PCOS, or polycystic ovary syndrome is a condition that affects up to 10% of women of reproductive age and can cause a range of symptoms from irregular periods, to acne and weight gain. But did you know there are four different types? Each with its own set of symptoms and challenges.

Whether you've been recently diagnosed, or you're simply curious to learn more, know that you’re not alone, and you’ve come to the right place for information. Let's dive into what you need to know.

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in women.

PCOS is a hormonal disorder that affects the ovaries, causing them to produce more androgens (male hormones) than normal. Despite its name, PCOS isn't usually associated with cysts on the ovaries. Instead, PCOS is often rooted in metabolic health, inflammation, and adrenal function.

This imbalance can lead to a range of symptoms including:

• Weight gain
• Fatigue
• Oily skin & hair
• Difficulty getting pregnant
• Mood changes
• Heavy or irregular periods
• Pelvic pain
• Acne
• Thinning hair
• Excessive hair growth 
• Insulin resistance

Diagnosing PCOS

Onto the big question: how is PCOS diagnosed? The truth is, PCOS can be a tricky one. However, some common tools are used to help identify the condition.

The first thing your doctor will do is take a detailed medical history. They'll ask about your family history, menstrual cycle, any symptoms you're experiencing, and other existing medical conditions you may have. A physical exam is typically performed. This could include a pelvic exam to check for any abnormalities in the ovaries or uterus, as well as a blood pressure check and a body mass index (BMI) calculation.

PCOS may also be diagnosed by blood and ultrasound tests. These tests can check for hormone levels, glucose levels, and other markers that may indicate PCOS. Imaging studies, such as transvaginal ultrasound or MRI, can be used to evaluate the ovaries and detect the presence of cysts.

It's important to note that there's not one definitive test for PCOS, and diagnosis is often a process of elimination. Your doctor will need to rule out other potential causes of your symptoms before making a PCOS diagnosis.

Uncovering The 4 Types of PCOS

Let’s highlight each type and what you can do to help manage your symptoms.

Insulin-resistant PCOS

Insulin-resistant PCOS is the most common type, accounting for up to 70% of all cases. Insulin resistance occurs when the body becomes less responsive to insulin. This can cause the pancreas to produce even more to compensate, creating a vicious cycle. Elevated insulin can cause your ovaries to produce more androgens (male hormones) than they should. 

To support insulin-resistant PCOS:

Focus on a low-glycemic diet. A balanced diet high in fiber and low in simple carbohydrates and processed foods can help stabilize blood sugar levels.

Exercise regularly. Exercise helps to improve insulin sensitivity and maintain a healthy weight. Aim for at least 30 minutes of light to moderate intensity exercise most days of the week.

Supplements: Magnesium, omega-3 fatty acids, and vitamin D can also be helpful for supporting insulin sensitivity.

Inflammatory PCOS

Chronic inflammation in the body is the primary cause of elevated androgens in inflammatory PCOS. 

A high level of inflammation resulting from an overactive immune system can stimulate the ovaries to produce excessive amounts of androgen hormones, which can disrupt ovulation and cause irregular periods. Women with this subtype may also have higher levels of C-reactive protein (CRP), a marker of inflammation, in their blood. 

Those with inflammatory PCOS typically don't experience symptoms of insulin resistance, but they may experience other signs related to inflammation including:

• Bowel irregularities
• Fatigue
• Joint pain and stiffness
• Skin conditions like eczema or hives
• Headaches 

To support inflammatory PCOS:

To manage inflammatory PCOS, it's essential to focus on reducing inflammation in the body. 

Address gut health with an anti-inflammatory diet: Anti-inflammatory and probiotic-rich foods can help reduce inflammation. Focus on eating healthy fats, and plenty of fruits and vegetables. 

Remove food triggers: To manage inflammation, address food sensitivities, such as dairy or gluten, and remove triggers where you can. Finding out what foods might be driving your inflammation can be tricky, so it may be a good idea to consult with a nutritionist if needed.

Reduce your exposure: Take steps to reduce your exposure to environmental toxins that can exist in pesticides and conventional skincare, beauty, and cleaning products.

Supplements: Omega-3 fatty acids and magnesium can help.

Post-pill PCOS

Post-pill PCOS is a temporary type of PCOS that can develop after stopping hormonal birth control pills. Birth control contains hormones that regulate the menstrual cycle and prevent ovulation. When a woman stops taking the pill, it can take some time for her body to resume normal hormone production. 

To support post-pill PCOS:

Be patient: Post-pill PCOS is usually temporary and often resolves on its own within a few months to a year. Be patient, know that it’s just a phase, and allow your body time to adjust.

Prioritize sleep and stress management: To support overall hormonal balance, keep in mind the importance of a good night's sleep and find ways to de-stress. Try to stay away from caffeine, alcohol, and intense exercise.

Supplements: Magnesium, vitamin E, vitamin B6, and zinc can help restore key nutrients.

Adrenal PCOS

Unlike the other types that are driven by insulin resistance, hormonal birth control, or inflammation, adrenal PCOS is all about stress.

