Four types of PCOS: Sign, Symptoms and Holistic Treatment
There are four types of PCOS and every woman experiences PCOS differently based on the type affecting her body
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder based on a collection of symptoms that affects females of reproductive age. You may be surprised to learn that there are four types of PCOS. Women can experience PCOS differently based on the type affecting her body.
In this blog article, you’ll learn about the four types of PCOS, including symptoms to look out for and treatment approaches.
To achieve healing, it’s vital that you know which factors are driving your PCOS symptoms, and that requires knowing which type you have. At Denver Sports and Holistic Medicine, we help you uncover the root cause of your PCOS and tailor a plan to help you reverse your symptoms and balance your hormones.
What is PCOS?
Firstly, what is PCOS? Simply put, it’s a hormonal imbalance where your body produces more male hormones than necessary. The name for this phenomenon is androgen excess.
PCOS is not a single disease; researchers describe it as a diverse disorder with different underlying biological mechanisms (1).
In other words, it’s a set of symptoms. Those symptoms include excess androgens and anovulation, where the egg is not released in the female menstrual cycle.
Interestingly, PCOS is not a condition that causes cysts on your ovaries. Polycystic ovaries are a potential symptom but should not be the main reason for diagnosis.
Other symptoms of a general PCOS diagnosis include:
Missed or irregular periods
Ovaries that have cysts
Weight gain, particularly around the abdomen
Excess body hair
Male-pattern baldness or thinning
Acne or oily skin
Infertility
Skin tags
Dark or thick patches of skin on the back of the neck or under armpits or breasts
Let’s talk about how to get a diagnosis if you have some of these symptoms and suspect you might have PCOS.
Requirements for a PCOS Diagnosis
Regardless of the name, the cysts seen in PCOS are not actually cysts at all. They are an increased number of follicles, which in some cases can be pretty standard, and are seen in women without PCOS.
In fact, ovarian follicles are tiny sacs filled with fluid found inside a woman's ovaries. They secrete hormones that influence stages of the menstrual cycle. Each has the potential to release an egg for fertilization.
Researchers found that the presence of polycystic ovaries has no implication with the endocrine (hormonal) features of PCOS (2). Essentially, you can have polycystic ovaries without excess androgens. On the other hand, you can have normal ovaries but have a hormonal imbalance. That’s why an ultrasound alone cannot be used as a diagnosis for PCOS.
You also have symptoms of significant facial hair or jawline acne.
To be diagnosed with PCOS, you must have androgen excess. That means you have a high amount of male hormones, such as testosterone and more specifically dihydrotestosterone (DHT), your most potent androgen.
An enzyme called 5-alpha-reductase converts testosterone to DHT. Dried Urine Testing for Advanced Hormones (DUTCH testing) allows us to evaluate hormones, their metabolites and thus also the enzyme activity that converts hormones to their downstream metabolite.
A woman might have low testosterone because 5-alpha-reductase activity is high and consequently DHT (which is not often tested) is high. They are then prescribed testosterone which is putting fuel on the fire and their symptoms get worse! The importance of testing the whole picture can’t be stressed enough, hence why the DUTCH test is the only kind of hormone testing we use at Denver Sports and Holistic Medicine.
If you don’t have androgen excess, you don’t have PCOS, even if you have some of the other symptoms. You likely have a different hormonal imbalance. A functional medicine doctor can help you get to the root cause of your symptoms.
Now, if you do have PCOS, you have one of the four types of PCOS.
Insulin-Resistant PCOS
Insulin-resistant PCOS is the most common type affecting up to 70% of people with the syndrome (3). If you have higher insulin levels than normal, you are insulin resistant and have this type of PCOS.
Insulin resistance happens when your cells ultimately become numb to the effects of insulin. In the early stage, the pancreas produces more and more insulin in response to elevated blood sugar levels. Cells get the message to uptake more and more glucose from the bloodstream. Since the cells become overloaded with glucose they begin to produce fewer receptors for insulin to bind to on the cell surface. As a consequence of the cell protecting itself from glucose overload, both insulin and glucose remain high in the blood. This is also known as pre-diabetes or metabolic syndrome , depending on the stage.
