What is PCOS?
Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder among women in their reproductive years and the leading cause of infertility. If PCOS is something that you have been diagnosed with recently, or have struggled with for a while, know that you are not alone! This condition can be difficult to manage, and frustrating to understand.
PCOS is commonly known for driving hormone imbalances in the body, leading to high levels of androgen hormones, like testosterone. High testosterone causes unwanted symptoms like acne, excess body hair growth, and irregular periods. PCOS is diagnosed when 2 of the following criteria are met:
(1) Abnormal menstrual cycles
(2) Hyperandrogenism: acne, excess body hair, oily skin, hair loss, deepened voice
(3) Presence of polycystic ovaries detected in an ultrasound
Something that many people don’t know is that there are four different types of PCOS, and each one can present a little differently. Depending on the type of PCOS you have, different treatment methods and considerations may be involved to manage your condition. Be sure to work with a provider that specializes in this condition!
The Four Types of PCOS:
1) Insulin-Resistant PCOS
This type of PCOS makes up about ~70% of all PCOS cases. In this type, there are elevated levels of serum insulin, and resistance in the body to properly utilize it, which can cause symptoms like weight gain, high blood sugar, and other metabolic issues. On top of that, the increased insulin can cause androgens like testosterone to rise in the blood, leading to symptoms of hyperandrogenism and infertility.
The first order of business for managing insulin-resistant PCOS is tackling the insulin-resistance piece to bring down insulin in the blood and normalize blood sugar levels. This can be done by:
- Eating balanced meals with protein, complex carbohydrates, healthy fats, and fruit/vegetables
- Keeping consistent mealtimes
- Keeping portion sizes moderate
- Avoiding added sugars and saturated fats
- Adding in routine exercise like weight-lifting and daily walks
When the body begins to become more sensitive to insulin and use it appropriately, androgen levels may begin to decline to normal levels.
2) Inflammatory PCOS
This type of PCOS is caused by chronic inflammation. The inflammation can lead to ovaries producing excess testosterone, resulting in unwanted physical symptoms and abnormal menstrual cycles. Signs of this type of PCOS include chronic headaches, joint pain, skin issues like rashes and eczema, and GI issues like IBS. Fasted glucose and insulin markers may be normal with inflammatory PCOS, but blood markers to watch would be the C-Reactive Protein, which indicates overall inflammation when on the higher end.
The inflammation in this type of PCOS can be caused by environment, stress, or diet, and treating it could involve the following:
- Addressing underlying gut issues (leaky gut or dysbiosis)
- Removing any foods that cause inflammation
- Managing stress overall through lifestyle interventions
3) Adrenal PCOS
Adrenal PCOS makes up about 10-20% of PCOS cases and is caused by unusual stress responses in the body. In this PCOS type, there are high amounts of androgens circulating in the blood and dysregulated adrenal glands. The adrenal glands produce the stress hormone cortisol, and when there are high levels of androgens in the blood, a cortisol imbalance could develop in the body leading to too high or too low cortisol.
In this type of PCOS, high blood sugar and insulin resistance tend to be less prominent, and cortisol and androgen issues are the main players to address. Managing adrenal PCOS involves looking at stress management overall:
- Ensure sleep duration AND quality are on point
- Reduce high-intensity exercise to lower stress
- Bring in stress-lowering practices like meditation and breathwork
4) Post-Pill PCOS
Post-Pill PCOS is seen when someone comes off the oral contraceptive pill and experiences a hormonal imbalance caused by a short-term hormone rebound. It is common for androgens to overwhelm the system when coming off the pill, and in most cases, it takes time and patience for hormones to rebalance and resume back to normal. With this type of PCOS, typically only symptoms of high androgens are seen.
Managing this type of PCOS means considering:
- Time and Patience to allow for hormones to balance out
- Lowering inflammation overall can help
- Maintaining good quality sleep
- Lowering Stress overall
PCOS is a complex condition that is becoming more and more prevalent among women in their reproductive years, and it is crucial to take appropriate steps in managing it for the best health outcomes. Be sure to work with a healthcare provider that is well-versed in PCOS and the four different types, as they all require different attention to detail in how they are managed. Our coaches at CorePerform are trained to help women manage their PCOS and restore their health- book a discovery coaching call with us!
References
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Garg, A., Patel, B., Abbara, A., & Dhillo, W. S. (2022). Treatments targeting neuroendocrine dysfunction in polycystic ovary syndrome (PCOS). Clinical Endocrinology, 97(2), 156–164. https://doi.org/10.1111/cen.14704
González, F. (2011). Inflammation in polycystic ovary syndrome: Underpinning of insulin resistance and ovarian dysfunction. Steroids, 77(4), 300–305. https://doi.org/10.1016/j.steroids.2011.12.003
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Khan, M. J., Ullah, A., & Basit, S. (2019). Genetic Basis of Polycystic Ovary Syndrome (PCOS): Current Perspectives. The Application of Clinical Genetics, 12, 249–260. https://doi.org/10.2147/tacg.s200341
Kulshreshtha, B., Arora, A., Pahuja, I., Sharma, N., & Pant, S. (2016). Menstrual Cyclicity Post OC Withdrawal in PCOS: Use of Non-Hormonal Options. Journal of Obstetrics and Gynaecology, 36(6), 833–838. https://doi.org/10.3109/01443615.2016.1159667
Rosenfield, R. L., & Ehrmann, D. A. (2016). The pathogenesis of polycystic ovary syndrome (PCOS): The hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine Reviews, 37(5), 467–520. https://doi.org/10.1210/er.2015-1104