PCOS - The 4 TYPES
Polycystic Ovarian Syndrome (PCOS) is one of the most common hormonal disorders in women of child bearing age. Approximately 12-21% of women are affected with up to 70% of women undiagnosed (1). PCOS is defined by a group of symptoms that are driven by different underlying factors, rather than one specific disease. The symptoms are related to anovulatory cycles (no ovulation) and androgen excess (high levels of male hormones, such as testosterone). The main symptom of PCOS is irregular periods, due to the lack of ovulation. No ovulation can result in an overproduction of androgens which is what can drive other common symptoms, such as; excessive body hair, acne, weight gain (especially around the belly), and hair loss on the scalp. Infertility is another common symptom.
Did you know there are four types of PCOS, or four different factors that can drive PCOS symptoms
These 4 types of PCOS include:
Insulin- resistant PCOS (most common)
Post-pill PCOS (temporary PCOS)
Inflammatory PCOS
Adrenal PCOS (least common)
Diagnosis:
If you have been diagnosed with PCOS, firstly, how was it diagnosed?
Because of the lack of understanding of PCOS by clinicians, it can commonly be misdiagnosed and also completley missed altogether.
There is a certain criteria that must be met for a diagnosis. Read more about diagnosis here.
PCOS can not be diagnosed or ruled out by ultrasound alone.
In fact, polycystic ovary syndrome does not mean you actually have cysts on your ovaries.
The ‘cysts’ seen on ultrasound are actually follicles or eggs which are very much normal for your ovaries. Having polycystic ovaries does not always mean you have the syndrome PCOS. If you have polycystic ovaries you can still have regular and ‘normal’ periods with no hormonal symptoms of PCOS. And… It is actually possible to have normal-looking ovaries on the ultrasound but still have the hormonal condition PCOS. For follicles to be categorised as PCOS it requires more than 20 follicles (partly developed eggs) are visible on one or both ovaries or the size of one or both ovaries is increased (more than 10ml)
Confusing right? My opinion is that the name of PCOS is very deceiving and should be renamed (haha).
So you have irregular periods… let's determine if you actually have the syndrome PCOS??
Have you had a blood test result of hyperandrogenism (high levels of male hormones) and all other reasons for high androgens have been ruled out?
Do you have ‘abnormal’ facial/body hair or acne along the jawline?
If you said yes to either of these it is likely you may have PCOS. Now let’s identify what type of PCOS you have to direct the treatment. Something to keep in mind is that it is possible to have more than 1 type of PCOS… You can have Insulin resistance and inflammation at the same time, plus you may have just come off the pill which has worsened your symptoms.
The 4 Types of PCOS:
INSULIN- RESISTANT PCOS:
Insulin resistance is the most common driver of PCOS. If you have PCOS it is likely that you are insulin resistant- 80% of women with PCOS are (2). Insulin is a hormone that regulates blood sugars- basically, helps your body utilise sugar for energy. Insulin resistance is a hormonal condition where you have too much insulin. You can have normal blood sugars, and still have too much insulin. The best way to determine if you are insulin resistant is to do a blood test measuring insulin not glucose. High insulin is what can cause high androgens and high androgens is what drives PCOS symptoms. The good news is, insulin resistance can be reversed through lifestyle changes, particularly diet.
Can food be medicine for PCOS??
As I have mentioned, insulin resistance can be reversed and can be done through diet and lifestyle changes! I predominantly treat my PCOS patients through food and dietary changes to manage blood sugar levels. So how do we do this?
Stop eating (and drinking) processed sugar! This especially includes sugary drinks, deserts, cakes and biscuits. If you have insulin resistance, unfortunately your hormones will struggle to handle any high sugar foods.
Reduce carbohydrates and especially avoid refined carbohydrates; breads, pasta, pastry, cereals and any processed foods. Lowering carb intake can help manage insulin levels and blood sugars.
Ensure each meal contains FATS, FIBRE and PROTEIN; this helps you to feel satisfied and full. It will also allow for a slower release of sugars to improve insulin sensitivity.
Exercise: moving your muscles requires glucose and can increase insulin sensitivity (4).
Prioritise sleep! Quality sleep is a way of maintaining healthy insulin. Additionally, your circadian rhythm AKA body clock, has a role in regulating glucose, energy expenditure and insulin sensitivity (7). To regulate your circadian rhythm it is important to have natural light exposure in the morning and dimmed light in the evening- turn off your devices an hour before bed. Having a regular bedtime routine and regulated eating patterns can also help (7).
Consider supplements and spices that support insulin sensitivity:
Magnesium supplementation has been shown to improve insulin sensitivity. Additionally, low levels of magnesium have been associated with insulin resistance risk (5).
Cinnamon: Cinnamon has properties that can enhance insulin’s actions and increase insulin sensitivity (8).
Myo-inositol: Inositol is a messenger for insulin and studies show supplementation can improve insulin sensitivity and reduce circulating insulin (6).
So you've had a blood test and you are pretty certain you are not insulin resistant- what other PCOS could it be? Did your symptoms begin around the same time you came off the oral contraceptive pill?
POST PILL PCOS:
Coming off the pill your body can go through a ‘withdrawal process’ in which you may experience an elevation of androgens. This is a temporary elevation of hormones… yay! However, knowing it is only temporary doesn’t make the symptoms any less debilitating and the high levels of androgens still qualify for PCOS. Know that this will not last forever, you need to give it time… Eating well, including lots of vegetables, protein, fats and fibre can support the recovery.
If you meet the criteria for PCOS but you did not just come off the pill and you do not have insulin resistance then chances are you may have inflammatory PCOS.
INFLAMMATORY PCOS
Inflammatory markers are generally elevated in PCOS (3). Inflammation is one way to mediate insulin resistance. However, Inflammation can be a driver of PCOS independently of insulin resistance. Inflammation can stimulate excessive androgen production from the ovaries. On the flip side, anti inflammatories such as polyphenols can do the opposite and can inhibit the excessive production of androgens (3).
Treatment…
Addressing the underlying driver of your inflammation is the first step. This may be identifying foods that you are sensitive/intolerant to or addressing your gut and immune health. For some it may be looking at your lifestyle; smoking, alcohol and environmental toxins can contribute to inflammation. Including an abundance of anti-inflammatory foods and more importantly, avoiding inflammatory foods are key steps to reduce inflammation and PCOS symptoms.
ADRENAL PCOS
As we have learnt PCOS is due to high levels of all androgens. Testosterone and androstenedione are androgens from the ovaries and DHEAS are from the adrenal glands. In Adrenal PCOS, only DHEAS are elevated. Adrenal PCOS is a lot less common and is driven by the body’s stress response. This may be due to high levels of stress, or the body responding to stress abnormally. It potentially could also be a result of stress around the time of puberty.
Treatment…
Prioritise sleep and rest - this will allow your body to recover and regulate your stress response. Aim to manage your stress levels in a way that works for you. The first step is to allow time for relaxation. This could be to practice meditation, yoga, or even just listening to music or a stroll along the park are ways to help reduce our mental load. Reducing stress will help lower DHEAs produced by the adrenal glands.
As you can see PCOS is a complex hormonal disorder and it can be difficult to navigate alone. Whilst healing can be a long process, please remember that it is possible to be treated with the right guidance and persistence.