High insulin levels prevent ovulation and activate the ovaries to produce testosterone, leading to an excess of male hormones, a.k.a. excess androgens.
Symptoms specific of insulin resistant PCOS include:
Struggling with your weight
Holding weight around the stomach/abdomen
Struggling with sugar cravings
Fatigue
Treatment for insulin-resistant PCOS consists of reversing insulin resistance with diet and exercise. Supplements like magnesium, chromium, berberine, cinnamon, and inositol also lend support, but as we always emphasize, it is important to seek professional support so that the appropriate treatment plan can be devised for your unique case.
Post-Birth Control Pill (BCP) PCOS
Birth control pills (BCP) are used to suppress ovulation. When you stop taking the pill, your ovaries should begin to work again. You should get a monthly period and resume ovulation. However, sometimes post-BCP PCOS can occur when you stop taking oral contraceptives.
You see, your ovaries experience a temporary surge in androgens when coming off of these pills. Various contraceptives are often involved in this type of PCOS due to the type of synthetic progestin used.
Women with post-pill PCOS may not recover from the BCPs effects for quite some time and continue to experience suppressed ovulation.
To qualify for post-BCP PCOS, you need to meet three requirements:
Criteria for general PCOS (excess androgens and anovulation).
You DO NOT have insulin resistance.
Symptoms started when you went off the pill.
This type of PCOS may reverse itself in time. However, helping your body re-establish balance is the best approach to expediting this process and symptom relief. Here’s what you can do:
Acupuncture (4)
Herbs
Supplements
Prioritize sleep
Reduce Stress
You should also speak to a practitioner about supplementation, as oral contraceptives often deplete many of your essential nutrients, which leads to other long-term health issues. Micronutrient testing is an essential part of your diagnostic evaluation.
Inflammatory PCOS
Inflammatory PCOS is a condition in which chronic inflammation causes the ovaries to overproduce testosterone (5).
Inflammation is a factor in each type of PCOS, but in inflammatory PCOS, it is the primary factor.
Symptoms of inflammatory PCOS include:
Headaches
Joint pain
Unexplained fatigue
Skin issues like eczema
Bowel issues like IBS
In Inflammatory PCOS, you often see raised inflammatory markers on a blood test, such as a high sensitivity C-reactive protein (hsCRP)
above 5.
Treatment for this type of PCOS starts by reducing inflammation (6).
Sources of inflammation can come from::
food sensitivities
underlying gut problems
histamine intolerance
Treatment should also involve an anti-inflammatory diet, herbs, and supplements.
Adrenal PCOS
The fourth type of PCOS is adrenal PCOS. It is often due to abnormal stress response and only affects about 10% of those with PCOS.
DHEA, a type of androgen produced by the adrenal glands, will be elevated in this situation. The other male hormones, testosterone and androstenedione, are not elevated.
Your adrenal glands are responsible for regulating your body's stress response. In the case of adrenal PCOS, the adrenal gland is overstimulated to produce higher levels of this androgen. DUTCH testing can provide a deeper look into your hormones and help determine if you have adrenal PCOS.
Treatment for Adrenal PCOS begins with managing stress levels, getting enough sleep, and avoiding caffeine. Magnesium, zinc, ashwaganda, rhodiola, and other adaptogenic herbs can support the treatment of adrenal PCOS.
Need Help Healing with Your PCOS?
Have you been struggling with your fertility? Do you have weight gain? Acne? Excess body hair?
PCOS is a complex hormonal disorder with a variety of underlying causes. You can’t reverse it with a prescription. It’s critical to be diagnosed appropriately so you can begin addressing the root cause.
Denver Sports and Holistic Medicine offers in-person and telemedicine consultations. To get started, schedule a free consultation today.
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