Polycystic Ovarian Syndrome (PCOS) is a common disease affecting up to 13% of reproductive age women in Australia (1). However, like most diseases – the cause is often multifactorial and specific to the individual.

In order to treat PCOS, we need to identify what type of PCOS you have. So let me explain to you the 4 different types…

What is PCOS?

Polycystic Ovarian Syndrome (PCOS) is a common hormonal condition in women where they have an excess in androgens (male hormones) and/or insulin resistance. The cause is not understood fully; however, it is suggested that it is a combination of family history, genetics, hormones and lifestyle factors play a role in the development.

Many people assume that you need to have cysts on your ovaries in order to have PCOS, however that is simply untrue. To be diagnosed with PCOS, women need to have two out of the three of the following symptoms:

  • Irregular or absent periods
  • High androgens or symptoms such as excess hair growth and acne.
  • 12 or more follicles on the ovaries visible on an ultrasound (i.e. polycystic ovaries).

However, the diagnosis of PCOS does not stop here. Once you have been diagnosed with PCOS, it is recommended that you delve deeper to determine the type that you have in order to treat the symptoms that you are experiencing.

The 4 Types of PCOS

In order to gain control over your PCOS symptoms, you do NOT need to eliminate any foods or follow a restrictive diet. That’s why, we need to address the root cause of your PCOS and hence identify which type of PCOS you have. So, what type of PCOS do you have?

1. Insulin-Resistant PCOS

Insulin resistance is essentially a condition where your cells become blunted to the action of insulin. When we eat food, it gets broken down into glucose in the bloodstream and insulin is released in order for your body to store that glucose. However, when your cells become unresponsive to the insulin being released it causes elevated blood glucose levels and potentially elevated insulin levels to compensate.

High levels of insulin result in an increased production of androgens, resulting in insulin-resistant PCOS (2).

Read our recent blog post on Insulin Resistance to learn more about the top dietary and lifestyle tips to support your insulin sensitivity.

CRITERIA: 2 of the general criteria symptoms + high insulin levels.

2. Post-Pill PCOS

Hormonal birth control pills are often prescribed to ‘manage’ your PCOS symptoms, but did you know that they can be the root cause?

If the signs of PCOS begun when you stopped taking the oral contraceptive pill (OCP) then it is most likely you have you have post-pill PCOS. The OCP aims to temporarily prevent ovulation, however this can last for months or even years for some women coming off it. This in combination with a temporary surge in androgens is enough to qualify for PCOS – or more specifically, post-pill PCOS (2).

The good news? This type of PCOS is temporary, it can heal with time however appropriate support may be needed.

CRITERIA: 2 of the general criteria symptoms + symptoms begun once coming off the pill (+ insulin resistance has been ruled out).

3. Inflammatory PCOS

As we know, inflammation in the body can manifest as many diseases and conditions in the body. Factors such as stress, environmental toxins, intestinal permeability and certain inflammatory foods drive inflammation (3).

But why is this a problem for PCOS? Inflammation prevents ovulation, disrupts hormone receptors and enhances the production of adrenal androgens (e.g. DHEA and androstenedione) (3).

Symptoms of inflammatory PCOS include unexplained fatigue, bowel problems like IBS or SIBO, headaches, joint pain and chronic skin conditions such as eczema, hives or psoriasis (2).

CRITERIA: 2 of the general criteria symptoms + inflammatory symptoms (+ insulin resistance has been ruled out + you have not just come off the pill).

3. Adrenal PCOS

Adrenal PCOS is the least common type affecting approximately 10% of those with PCOS – but nonetheless important to identify (2).

In most PCOS cases, all androgen levels are elevated including testosterone and androstenedione (from the ovaries) and DHEAS (from the adrenal glands) (3). However, if you have normal testerosterone and androtestosterone and elevated DHEAS then you may have adrenal PCOS.

These elevated DHEAS are a result of genetic upregulated adrenal androgens (2).

CRITERIA: 2 of the general criteria symptoms + solely elevated DHEA (+ insulin resistance has been ruled out + you have not just come off the pill + no signs of inflammation).

The bottom line.

Are you feeling overwhelmed?

The good news is in most cases, PCOS is not a permanent condition. Once you know your type of PCOS, it is much easier to treat the root cause. If you need assistance with this, don’t hesitate to reach out and ask any questions via [email protected] or book an Initial Nutrition Consultation so we can treat your PCOS holistically.

Written by:

Mollie Caughey-Wade,

Clinical Nutritionist (BSc).

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