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The 4 Different Types of PCOS

How to distinguish what type of PCOS you have @Nutrition_with_Lillia

Polycystic Ovarian Syndrome (PCOS) is a multifaceted hormonal disorder affecting approximately 10% of women. If you’ve recently received a diagnosis, rest assured that 1. you’re not alone, and 2. you’re in the right place for all the knowledge you require to naturally alleviate your symptoms.

What is PCOS?
Simply, PCOS is as a hormonal disorder that can cause irregular periods alongside other unwelcome physical symptoms. Common signs and symptoms of PCOS include:

  • Challenges with weight loss or gaining weight
  • Excessively oily skin and hair
  • Acne
  • Unwanted facial and body hair growth
  • Hair thinning or hair loss on the scalp
  • Areas of darkened skin
  • Unpredictable or absent menstruation
  • Difficulty conceiving
  • Anxiety and/or depression

The root cause of PCOS symptoms is in hormonal imbalances. Most often characterised by elevated levels of androgens (often deemed ‘male’ hormones in the body) such as testosterone and DHT. When DHT and testosterone are higher than they should be, they can cause acne, excessive hair growth, complications with ovulation, erratic periods, weight gain, difficulty losing weight and infertility.

But what about the ovarian ‘cysts’?
An intriguing inquiry! Despite the label, it’s crucial to comprehend that the ‘cysts’ associated with PCOS are not really cysts. They are actually just an increase in follicles, which is fairly common and even observable in women without PCOS. The term ‘polycystic’ then becomes rather misleading and is one of the reasons why there is debate about changing the name to something more accurate.

Remember this: PCOS can’t be conclusively diagnosed via ultrasound exclusively. Hormone levels need to be checked and investigated alongside symptoms.

PCOS Treatment
Traditional medical PCOS treatment frequently adopts a “one size fits all approach”, however no two women’s PCOS is the same. Therefore, no two women should receive the same treatment. Common advice my clients receive from doctors include “just loose weight” or “try the pill to regulate cycles”, but it is not as simple as that and more often than not this advice can make PCOS worse! This is why:

  1. Birth control pills don’t address the root cause of PCOS. Instead, they flood the body with artificial hormones that act like a plaster that mask PCOS symptoms. This can cause a myriad of issues when women stop the pill later on—especially if aiming for pregnancy—because symptoms tend to resurface and post-pill PCOS or Post Pill Syndrome can occur.
  2. Losing weight with PCOS can be very difficult (when not given the correct advise), because weight gain alone is one of the symptoms.
  3. There are four different types of PCOS and PCOS impacts each woman differently. Establishing your specific PCOS type is an important step towards managing your symptoms to recover from PCOS successfully.

So, what type of PCOS do you have?

For effective PCOS treatment and to natural reverse symptoms, identifying your specific PCOS type is essential. The four PCOS types include:

1. Insulin-Resistant PCOS
This represents the most common PCOS type, affecting around 70% of women. Insulin resistance (IR) is when there are higher insulin levels than there should be—also known as hyperinsulinemia. This occurs when our cells become insensitive to insulin, prompting the pancreas to increase insulin production until cells listen. Genetic and epigenetic changes, hyperandrogenaemia, and obesity aggravate IR. In this particular PCOS type, struggles with weight, fat retention in the abdominal region, sugar cravings, and symptoms like fatigue or mental fog are very common. Elevated insulin levels increase androgen levels, contributing to issues like excessive hair growth, male-pattern hair loss, infertility, and acne.

Medical practitioners often assess HbA1c or glucose levels. Although these readings provide partial insight into blood sugar, they don’t deliver the full picture. To rule out insulin resistance, it’s important to measure fasting insulin. Normal fasting insulin levels should be below 10 mIU/L (60 pmol/L).

To help treat the symptoms of PCOS, insulin sensitivity must be enhanced. This can be done with:

  • Regular physical activity and daily movement enhances sugar metabolism, muscle building, and insulin sensitivity.
  • Eliminate high-sugar foods and adopt a lower carbohydrate diet with adequate quality protein and healthy fats to stabilize blood sugar.
  • Prioritise quality sleep and stress management, both aid blood sugar and insulin control.
  • Supplementation with key nutrients such as magnesium, chromium, NAC, inositol, and berberine. It’s wise to collaborate with a nutritionist or naturopath to establish the correct supplementation and dosages as individual variations play a pivotal role.

2. Post-Pill PCOS
PCOS manifests in certain individuals upon discontinuing the oral contraceptive pill. Post-pill PCOS symptoms can include acne, sporadic periods, anxiety, insomnia and excessive hair growth that were notably absent before commencing birth control. Brands such as Ginet, Yasmin, and Yaz are often linked to this PCOS variation due to the types of synthetic progesterone’s they contain. Following stopping birth control, the ovaries undergo a surge in androgens, provoking PCOS symptoms.

