Uncovering the Four Types of Polycystic Ovarian Syndrome: What You Need to Know

Polycystic ovarian syndrome is classified as a heterogeneous endocrine disorder, meaning it is a ‘group of symptoms’ that can result from several different underlying drivers.

Some symptoms of PCOS, are:

·       Anovulation (no ovulation)

·       High androgens (testosterone, androstenedione, and DHEAs)

·       Irregular periods e.g., skipping periods throughout the months

·       Infertility

Some other symptoms you may experience, but not always, are

·       Weight gain, or struggling to lose weight

·       Hair loss

·       Hirsutism (excessive facial and body hair, typically around the nipples, belly, cheeks, and chin)

·       Acne

PCOS is estimated to affect up to 10% of women and can predispose you to long-term risk of developing diabetes and heart disease. In this article, we will discuss the ‘whole-body’ approach to treating PCOS, and why it is not just a hormonal condition.

PCOS cannot be diagnosed with just an ultrasound.

Many women of reproductive age may have the appearance of polycystic ovaries. The confusion lies within the ‘cyst’ formation.

At any given time, several follicles are developing within our ovary every month. If you are a teenager, this number could be as high as twenty-five. Only one follicle is chosen to become 'dominant', and continues to grow larger and produce the Oocyte (egg) that is released for fertilization.

If you do not progress to ovulation, either due to nutrient deficiencies, stress, inflammation, or contraception use, then the dominant follicle does not form and the other follicles’ development becomes suppressed. The other follicles will continue to grow slightly but stunted, and you will end up with many small undeveloped follicles called ‘cysts’. The real issue here is that you did not ovulate that month, resulting in too many follicles.

The menstrual cycle takes 6-8 years to fully mature until all cycles are ovulatory.

In this timeframe, teenage girls may have the appearance of polycystic ovaries, and experience heavy or light bleeding, along with spotting, while the communication between the hypothalamus, pituitary gland, and ovaries develops.

So, is there a genetic component here?

You can be born with genes that may put you at risk of developing PCOS – for example, you may have genes that affect your hypothalamus’s communication to the ovaries, make you more susceptible to developing insulin resistance, or genes that cause your ovaries to overproduce androgens.

The 4 types of PCOS that will drive androgen excess, are:

Insulin-resistant Polycystic ovarian syndrome

This may be you if your blood sugar reading is fine, but your insulin levels are elevated. High levels of insulin cause the ovaries to overproduce androgens and make more testosterone than estrogen. Furthermore, high insulin will stimulate the pituitary gland to make more luteinizing hormone (LH), which stimulates more androgens. Elevated luteinizing hormone throughout your cycle also stops ovulation.

What causes insulin resistance?

·       Hormonal birth control

·       Sleep deprivation

·       Alcohol

·       Smoking

·       Magnesium deficiency

·       Stress

·       Unbalanced gut bacteria

How do I know if this is me?

This is you if you meet the following criteria

·       Irregular periods

·       High androgens

·       Insulin resistance (blood testing fasting insulin, HOMA-IR index, or, glucose tolerance test with insulin)

Post-pill Polycystic ovarian syndrome

Coming off contraception can cause symptoms that may qualify you for a PCOS diagnosis. This is because:

Hormonal birth control can either cause or worsen insulin resistance. Birth control impairs carbohydrate metabolism by decreasing insulin sensitivity, and forms with Norethindrone and levonorgestrel-containing combinations have a higher risk of developing hyperinsulinemia.

Hormonal birth control suppresses ovulation causing anovulatory cycles. This is its job, however, for some individuals, ovulation may not return for months or years post-contraception use. During this time, you may be diagnosed with PCOS.

Some contraceptive methods have a ‘low androgen index’ and are recommended for controlling acne as they reduce testosterone and regulate sebum production. When coming off contraception this can cause your androgens to ‘surge’ for 1-2 years and will show up on a blood test.

This form of PCOS is often temporary and does not involve a genetic susceptibility of insulin resistance or overproduction of androgens.

How do I know if this is me?

This is you if you meet the following criteria

·       Irregular cycles

·       Elevated androgens

·       Do not have insulin resistance

·       Your periods were fine before you started hormonal contraception

Inflammatory Polycystic ovarian syndrome

This type of PCOS is driven by environmental toxins that can negatively affect hormone receptors and therefore suppress ovulation. Environmental toxins may also stimulate the ovaries AND your adrenal glands to make more androgens.

Inflammation can come from several different drivers: insulin resistance (in which you may have insulin-resistant PCOS), sleep deprivation, inflammatory diet, smoking and drug use, high environmental toxins, and digestive issues.

How do I know if this is me?

This is you if you meet the following criteria

·       Irregular cycles

·       Elevated androgens

·       Do not have insulin resistance

·       Your periods were not affected by the pill

·       You have signs of inflammation: fatigue, digestive issues like IBS, candida infections (chronic thrush, skin fungal infections), joint pain, skin conditions, headaches, and migraines

Adrenal Polycystic ovarian syndrome

Adrenal PCOS is caused by environmental toxins affecting the hormone receptors, and an underlying genetic component. These individuals may have an abnormal or overactive stress response, due to environmental stress exposure years before or during puberty.

How do I know if this is me?

This is you if you meet the following criteria

·       Irregular cycles

·       Do not have insulin resistance

·       No symptoms of inflammation

·       Were not negatively affected by the pill

·       Normal ovarian androgens (testosterone and androstenedione)

·       Elevated adrenal androgens (DHEAS)

As you can see, PCOS requires a multi-faceted treatment approach. It is not just a hormonal condition, the whole endocrine system and metabolism need to be supported. Our goal is to discover and treat the root cause of your PCOS.

Through a personalised treatment plan, you will receive nutrition education and strategies to support blood sugar, inflammation, weight management, and muscle growth; herbal medicine; and, specific vitamins and minerals to improve ovarian function and ovulation.

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5.     Cortes & Alfaro (2014). PMID: 25249703