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4 types of PCOS (and HOW to know which one you have!)

Polycystic Ovarian Syndrome (also known as PCOS) is a complex, yet common hormone disorder that affects approximately 1 in 10 women of reproductive age. If you’ve recently been diagnosed with PCOS or have struggling with PCOS for a while, I’m sure you’ll be all too familiar with the signs associated with the condition including irregular periods, weight gain, hair thinning and acne (particularly around the jawline).

Finding out you have PCOS can be a real shock, sometimes causing fear, anxiety and even guilt around your future fertility (due to its effect on ovulation).

Please know you’re not alone and let me tell you that there are SO many ways to naturally manage your symptoms of PCOS through dietary and lifestyle changes! The good news is that PCOS doesn’t have to be an infertility diagnosis and can be successfully managed by both conventional and functional medicine approaches.

But firstly, what exactly is PCOS?

According to the NHS, the 3 main features of PCOS include:

  • Irregular periods or no periods at all (due to ovulatory dysfunction).

  • Excess androgens (or higher levels of ‘male’ hormones that may cause physical signs such as excess body hair (also known as hirsutism) or acne.

  • Polycystic ovaries – your ovaries contain many fluid-filled sacs (or follicles) that surround the eggs. When ovulation isn’t happening on a regular basis, the ovaries can develop many small cysts. This will usually be confirmed via a vaginal ultrasound but it’s worth mentioning that PCOS cannot solely be diagnosed by an ultrasound alone.

If a woman has at least 2 of these symptoms, they may be diagnosed with PCOS. However, there has been lots of controversy surrounding the criteria to diagnose PCOS, as women can present with different symptoms and despite its name, not all women develop ‘cysts’.

PCOS is also associated with an increased risk for developing health problems later in life, such as high cholesterol or type 2 diabetes. You may be more likely to have PCOS if your Mum or sister has it.

How to treat PCOS

Unfortunately, there isn’t a one-size-fits all approach when it comes to PCOS. As a registered nutritionist specialising in women’s hormonal health, I know from client experience just how unhelpful it can be when you’re just told to “lose weight” or “go on the pill” to manage the condition. The truth is, it can be difficult to lose weight when you have PCOS – weight gain is one of the symptoms associated with PCOS after all!

Why is it so hard to lose weight with PCOS?

Many women struggle to lose weight with PCOS as the condition can create an imbalance in hunger hormones and cause your blood sugar levels to spike and crash throughout the day. As PCOS can also make your body resistant to insulin, causing your pancreas to make more of the hormone. The excess insulin can put your body is constant fat-storing mode and cause more weight gain.

However, it is possible to still lose weight with PCOS!

PCOS affects every woman differently and knowing WHAT type of PCOS you have is, in my opinion, the first step in understanding your condition and therefore being able to successfully manage your PCOS.

What type of PCOS do I have?

1) Insulin-resistant PCOS

Many women who have PCOS have the ‘classic’ type of PCOS which is characterised by high fasting insulin levels or abnormal levels on a glucose tolerance test. You may also have had an elevated HbA1c reading or have been told you are pre-diabetic alongside your diagnosis. This type of PCOS is the most common and thought to affect 70% of those with PCOS. In this type of PCOS, you may be struggling to lose weight, have sugar cravings and fatigue.

Top tips for managing Insulin-resistant PCOS: prioritising sleep and reducing stress is KEY to maintaining blood sugar and insulin levels. You also want to focus on eating whole-foods that don’t spike your blood sugar and ensuring you eat a decent source of quality protein with every meal. Choosing low-glycemic index foods such as whole grains, brown rice, salmon, eggs, lentils, beans carrots, broccoli, peppers, apples, and blueberries are just a few suggestions. Chromium may be a helpful supplement in those with insulin resistant PCOS to help address blood sugar issues, though please check with your GP before taking any new supplements, especially if you are on any medication.

2) Post-pill PCOS

Did you have normal periods before going on the oral contraceptive pill? If so, there’s a chance your PCOS is essentially a temporary state of higher androgen levels when you came off the pill (which peaks 3-6 months after coming off the pill). Some contraceptive pills such as Dianette or Yasmin cause a temporary rise in androgens which affect ovulation.

Top tips for managing post-pill: Be patient! This type of PCOS may even resolve on its own, though you can help to speed things up by implementing the right nutrition and lifestyle changes. We know that most oral contraceptive pills can severely deplete the body of certain nutrients such as magnesium. Not surprisingly, magnesium is crucial for blood sugar management and sleep, so can be helpful for those with PCOS! Great sources include dark-green leafy vegetables such as spinach, avocado, beans, almonds and cashews.

3) Inflammatory PCOS

Chronic signs of inflammation such as gut dysbiosis (an imbalance of good to bad bacteria within the digestive tract), unexplained fatigue, skin issues such as psoriasis or eczema, headaches or joint pain may be driving the ovaries to make excess testosterone. With Inflammatory PCOS, it’s common to see raised inflammatory markers on a blood test such as CRP/C reactive Protein) as well as the symptoms mentioned above.

Top tips for managing inflammatory PCOS: address gut health if you are having symptoms of gut dysbiosis (IBS, bloating, cramping and urgency) and adopt and anti-inflammatory diet. Check out my blog on gut health here for more info on supporting good digestion.

4) Adrenal PCOS

Adrenal PCOS suggests that you have high adrenal androgens such as DHEA-S or androstenedione. Unfortunately, these androgens aren’t usually tested, unless you see a hormone specialist. Your testosterone levels on the other hand, may be normal and you may even have regular periods/ovulate regularly.

Top tips for managing adrenal PCOS: Managing stress is key to support this type of PCOS so you should be prioritising daily self-care such as getting outside in natural daylight, journaling, yoga and even meditation. Reducing caffeine can also be helpful – especially in the afternoon when it may affect your sleep quality. You may also want to think about scaling back on any intense exercise which can put further stress on your adrenals.

Q: I’m still unsure as to what PCOS I have – is there another way I can find out which type I have?

If you’re feeling overwhelmed by all the various treatment options available for PCOS, but still aren’t sure exactly what is driving your PCOS, you’re in the right place! This is where I’ll often recommend comprehensive hormone testing such as the DUTCH test to help us create personalise a protocol depending on which hormones are out of balance for you. It can also tell us how effective your body is clearing hormones through the correct pathways. The DUTCH test is a urine test, so a great option if you’re not a fan of needles.

Hormones tested within the DUTCH test:

  • Estrogen (including 10 different types)

  • Testosterone

  • Progesterone

  • DHEA, DHEA-S and Androstenedione which can play a part in adrenal PCOS if elevated

  • Cortisol (including 4 different samples taken over 24 hours providing information about stress patterns throughout the day)

  • Melatonin which provides information into your circadian rhythm and sleep cycle

  • Vitamins B6 and B12 which play a key role in hormone metabolism, ovulation, and mood

  • Neurotransmitters such as dopamine and serotonin

  • Oxidative Stress Markers which give insight about free radicals and damage to cells

PCOS can be difficult to navigate alone. If you want to find out more information on the DUTCH test or how nutritional therapy can give you the tools to help manage your symptoms of PCOS and no longer want to feel in the dark about your condition, please feel free to book a FREE 30-minute Discovery call to find out if I can help you.

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