Adrenal PCOS is characterized by high levels of cortisol and/or DHEA (an androgen hormone produced by the adrenal glands). It's estimated that up to 30% of PCOS patients have elevated DHEA. Think of the adrenal glands as little stress balls - releasing hormones to help us cope. But over time, they can become exhausted, disrupting the body's hormonal balance.

To support adrenal PCOS:

Manage stress: Yoga, breathing exercises, meditation, and journaling are among a few of the strategies that can help reduce stress levels and support your nervous system.

Prioritize sleep:  Aim for a minimum of 7-8 hours of sleep each night to support hormone regulation, stress levels, and recovery.

Avoid excess caffeine from coffee, tea, and energy drinks, as this can put additional strain on your adrenals.

Supplements: Magnesium, vitamin C, and a full spectrum B-vitamin complex are good options.

Keep in mind, everyone's body is different, so what works for one person may not work for another. It's important to listen to your body to find the best strategies for you.

Long-term Complications of PCOS

Type 2 Diabetes: Women with PCOS are at a higher risk of developing type 2 diabetes because this condition makes it difficult for the body to use insulin effectively. Over time, this can lead to insulin resistance, which can progress to type 2 diabetes if left untreated.

Heart Disease: PCOS is commonly associated with higher levels of LDL or "bad" cholesterol, which can lead to the buildup of plaque in the arteries, increasing the risk of a heart attack and stroke. Studies have shown that women with PCOS may be two times more likely to develop heart disease than women without it.

Infertility and pregnancy complications: A common symptom of PCOS is irregular menstrual cycles, which can make it difficult to conceive. Additionally, PCOS can cause hormonal imbalances that can lead to miscarriages, gestational diabetes, and pre-eclampsia during pregnancy.

To reduce your risk of long-term complications, early diagnosis and management of PCOS are key. If you're experiencing any PCOS-related symptoms such as irregular periods, acne, or weight gain, make an appointment with your healthcare provider. 

FAQ’s

We've gathered answers to the most commonly asked questions about PCOS below.

What’s the difference between ovarian cysts and PCOS?

Essentially, ovarian cysts are a physical symptom, while PCOS is a hormonal disorder.

Ovarian cysts are fluid-filled sacs that develop on or inside the ovaries. While they can cause pain and discomfort, they usually don't affect your overall health in a significant way. PCOS, on the other hand, can have a range of effects, from your menstrual cycle to fertility and mood. It's worth noting that some women with PCOS may develop ovarian cysts as a result of their hormonal imbalances, but not all women with ovarian cysts have PCOS. That's why it's important to get an accurate diagnosis if you're experiencing symptoms related to either of these conditions.

Why do women get PCOS? 

The exact cause of PCOS is not 100% certain. But several factors can contribute to the development of PCOS including:

• Genetics: Research shows that PCOS tends to run in families, so if your mother or sister has the condition, you may be at a higher risk of developing it as well.
• Insulin resistance
• Chronic stress
• Inflammation
• Obesity
• Lack of sleep
• Environmental factors

PCOS is a complex condition that affects women due to the hormones and genetic factors unique to the female reproductive system. While men may not develop PCOS in the same way, they can also experience reproductive health issues related to hormone imbalance.

How does PCOS affect fertility?

Those with PCOS typically have high levels of androgen hormones, which can prevent the ovaries from functioning properly, resulting in irregular periods. PCOS may make it harder for women to ovulate, or release an egg during their menstrual cycle. Even if you have regular periods, you may not ovulate regularly, making it harder to conceive.

Can you have PCOS with regular periods?

Yes, you can have PCOS with regular periods. Some women with PCOS may have longer cycles, meaning that their period comes every 35 days instead of the typical 28-day cycle. Others may experience very heavy or very light periods, or they may have irregular bleeding throughout the month.

Just because you’re getting a period with PCOS doesn’t mean that you’re ovulating. It’s common for women with PCOS to have irregular ovulation or even lack of ovulation (anovulation).

Could it be something else?

Often, PCOS is misdiagnosed for another condition called Hypothalamic amenorrhea.

Hypothalamic amenorrhea happens when a woman's menstrual cycle stops due to a problem with the hypothalamus, a part of the brain that controls the menstrual cycle.

How can these two conditions be misdiagnosed? Well, it all comes down to their symptoms. Women with PCOS often experience irregular periods, weight gain, acne, and excess hair growth. With hypothalamic amenorrhea, your period can stop due to low body weight, chronic stress or trauma, and/or over exercising. While these might seem very different, symptoms can sometimes overlap, making it difficult to distinguish between the two. For example, if a woman with PCOS loses a significant amount of weight, her menstrual cycle may stop, just like it would with hypothalamic amenorrhea. If you’re experiencing irregular periods or other menstrual problems, it's important to get a proper diagnosis so that you can receive the right treatment. 

Managing PCOS 

PCOS can feel like a puzzle with lots of different pieces, each one contributing to a bigger picture of your health. Understanding the four different types is a great first step to managing the symptoms. Knowing what each means for your body will help you work with your health practitioner to put together an effective treatment plan. With the right lifestyle changes, it's possible to take back control and live a healthy and fulfilled life.

Looking for additional tips on lifestyle changes and supplements for hormone health? You may be interested in reading ‘Understanding the Adrenal-Thyroid Connection’.