Types of PCOS - and How to Know Which One You Have

PCOS is a hormonal disorder that can cause irregular periods and 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 more elevated than they should be, this can lead to common signs like acne and excess hair growth, issues with ovulation, irregular periods, and infertility. Contact for the best PCOS treatment in Bangalore.

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 not cysts. They are 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 number of times my clients have been told to “lose weight” or “go on the pill” to “regulate” their cycle bothers me. Why?

1. Weight loss in PCOS can be extremely hard (without the right tools) because one of the symptoms alone is weight gain!
2. The pill doesn’t treat the underlying cause of PCOS. It just provides the body with synthetic hormones which mask symptoms temporarily. This, in particular, can be problematic when women come off the pill later on - especially if they are trying to conceive - only for their symptoms to return. And, importantly:
3. There are four different types of PCOS. PCOS can affect everyone differently, and knowing what kind of PCOS you have is important to treat your symptoms and successfully heal PCOS.

So, what type of PCOS do I have?

To effectively treat PCOS and reverse symptoms naturally, you need to know the type of PCOS you’re dealing with. The four types of PCOS include:

1. Insulin resistant PCOS
   This is the most common type of PCOS, affecting around 70% of people. Insulin resistance is when 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 struggle with weight, hold weight around the stomach/abdomen, and have sugar cravings and symptoms like fatigue or brain fog. High insulin levels drive up androgen levels which cause issues like excess hair, male pattern hair loss, and acne.
   Often doctors will test HbA1c or glucose levels, which gives us some information about your blood sugar levels but 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 ten mIU/L (60 pmol/L).
   To help treat insulin-resistant PCOS, the key is improving your insulin sensitivity. You can work on this through the following:
   Regular exercise and movement throughout the day help your body to burn sugar, build muscle and improve your insulin sensitivity.
   Avoid high-sugar foods and have a lower carbohydrate diet rich in protein and fat to balance blood sugar levels.
   Prioritizing sleep and reducing stress can also help to manage blood sugar and insulin levels.
   Supplementing key nutrients such as magnesium, chromium, NAC, inositol, and berberine. I strongly advise working with a nutritionist or naturopath to determine 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 absent before starting the medication. Oral contraceptives such as Ginet, Yasmin, and Yaz are often involved in this type of PCOS due to the kind of synthetic progestins used. After coming off the pill, your ovaries 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 3-6 months after stopping the pill. Remember that this type can take time to heal, but it can be addressed more quickly with 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 temporary.
   Speak to a practitioner about supplementation. Nutrients such as magnesium, vitamin E, vitamin B6, and zinc, as well as specific herbs like chaste tree and peony, can be helpful to support ovulation and lower excess androgens.
   Prioritize sleep and stress management. Like insulin resistance PCOS, getting a night of good quality sleep and reducing stress levels to maintain overall hormonal balance is important.
3. Adrenal PCOS
   This type of PCOS is due to an abnormal stress response and affects around 10% of those diagnosed. Typically DHEA-S (a different kind of androgen from the adrenal glands) will be elevated alone, and high testosterone androstenedione levels are not seen. Unfortunately, this type of androgen isn’t often tested unless you go through an endocrinologist or other specialist.
   To help treat adrenal PCOS:
   Manage stress. Reducing stress levels through yoga, meditation, mindfulness, and journalling will help support your nervous system and hormones.
   Get enough sleep each night. Make sure you get at least 8 hours of sleep each night to keep your stress levels and recovery.
   Avoid high-intensity exercise. Limit excessive, high-intensity training as this can further stress your adrenals.
   Avoid caffeine from coffee, tea, and fizzy drinks.
   Speak to a practitioner about herbs and supplements. Specific herbs like Withania, Rhodiola, and licorice can help the body adapt and recover from stress. Nutrients like magnesium, vitamin B5 and vitamin C are important to support the adrenal glands and nervous system. You’ll need to speak to a professional about the 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 the removal of inflammatory foods is a vital step to help manage 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 who can help you.
   • Natural anti-inflammatories such as turmeric, omega-three fatty acids, and antioxidants like NAC can help 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 for them to be effective.

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 over exercising. Similarly, to PCOS, it can present itself with mild acne, excess hair growth, and a polycystic ovary appearance on an ultrasound. This misdiagnosis is problematic as the treatment of the two conditions is very different.

The main difference when it comes to PCOS vs. hypothalamic amenorrhoea is what is known as the LH: FSH ratio. In PCOS, luteinizing hormone (LH) can be 2-3 times higher than follicle-stimulating hormone (FSH) when they should be at about a 1:1 ratio. However, in hypothalamic amenorrhoea, the opposite is true, and LH can be much lower than FSH.

Still, trying to figure it out?

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 like to manage your PCOS symptoms naturally, contact me at DOCPLUS to make an appointment for the best plan PCOS treatment in Bangalore.