Which PCOS Type Are You?

Polycystic Ovarian Syndrome (PCOS) is one of the common female hormone imbalances that we see at Acubalance, though it doesn’t always look the same in every patient. It is diagnosed based on a set of criteria, the main one being the failure to ovulate regularly. But while some women struggle with hair loss and hirsutism (excess hair growth), others don’t. When we’re talking fertility, women with PCOS often have trouble conceiving because they don’t ovulate on a predictable schedule and their egg quality and uterine environment may be affected. If you’ve been diagnosed with PCOS, knowing what type of PCOS you have can drastically change the way you should be treating it.

PCOS is not a singular disease – there’s no “PCOS test” that you can take and know with 100% certainty whether you have the condition or not. 

To diagnose PCOS, a patient must have two of the following three signs, as per the Rotterdam criteria:

1. oligo- or an-ovulation (failure to ovulate regularly)

2. excess androgen (‘male hormone’) activity – measured via lab testing (of testosterone, DHEA, and androstenedione) or speculated by symptoms like acne and hair loss

3. polycystic ovaries visualized by ultrasound, from follicles that grow but don’t ovulate

So, first things first – you should never accept the diagnosis of PCOS based on ultrasound alone. See a physician with expertise in this diagnosis, one who is familiar with the idea that you need to fit 2/3 criteria and may not look like the ‘classic’ PCOS patient.

Here’s a quick overview of four types of PCOS, as defined by Lara Briden ND, to help you and your doctor decide if you have PCOS.

1. Insulin Resistant PCOS

This is the ‘classic PCOS’ patient, and also the most common. The culprit in the development of classic PCOS is insulin resistance – when the body becomes less responsive to insulin and blood sugars become imbalanced. High insulin and leptin impede ovulation and stimulate the ovaries to make testosterone.

What’s the cause? Insulin resistance is caused by obesity, sugar intake, smoking, trans fats, and environmental toxins.

Do you have it? Ask your doctor to check your fasting insulin and fasting glucose levels. You may also have elevated LH (luteinizing hormone) or cholesterol levels. You may be overweight, or normal weight with a history of extreme dieting or eating disorders.

2. Immune-Related PCOS

This second type of PCOS is due to chronic inflammation, which can be the result of many different causes. This inflammation impedes ovulation and disrupts hormone receptors, stimulating adrenal gland androgens like DHEA. Women with family or past medical history of other immune dysfunctions, like autoimmune conditions, may be more likely to develop this type of PCOS.

What’s the cause? Immune system dysfunction causes chronic inflammation that eventually leads to elevated androgens. You may have a family history of autoimmune disease, or past history of skin conditions, recurrent infections, or joint pain. 

Do you have it? Blood tests for inflammatory markers like CRP, ESR, vitamin D deficiency, thyroid antibodies, and food sensitivities/allergies should be evaluated. You may also have elevated DHEA-S, an adrenal androgen.

3. Post-Pill PCOS

This type of PCOS is perhaps my favourite to treat because there is a fairly obvious cause and it is generally very responsive to natural treatment. For most women, a slow-to-restart period after stopping the birth control Pill will normalize within the first six months, but for others, the suppression can last years and require treatment.

What’s the cause? After years of the Pill hijacking your hormones, the body has a hard time producing its own Estrogen and Progesterone again, making ovulation natural or nonexistent.

Do you have it? Though you may have had regular periods before taking the Pill, since coming off you’ve had an irregular cycle and perhaps have battled with acne. You likely have elevated LH (luteinizing hormone), and potentially also have elevated prolactin, though lab tests may be normal.

4. Environmental PCOS

The final, and perhaps simplest, type of PCOS is one where there is a single environmental (or other hormonal) imbalance that is interfering with your body’s ability to ovulate on a regular schedule. It can take a bit of trial-and-error to determine the true cause of PCOS in these cases, but once found, patients respond very quickly to treatment. 

What’s the cause? In patients who are sensitive, certain food choices can play around with the body’s ability to ovulate. For example, I have seen patients begin to ovulate regularly after taking soy out of their diets, by properly supplementing a strict vegetarian diet, or by removing artificial sweeteners. I also include thyroid disease in this category, because hypothyroidism can disrupt normal ovulation.

Do you have it? If you don’t fit into the category of the other types of PCOS, or don’t respond well to regular PCOS treatments, it may be time to have a look at environmental factors or the thyroid.

Of course, there can be overlap between these categories, and the diagnosis is not always black and white. Ask your Acubalance practitioner for more information, or to have more comprehensive testing done to determine your PCOS type.