What are the Types of PCOS?
PCOS is a very common hormonal condition (ONE IN TEN WOMEN) that is not as simple as the conventional medical system puts it out to be. Did you know you don’t need cysts on your ovaries to have the condition PCOS? Therefore, its name is not actually a good one! And 50% of women with PCOS go underdiagnosed.
To truly diagnose PCOS, we need TWO OUT OF THREE of the following (known as the Rotterdam Criteria):
1. Oligomenorrhea or Anovulation – irregular menstrual cycles, lack of ovulation, or absence of menstrual cycle
2. Clinical or Chemical Hyperandrogenism – high androgens (testosterones) in bloodwork, or symptoms of high androgens such as acne, abnormal body hair growth, or thinning hair (androgenic alopecia)
3. Polycystic Ovaries – polycystic ovaries are present if there are 12 or more follicles present on a single ovary OR if there is an increase in size of at least one ovary.
Hormonal Imbalances Implicated in PCOS:
· Elevated estrogen (usually relative to low progesterone, as a result of anovulation)
· Increased in testosterone (free or bioavailable)
· Elevated LH compared to FSH (>3:1 ratio of LH to FSH)
· Increased insulin production (insulin resistance)
Heatlh Implications in PCOS:
· Increased estrogen & progesterone can lead to increased endometrial growth (hyperplasia) – causing painful heavy periods, or increases risk for uterine cancer
· Increased testosterone can cause acne, hair loss, or abnormal hair growth
· High LH & FSH lead to cystic ovaries, ovulation/menstrual irregularities, and infertility
· Elevated insulin creates a risk for developing type 2 diabetes and heart disease
Symptoms can widely vary: · Irregular cycles · Acne · Hirsutism (abnormal hair growth on face, nipples, abdomen, chest, thighs) · Overweight or obesity · Thinning hair or bald spots · Dark patches on skin · Pelvic pain or bloating · Infertility or difficulty conceiving · Anxiety or Depression or significant mood changes around your period Now there are actually different categories of PCOS, which widely varies treatment! Above is how to diagnose it, but the bigger question is what kind do we have, and how to treat it. There are FIVE types of PCOS!
FIVE FACES OF PCOS
1. Insulin-Resistant PCOS
· The most common type of PCOS, affecting around 70% of women
· Insulin resistance is present – found by a blood test that would show high fasting insulin
· Insulin resistance can create high testosterone levels, which lead to all the other symptoms (acne, weight gain, hair loss, excessive hair growth, irregular periods). So by working on insulin sensitivity and promoting even a 10% weight loss, ovulation can be restored and symptoms can be reduced.
2. Non-Insulin Resistant PCOS
· No insulin resistance is present, where ovulatory dysfunction still exists but elevated testosterone may or may not be present
3. Post-Pill PCOS
· induced by cessation of the oral birth control pill – which has been suppressing ovulation the entire duration of its use
· some birth control pills create a surge of androgens afterwards
· usually no insulin resistance, and more of a balance between estrogens/progesterones/testosterones
4. Adrenal PCOS
· Typically elevated DHEA-s (adrenal reserve hormone) and a high stress response picture
· Elevated or dysregulated cortisol patterns (this can be tested via a salivary cortisol profile)
5. Inflammatory PCOS
· Chronic inflammation in the body is contributing to the ovaries increasing output of testosterone
· High CRP on bloodwork can display this
· Root can be gut health a lot of the time
Other investigations that could be warranted, depending on causes of menstrual irregularities:
· Thyroid dysregulation
· Low nutrient status (vitamin D, zinc)
· Hypothalamic amenorrhea (mimics PCOS)
All of these types create individualized, specific treatment plans that your naturopathic doctor will walk you through. There are always dietary/lifestyle/exercises that are specific for your type of PCOS, certain supplements & herbs that have been studied to support PCOS (again depending on the type), as well as certain medications.
PCOS is treatable! The conventional medical system offers only a few options – take the pill to “regulate” your cycles (which really can just mask the symptoms of having PCOS) – or they just inform you there is not much that can be done. Some use blood sugar medications (like metformin), or acne treatments for the symptom (Accutane, spironolactone) or hair loss, however the other types are not as simple to treat. PCOS conventionally is only cared about if a patient is trying to conceive. But the goal should always be to balance our hormones to FEEL BETTER before we try to conceive (if we even want to!)