The Four Types of PCOS

PCOS (Polycystic Ovarian Syndrome) is a metabolic disorder that creates hormonal imbalances. In Australia, PCOS affects between 8 and 13 percent of people in their reproductive years. When treating a hormonal condition, the gold-standard is to first understand the root cause of the disease and what is contributing to your symptoms. It is believed that there are 4 main driving factors of PCOS, however, often these driving factors or ‘types’ of PCOS overlap and you may have a combination of contributing factors. Understanding the root cause of your PCOS can help to guide treatment options by placing more emphasis on particular strategies.

Insulin Resistance PCOS

The most common type of PCOS I see in my clinic is insulin resistance PCOS. It occurs in around 70% of women with PCOS, both overweight/obese and lean. Insulin resistance is when the body does not respond well to insulin and thus blood glucose is not being moved from the blood into cells. As a result, the body releases more insulin to help lower blood glucose levels. This leaves us with high blood glucose levels and high insulin levels. Excess insulin is associated with increased oestrogen and testosterone which contribute to anovulatory cycles and weight gain. This type of PCOS will often present with many of the typical PCOS symptoms such as high androgens, polycystic ovaries and insulin resistance.

Despite being commonly associated with excess weight, women who are highly active and lean can also present with insulin resistance due to a greater carbohydrate intake to support activity (e.g. endurance athletes).

How to get tested? As part of PCOS testing I always recommend getting fasting glucose, fasting insulin and HbA1C tested.

How to support: Balancing blood glucose levels is absolutely KEY here. Focus on a low to moderate carbohydrate intake, including unrefined varieties such as brown rice, quinoa, wholemeal/grain bread, starchy vegetables. All meals should have a quality protein source and about 1/2 plate of veggies. If there is excess weight, weight loss will be super beneficial with just as little as 5% showing improvements. Reduce intake of highly processed or high GI foods as they will contribute to inflammation and insulin resistance. Weight bearing exercise has been shown to reduce insulin resistance by creating more pathways for glucose to enter cells. Helpful supplements include inositol, magnesium and zinc.

Inflammatory PCOS

PCOS is understood to be a pro-inflammatory condition and it is believed that chronic inflammation can underpin the development of the condition. Inflammation is an important defence and protective mechanism in the human body and is crucial for when we have wounds to be healed and infections to fight, however long term elevated inflammation is linked to many health conditions and poor health outcomes. Research has shown that women with PCOS have elevated levels of CRP (C-reactive protein) compared to healthy individuals. Excess weight and androgens are both known contributors to inflammation and high inflammation also contributes to increased androgens and excess weight. Dietary triggers are also capable of stimulating an inflammatory response. You might find that along with PCOS, you also experience inflammatory symptoms such as aches and pains, IBS, fatigue, skin issues and headaches.

How to get tested? One way to test for chronic long term inflammation is by looking at CRP, cortisol and homocysteine levels through a blood test. Testing liver function can also help indicate the body’s ability to excrete toxins.

How to support: Following an anti-inflammatory diet can have a great impact on reducing inflammation levels. This typically looks like a Mediterranean diet with a focus on plant foods, fish, chicken, nuts, seeds, olive oil and a reduction in processed foods and red meat (max. 3-4 serves/week). The addition of supplements such as omega 3 and antioxidants can help reduce inflammation, along with adding herbs and spices such as ginger or turmeric. It is also crucial to look at overall gut health and identifying any food intolerances or triggers.

Post-Pill PCOS

When we are on the pill, our androgen production is supressed. Post-pill PCOS occurs when some women come off the pill and experience a surge in androgens, or nothing at all, which results in symptoms of PCOS. It is often temporary and only occurs for women who have no history of PCOS (i.e. before the pill). In order to identify post-pill PCOS, we must eliminate other possible causes such as insulin resistance. The best way to support this type of PCOS is to give your body time to recalibrate and focus on gut health, liver health and supplementing to correct common post pill deficiencies such as zinc. Focus on quality protein and fibre to help with detoxification pathways.

Adrenal PCOS

Adrenal PCOS is a stress induced type of PCOS that will present with elevated levels of DHEA (Dehydroepiandrosterone), a precursor to oestrogen and testosterone produced by the adrenal glands. In this type of PCOS it is common for only DHEA to be elevated and other androgens normal. Symptoms typically include chronic fatigue, irritability, weight gain, anxiety, hair loss, and trouble sleeping. Since this is a stress-induced type of PCOS, a lot of treatment therapies revolve around reducing stress on the body, both mental and physical. This can come from a range of diet and lifestyle strategies such as avoiding processed or triggering food, prioritising sleep, avoiding stimulants, avoiding high intensity exercise and implementing de-stress techniques. Magnesium, zinc and herbs can help to support the adrenals. If you are typically someone who is racing from A to B without any rest in between then this is your sign to slow down and let go. Get support in areas of your life where it’s needed and adjust your routine to allow for a slower pace.

Summary

Finding the root cause of your PCOS is crucial in targeting the appropriate diet and lifestyle changes. However, don’t get stuck into thinking there is just one answer to your PCOS and treatment will often look like a combination of strategies to help support and reduce symptoms. Working with a specialised health care professional can help to get you on the right track of managing your PCOS.

References

Aboeldalyl S, James C, Seyam E, Ibrahim EM, Shawki HE, Amer S. The Role of Chronic Inflammation in Polycystic Ovarian Syndrome-A Systematic Review and Meta-Analysis. Int J Mol Sci. 2021 Mar 8;22(5):2734. doi: 10.3390/ijms22052734. PMID: 33800490; PMCID: PMC7962967.

González F. Inflammation in Polycystic Ovary Syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids. 2012 Mar 10;77(4):300-5. doi: 10.1016/j.steroids.2011.12.003. Epub 2011 Dec 8. PMID: 22178787; PMCID: PMC3309040.

Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S. Comparison of the Different PCOS Phenotypes Based on Clinical Metabolic, and Hormonal Profile, and their Response to Clomiphene. Indian J Endocrinol Metab. 2019 May-Jun;23(3):326-331. doi: 10.4103/ijem.IJEM_30_19. PMID: 31641635; PMCID: PMC6683693.