is a temporary situation.

Supplements:

• Magnesium
• Vitamin E
• Vitamin B6
• Zinc

Herbs: 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.

As always, other factors such as your gut health, methylation and biochemistry balance all play a major role in how your body functions and recovers from disease.

Adrenal PCOS

This type of PCOS is due to an abnormal stress response and affects around 10% of those diagnosed. This usually occurs during a massive stressful period. Marked indicators are high levels of cortisol and DHEA. [6]  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 a functional medicine specialist. [7]

Treatment

Stress Management: Reducing stress levels through activities like yoga, meditation, mindfulness exercises and journaling will help to support your nervous system and settle your hormones.

Get enough sleep each night. Try to get 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 put further stress on your adrenals.

Avoid caffeine from coffee, tea and fizzy drinks.

Herbs: Herbs such as withania, rhodiola and licorice can help the body adapt and recover from stress. You’ll need to speak to a practitioner about correct dosages and which supplements to take, especially when it comes to herbs as they may not be right for you.

Supplements. Supplements such as magnesium, vitamin B5 and vitamin C are also important to support the adrenal glands and nervous system.

Inflammatory PCOS

In inflammatory PCOS, chronic inflammation causes the ovaries to make excess testosterone, resulting in physical symptoms and issues with ovulation.

Signs & Symptoms

• Headaches
• Joint pain
• Unexplained fatigue
• Skin issues like eczema
• Bowel issues such as IBS

Blood tests will typically see raised inflammatory markers, 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. [8]

Treatment

Address gut health. Repairing leaky gut tissue, balancing gut bacteria, improving digestive function and eliminating pathogenic bacteria are all important steps to reduce overall inflammation.

Address & 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 or functional medicine specialist to help assist you.

Natural anti-inflammatories such as

• Turmeric
• Omega 3 fatty acids
• NAC

Natural Treatment of PCOS in Perth & Australia wide

At Advanced Functional Medicine we investigate the underlying causes of PCOS at our Perth clinic of Advanced Functional Medicine: Insulin resistance, gut dysbiosis, SIBO, methylation imbalances, poor clearance of oestrogen and poor diet and lifestyle are key areas that we regularly support with our PCOS patients.

Supporting the body to process hormones efficiently and through the correct pathways is required to balance the body and regulate hormones.

If you or a family member are suffering from Polycystic ovarian syndrome or another hormonal related condition we would love to hear from you.