What are the 5 Types of PCOS - How to Know Which One You Have?

Firstly, what is PCOS?

PCOS (polycystic ovarian syndrome) is a hormonal disorder that can cause irregular periods and various unwanted physical symptoms. It is characterized by an imbalance in hormones, particularly high levels of androgens (male hormones) like testosterone and DHT.

What are the PCOS symptoms?

Common signs and symptoms of PCOS include:

• Acne

• Oily skin and hair

• Excess hair growth on the face and body (Hirsuitism)

• Hair thinning or loss on the head

• Weight gain or trouble loosing 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 higher than they should be, this can lead to common signs like acne and excess hair growth as well as issues with ovulation, irregular periods and infertility. What about the cysts on my ovaries? Contrary to the name, the so-called "cysts" on the ovaries in PCOS are not actually cysts. They are an increased number of follicles, which can be seen in women even without PCOS. The term "polycystic" is misleading, and there is ongoing debate about changing the name to something more accurate. It's important to note that PCOS cannot be diagnosed based on ultrasound alone, and a comprehensive evaluation is necessary.

How to treat PCOS?

Treatment for PCOS often follows a one-size-fits-all approach, which can be problematic. Simply recommending weight loss or the use of hormonal birth control pills to regulate cycles overlooks the complexities of PCOS. Weight loss can be challenging in PCOS, as weight gain is a common symptom. Hormonal birth control pills only mask the symptoms temporarily and don't address the underlying causes of PCOS. This can be particularly problematic when women discontinue the pill, especially if they are trying to conceive, as symptoms often return.

It is crucial to understand that there are five different types of PCOS, and each type may require different approaches to treatment. PCOS can affect individuals differently, and knowing your specific type of PCOS is essential for effectively managing symptoms and achieving successful healing. By identifying the underlying causes and tailoring treatment accordingly, individuals with PCOS can address their symptoms and improve their overall well-being.

So, what type of PCOS do I have?

In recent years, researchers have identified several different phenotypes or subtypes of PCOS based on variations in symptoms, hormonal profiles, and metabolic characteristics. While there isn't a universally agreed-upon classification, the following are five commonly recognized types of PCOS:

1. Insulin-Resistant PCOS:

This type is characterized by insulin resistance as a primary feature. Insulin resistance impairs the body's ability to use insulin effectively, leading to elevated insulin levels. Symptoms may include weight gain, difficulty losing weight, and increased risk of type 2 diabetes.

Insulin resistance, also known as hyperinsulinemia, occurs when there are higher-than-normal levels of insulin in the body. It happens when cells become less responsive to the effects of insulin, prompting the pancreas to produce more insulin until the cells become more receptive. In PCOS characterized by insulin resistance, individuals may struggle with weight management, especially around the abdomen, experience sugar cravings, and exhibit symptoms like fatigue or brain fog. Elevated insulin levels drive up androgen levels, leading to issues such as excess hair growth, male pattern hair loss, and acne.

Diagnostic tests such as glucose tolerance tests and insulin level measurements can help identify insulin-resistant PCOS. While doctors often test HbA1c or glucose levels to assess blood sugar, it's crucial to test fasting insulin levels to rule out insulin resistance. Normal fasting insulin levels are typically less than 10 mIU/L (60 pmol/L). Treating insulin-resistant PCOS involves improving insulin sensitivity.

This can be achieved through :

1. regular exercise and movement

2. a lower carbohydrate diet with balanced protein and fat

3. prioritizing sleep and stress reduction

4. considering supplementation with nutrients like magnesium, chromium, NAC, inositol, and berberine.

2. Classic PCOS: ( Described in detail here )

This type represents the most common presentation of PCOS and is characterized by irregular menstrual cycles, elevated androgen levels, and polycystic ovaries seen on ultrasound. Symptoms often include hirsutism (excessive hair growth), acne, and obesity.

3. Non-Classic PCOS:

This type is similar to classic PCOS but lacks some of the typical features. Women with non-classic PCOS may have normal androgen levels or regular menstrual cycles, but still exhibit polycystic ovaries on ultrasound. Diagnosis is often based on the exclusion of other potential causes of symptoms. One of the examples of non-classic PCOS is Adrenal PCOS.

Adrenal PCOS, also known as adrenal hyperandrogenism, is a less common form of PCOS that is considered a non-classic subtype. It is characterized by elevated levels of androgens (male hormones) produced by the adrenal glands, which are located on top of the kidneys.

In adrenal PCOS, the excess androgen production primarily stems from the adrenal glands rather than the ovaries, which is the characteristic feature of classic PCOS. This distinction is important because the underlying hormonal imbalance in adrenal PCOS is driven by the adrenal glands, leading to an androgen excess and subsequent PCOS symptoms.

The diagnosis of adrenal PCOS involves assessing hormone levels, including androgens, LH/FSH ratio, and other relevant hormonal markers. Imaging tests such as adrenal gland imaging or adrenal stimulation tests may also be conducted to evaluate adrenal function and rule out other potential causes of androgen excess.

Treatment for adrenal PCOS focuses on managing the underlying hormonal imbalance and reducing androgen levels. This may involve lifestyle modifications such as maintaining a healthy diet, regular exercise, stress management techniques, avoiding caffeine and weight management. Medications that target androgen production or action, such as anti-androgens or certain oral contraceptives, may be prescribed to help regulate hormone levels and alleviate PCOS symptoms.