However, unlike other PCOS types, insulin resistance is not a factor. This variant commonly emerges 3-6 months post-pill cessation and is often missed for this reason. Post-pill PCOS symptoms can naturally resolve with time (typically 6 months to 2 years) however this but can be sped up with proper nutrition, lifestyle alterations, and supplementary or herbal assistance.

Successful management of post-pill PCOS involves:

  • Practicing patience as this type necessitates time for reversal.
  • Consulting a Nutritional Therapist for supplementation. Essential nutrients such as magnesium, vitamin E, vitamin B6, zinc, as well as specific herbs like chaste tree and peony can support ovulation and mitigate excessive androgens.
  • Quality sleep and stress management. Like insulin resistant PCOS, a balanced hormonal state relies on adequate sleep and stress reduction.

3. Adrenal PCOS
Adrenal PCOS originates from an irregular stress response, affecting roughly 10% of those diagnosed due to dysregulated cortisol. Typically, elevated DHEA-S (another androgen from the adrenal glands) is observed independently, while heightened testosterone and androstenedione levels are not present. Unfortunately, this androgen variety is infrequently examined unless investigated by an endocrinologist, Nutritional Therapist or functional health specialist.

Successful management of adrenal PCOS entails:

  • Stress management: engaging in activities like yoga, meditation, mindfulness, and journaling bolsters the nervous system and hormonal aids hormonal balance.
  • Adequate sleep: aim for a minimum of 8 hours per night, this fosters stress alleviation, recovery and hormonal balance.
  • Moderate exercise: intense exercise training puts undue stress on the adrenal glands adding to adrenal dysfunction, instead opt for regular daily gentle and calming exercise.
  • Limit caffeine: steer clear of coffee, tea, and fizzy drinks.
  • Consultation for herbal and supplement guidance: herbs such as withania, rhodiola, and liquorice can aid in stress adaptation and recovery. Key nutrients like magnesium, vitamin B5, and vitamin C support adrenal glands and nervous system health. Precise dosages and suitable supplements varies between individuals, consult a healthcare practitioner to determine the suitability and appropriate dosages for your specific needs.

4. Inflammatory PCOS
Inflammatory PCOS is characterised by chronic inflammation that encourages the ovaries to overproduce testosterone, resulting in ovulation difficulties and physical symptoms. Indicators of inflammation include headaches, joint discomfort, unexplained fatigue, skin conditions like eczema, and gastrointestinal issues such as irritable bowel syndrome (IBS). Blood tests generally reveal elevated inflammatory markers, include elevated CRP (C-reactive protein), while fasting glucose and insulin are within the normal range.

Successful management of adrenal Inflammatory PCOS entails:

  • Addressing gut health: supporting the healing process for the gut, including repairing the integrity of the gut lining to address leaking gut, balancing the gut microbiome, enhancing digestive enzyme function, and eliminating pathogenic bacteria. These measures collectively contribute to an overall reduction in inflammation.
  • Identify and remove food triggers: identifying potential food sensitivities and subsequently eliminating inflammatory foods is a crucial step in managing inflammation associated with PCOS. It can be challenging to pinpoint which foods might be the culprits behind your inflammation, collaborating with a nutritionist is highly recommended to guide you through this process.
  • Incorporate natural anti-inflammatories: consider integrating natural anti-inflammatory agents into your regimen. These may include turmeric, omega-3 fatty acids, and antioxidants like NAC (N-acetylcysteine). Before adding these supplements to your routine, consult a healthcare practitioner to determine the suitability and appropriate dosages for your specific needs, ensuring their effectiveness.

Could it be another condition?
PCOS can sometimes be confused with another condition known as Hypothalamic Amenorrhoea (HA). In Hypothalamic Amenorrhoea, your menstrual cycle can halt due to insufficient caloric intake and/or excessive exercise. Interestingly, HA can share some resemblances with PCOS, such as mild acne, excessive hair growth, and an ovarian appearance on ultrasound that mimics polycystic ovaries. This misdiagnosis can be problematic because the treatment approaches for these two conditions differ significantly.

The primary distinguishing factor between PCOS and Hypothalamic Amenorrhoea lies in what’s known as the LH:FSH ratio. In PCOS, the luteinising hormone (LH) levels can be 2-3 times higher than the levels of follicle-stimulating hormone (FSH). Ideally, these hormones should maintain a 1:1 ratio. Conversely, in Hypothalamic Amenorrhoea, LH levels tend to be much lower than FSH levels, presenting a stark contrast to the hormonal imbalance observed in PCOS. This differentiation underscores the importance of precise diagnosis to tailor the most appropriate treatment strategy for your specific condition.

Still Uncertain?
Polycystic Ovarian Syndrome can be a challenging journey to navigate solo. PCOS is a complicated, multifaceted hormonal disorder that may require time and functional testing to resolve. If you’re fed up of being on hormonal contraception, planning to begin a family, or seeking a natural approach to manage your PCOS symptoms, reach out to me for further information on how my health packages can provide you with the assistance you need.

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