Welcome back to Part 2 of my PCOS blog series! Today, we’re going to explore the different types of PCOS. You might think there’s just one type of Polycystic Ovary Syndrome, but trust me, it’s a bit more complex than that! We’ll chat about the various types—like insulin-resistant PCOS, adrenal PCOS, inflammatory PCOS, and post-pill PCOS—and what makes each one unique. By understanding these differences, you’ll gain insight and be able to take some proactive steps for better management.
If you missed Part 1, where we chatted about the basics of PCOS, its symptoms, and some common myths, you can check it out right here!
1. Insulin-Resistant PCOS
Insulin-resistant PCOS is actually the most common type of PCOS, affecting about 70% to 80% of people dealing with it. Basically, it means the body’s not responding well to insulin, the hormone that helps keep our blood sugar levels in check. This resistance leads to higher insulin levels, which can result in weight gain, irregular periods, and even an uptick in testosterone production. Think of it like a thermostat in your house that’s not working quite right. When it ignores the signals to cool things down (insulin), the house (your body) gets too warm (with elevated insulin levels), leading to problems like weight gain and irregular periods.
Symptoms to Watch For
People with this type of PCOS might be overweight or obese, but it’s good to remember that they can also be at a normal weight or even “skinny” and still deal with other symptoms linked to insulin overload. If you’re experiencing persistent fatigue, unexplained weight gain, or sugar cravings, you might have insulin-resistant PCOS. Elevated insulin levels can also lead to skin changes like darkened patches in areas like the inner thighs, armpits, and back of the neck.
Testing for Insulin Resistance
Your doctor will probably look at your HBA1C levels, which can give a good idea of your average blood sugar over the past few months. However, keep in mind that it’s not always the best indicator for insulin resistance. To rule out insulin resistance, request a fasting insulin test (your doctor will likely decline, so you might need to go private). If so, it’s not an expensive test compared to most. Normal fasting insulin levels are less than 10 mIU/L (60 pmol/L), and optimal is between 2-5.
2. Adrenal PCOS
Adrenal PCOS arises when the adrenal glands produce excessive amounts of DHEA-S, a type of androgen, often triggered by stress. This form is associated with hyper-responsive adrenals, genetic factors, and stress, affecting approximately 10% of individuals diagnosed with PCOS. Interestingly, PCOS characterised solely by excess androgen production from the adrenals—without ovarian involvement—accounts for just 5-10% of cases. However, it is estimated that 20-30% of women with PCOS exhibit some degree of adrenal involvement.
Symptoms to Watch For
Women with adrenal PCOS might not exhibit insulin resistance or significant weight gain but may notice symptoms like acne or hair loss. Acne, hair thinning, and increased body hair are common symptoms. Stress often exacerbates these symptoms, making stress management essential.
Tests for Adrenal PCOS
My go-to for managing PCOS is the DUTCH Plus test, which is considered the gold standard for hormone testing. While blood tests can measure DHEA-S (Dehydroepiandrosterone sulfate) levels, they only provide a glimpse of the full picture.
In contrast, the DUTCH Test is comprehensive, measuring seven androgen metabolites in urine. These metabolites are important because they reflect the body’s hormone production and metabolism, offering deeper insight into androgen levels than serum testing. This is crucial since elevated androgens aren’t always detected in the serum of women with PCOS, making metabolite analysis vital for effective management.
3. Inflammatory PCOS
In inflammatory PCOS, persistent low-grade inflammation causes the ovaries to produce excess testosterone, resulting in various physical symptoms and disrupted ovulation. This inflammation also elevates cortisol, our stress hormone. Elevated cortisol levels can further increase androgens, complicating the hormonal balance even more. Elevated cortisol levels can further increase androgens, complicating the hormonal balance even more. So, inflammation isn’t just something that happens with PCOS; it’s actually connected to how the condition develops and progresses.
Symptoms to Watch For
If you have this type of PCOS, you might notice signs of inflammation like headaches, bloating, joint pain, allergies, and fatigue. You may experience brain fog, unexplained body aches, skin problems such as eczema and cystic acne, irritability, and digestive issues like constipation, diarrhoea, and IBS. Inflammatory PCOS can sometimes show up alongside other autoimmune disorders, like Hashimoto’s. In fact, women with PCOS are three times more likely to have Hashimoto’s compared to those without it because both conditions are rooted in inflammation.
Testing for Inflammatory PCOS
Testing typically involves checking for raised inflammatory markers on a blood test. Key markers include:
- C-Reactive Protein (CRP): Released by the liver during inflammation,
- Leukocytes/White Blood Cells (WBCs): Increased counts indicate an underlying inflammatory process.
- Interleukins: IL-6, IL-17, IL-1, and IL-8 are associated with PCOS. Elevated IL-6 is a recognised risk factor for cardiovascular disease and may indicate insulin resistance, while increased IL-17, IL-1, and IL-8 may signal the presence of polycystic ovaries.
Gut Health Testing
Testing your gut can be a game changer for anyone dealing with inflammatory PCOS. It helps pinpoint imbalances in the gut microbiome that are linked to this condition.
DNA Testing
Identifies genetic predispositions to inflammation-driven PCOS and inflammation as a whole
Oxidative Stress Markers
Measuring markers such as 8-0HdG provides insights into the level of oxidative damage occurring in the body.
4. Post-Pill PCOS
For some women, the cessation of birth control pills can trigger PCOS symptoms, known as post-pill PCOS. This type typically resolves itself within a few months, but during this period, women may experience irregular cycles and other typical PCOS symptoms.
Symptoms to Watch For
Irregular menstrual cycles, acne, mood swings, weight gain, and hair loss are some of the symptoms that can occur after stopping birth control.
Coming up in Part 3
Get ready to dive deeper into managing PCOS with lifestyle, nutrition, and supplements in the final part of this blog series.
In Part 3, we’re going to chat about some practical and effective strategies to boost your well-being. You’ll see how simple lifestyle tweaks can really make a difference—think stress management tips and the perks of staying active. We’ll also dive into some nutritional ideas that can help balance hormones and enhance your overall health. And let’s not forget about the role of supplements in managing symptoms. By the end, you’ll have a holistic toolkit ready to take on PCOS with confidence!.
Need Support?
PCOS can be a bit tricky to navigate, but I’m here to help! Maybe you’re thinking about starting a family, or simply want to manage your PCOS symptoms naturally, let’s chat about how I can support you!