4. Post-Pill PCOS:

Some women may develop PCOS-like symptoms after discontinuing certain hormonal contraceptives. This type is believed to result from hormonal imbalances that persist after stopping the pill. Symptoms may include irregular periods, acne, and hirsutism.

It is commonly observed that post-pill PCOS tends to manifest in clients within 3-6 months after discontinuing contraceptive pills. It's important to note that this type of PCOS may naturally resolve over time, but its reversal can be expedited with appropriate nutrition, lifestyle changes, and supplementation or herbal medicine support. When addressing post-pill PCOS, it's essential to:

1. Exercise patience as it may take time for the body to rebalance itself. Remember that this condition is temporary.

2. Consult a healthcare practitioner to discuss potential supplementation options. Nutrients such as magnesium, vitamin E, vitamin B6, zinc, and herbal remedies like chaste tree and peony can be beneficial in supporting ovulation and reducing excess androgens.

3. Place emphasis on adequate sleep and stress management. Similar to insulin-resistant PCOS, prioritizing quality sleep and implementing stress reduction techniques is crucial for promoting overall hormonal balance.

5. Inflammatory PCOS:

Inflammatory PCOS is characterized by chronic inflammation that triggers the overproduction of testosterone by the ovaries, leading to physical symptoms and ovulation issues. Common indications of inflammation in this type of PCOS include headaches, joint pain, unexplained fatigue, skin conditions like eczema, and bowel problems such as irritable bowel syndrome (IBS). Blood tests often reveal elevated inflammatory markers, such as a high level of CRP (C-reactive protein) above 5. While fasting glucose and insulin levels may appear normal, they can sometimes be influenced by inflammation.

To effectively address inflammatory PCOS, the following approaches can be helpful:

1. Focus on improving gut health: Repairing the integrity of the gut lining, balancing gut bacteria, enhancing digestive enzyme function, and eliminating harmful bacteria are essential steps in reducing overall inflammation.

2. Identify and eliminate food triggers: Identifying potential food sensitivities and removing inflammatory foods from the diet is crucial in managing inflammation. Working with a nutritionist can be beneficial in identifying specific trigger foods.

3. Consider natural anti-inflammatories: Certain natural substances like turmeric, omega-3 fatty acids, and antioxidants such as NAC (N-acetyl cysteine) can support the management of inflammatory PCOS. It is important to consult with a healthcare practitioner to determine if these supplements are appropriate for your specific situation and to determine the correct dosage.

5 TYPES OF PCOS- Diagnostic and Therapeutic approach

Determining the specific type of PCOS typically requires a comprehensive evaluation by a healthcare professional, including a thorough medical history, physical examination, laboratory tests (such as hormone levels and ultrasound), and ruling out other conditions that may present similar symptoms.

It's important to note that PCOS is a complex condition, and individuals may exhibit characteristics of more than one subtype or have unique variations. Treatment plans are typically tailored to address the individual's specific symptoms, hormonal imbalances, and metabolic concerns, focusing on lifestyle modifications, medication management, and fertility options if necessary. Consultation with a healthcare professional experienced in managing PCOS is essential for accurate diagnosis and appropriate treatment.

5. Hypothalamic Amenorrhoea. (not real PCOS) Hypothalamic amenorrhea (HA) is a condition characterized by the absence or cessation of menstrual periods in individuals with normally functioning ovaries. It occurs due to a disruption in the normal functioning of the hypothalamus, a region of the brain that plays a crucial role in regulating hormonal processes, including the menstrual cycle.

Several factors can contribute to the development of hypothalamic amenorrhea. These may include:

1. Excessive Physical or Emotional Stress: Intense exercise, rapid weight loss, chronic illness, or emotional stress can disrupt the hypothalamic-pituitary-ovarian axis, which controls the menstrual cycle.

2. Low Body Weight or Caloric Restriction: Maintaining a low body weight, engaging in extreme dieting, or insufficient calorie intake can signal to the body that it is not in an optimal condition for reproduction, leading to the suppression of menstrual cycles.

3. Hormonal Imbalances: Dysregulation of hormones such as cortisol (the stress hormone), insulin, or thyroid hormones can impact the hypothalamus and contribute to hypothalamic amenorrhea.

The absence of menstrual periods is the primary symptom of hypothalamic amenorrhea. Other associated symptoms may include low estrogen levels, loss of bone density (osteoporosis), fatigue, disrupted sleep, and difficulty conceiving.

The main difference when in comes to PCOS vs hypothalamic amenorrhoea is what is known as the LH:FSH ratio. The LH-to-FSH ratio is commonly elevated in classic PCOS, typically greater than 2:1. In hypothalamic amenorrhoea however, The LH-to-FSH ratio in HA may be normal, low, or slightly elevated. However, the ratio is generally lower than that observed in classic PCOS.

Differences between Classic PCOS and Hypothalamic Amenorrhoea

Treatment for hypothalamic amenorrhea involves addressing the underlying causes and restoring the balance of hormones. This often involves making lifestyle modifications such as reducing stress levels, achieving a healthy body weight, and ensuring adequate caloric intake. It may also involve working with healthcare professionals such as endocrinologists, gynecologists, or dietitians to develop an individualized treatment plan.

In some cases, hormonal supplementation or medication may be prescribed to help stimulate the menstrual cycle and promote the return of regular periods. Fertility treatment may also be considered for individuals trying to conceive. Still unsure? take our help 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 just like to manage your PCOS symptoms naturally, contact me to make an appointment for a personalised health plan, or book in for a 15-minute VIDEO call to find out how I can help you.