Types of Polycystic Ovary Syndrome

Insulin Resistant PCOS

Our endocrine system is like a communication network. It’s made up of a series of glands that communicate with the rest of the body. The glands tell different cells in our body to do something by releasing specific instructions via chemicals (hormones) in the bloodstream. The system is complex and functions in a sort of lock and key system. Under normal conditions, the hormone insulin rises briefly after eating. It stimulates the liver and muscles to take up sugar from the blood and convert it to energy. That intern causes blood sugar to decrease, and then insulin to fall.

But, what happens with Insulin resistance?

In insulin resistance, the signal ‘Insulin’ lock is not working to get the message through so the body is not converting the sugar into energy. In turn, the pancreas basically has to keep making more and more insulin to try to get its message through and signal the cells to open. The cells overtime become resistant to the constant insulin and need to be signalled more and more to get the message through and lower the blood sugar. When this resistance goes on for a while, you can end up with high insulin and high blood sugar. This basically means the body can make the insulin but it struggles to use it effectively. Too much insulin is also an underlying physiological driver of PCOS as it can impair ovulation. High insulin instructs the ovaries to make too much testosterone, increases luteinizing hormone (which increases testosterone), and lowers proteins that are supposed to bind up free testosterone which increases active testosterone in your body. It can cause the ovaries to produce excess testosterone instead of oestrogen.

Adrenal PCOS

It’s well known that stress can cause the disruption or total loss of menstrual function in women. The adrenal glands sit on top of each kidney and produce a number of hormones including the stress hormones and androgens. In response to stress, the adrenal glands are stimulated to produce cortisol, adrenaline, and noradrenaline, as well as adrenal androgen hormones, including DHEA, DHEA-S, and androstenedione.

For most PCOS patients, both the adrenal glands and the ovaries are the source of excess androgens, but for a smaller group of PCOS patients, the adrenal glands play a larger role. The adrenal type of PCOS is driven by an abnormal stress response versus an impaired insulin or blood sugar response as seen in the insulin-resistant type of PCOS.

If DHEA-S is your only high androgen this can indicate an adrenal type of PCOS as DHEA-S is your adrenal androgen. It can also mean that woman with PCOS symptoms could have normally functioning ovaries with no ‘cysts ‘and no insulin resistance, yet still fit the profile of PCOS. This type can also be amplified when women are undereating or overtraining which puts their body in a constant state of stress and lacking vital nutrients their bodies need. I also look for extreme stress situations, PTSD, trauma, lack of sleep and toxic home or work environments.

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Conditions

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Inflammatory PCOS

Chronic inflammation can stimulate the ovaries to make too much testosterone and is a contributing factor for every type of PCOS. Inflammation causes hormone imbalance by suppressing ovulation (so you don’t make progesterone) and increasing production of androgens. Inflammatory PCOS would be indicated if you have the ‘normal’ symptoms of PCOS but you do not have insulin resistance and you haven’t recently come of the pill. You might also experience chronic inflammation symptoms like chronic fatigue, IBS symptoms, auto-immune conditions, a previous history of an EBV virus, joint pain, skin conditions, low immunity, excessive mucus production, headaches or low mood/depression.

The key to this type of PCOS is to identify and correct the underlying source of inflammation. Inflammation directly decreases progesterone and increases androgens, and inflammation causes higher blood sugar and insulin, which causes higher androgens and decreased progesterone production.

Post Pill PCOS

A very common time for women to be diagnosed with PCOS is after coming off the birth control pill. The pill suppresses the communication between the brain and your ovaries which stops ovulation. When most women stop the pill, this communication will come back right away along with regular ovulation and regular periods. Some women however, will experience ovulation suppression for months or even years after the pill.

This one can be tricky as it is not well researched and often women are prescribed the pill if they are experiencing hormonal imbalances. If your periods were normal before taking hormonal birth control and now you meet the diagnostic criteria for PCOS you may have the post-pill type of PCOS. If you had experienced PCOS symptoms before going on the pill, but never received an official diagnosis it’s possible you had PCOS before going on the pill.

“Post pill’ PCOS I would mostly consider a temporary situation or transient form of PCOS where we need to bring back communication signals within the body, nourish the body + hormones and clear out cycling synthetic hormones.

Lean PCOS

While weight struggles can be a symptom of PCOS it’s entirely possible to have a lean type of PCOS in a ‘lean’ body as well. It basically means that these women are not having the same issues with weight gain. Women with this type are often still experiencing blood sugar imbalances, even if they are maintaining a normal weight. Women with this type tend to have a higher LH to FSH ration then classic PCOS. They also seem to have higher levels of DHEA-S which can help with metabolism.

What happens with insulin resistance in lean PCOS?

Many women with ‘lean’ PCOS still have insulin resistance (up to 75%) but it is not yet well understood why they are not gaining weight. There are also a lot of different theories between scientists as to whether weight gain comes first or insulin resistance does. It seems to differ from person to person. Maintaining blood sugar levels without extreme dieting is still really important with this ‘type’ of PCOS’.

Sometimes (not always) this type can be confused with ‘hypothalamic amenorrhea (HA) which is a loss of periods due to undereating or overtraining. Hypothalamic amenorrhea – meaning the communication between the hypothalamus – pituitary – ovaries is disrupted causing a lack of ovulation and menstruation. It can even present with facial hair, polysystic ovaries and acne. This is why there are problems diagnosing PCOS just through an ultrasound as it can be misdiagnosed and can be a serious problem because the treatment for PCOS is to eat less while the treatment for hypothalamic amenorrhea is to eat more!

Hidden PCOS

There are women who meet the diagnostic criteria for PCOS, but don’t have insulin resistance, inflammation or adrenal issues, and have not been affected by hormonal contraception. There is still a trigger for the symptoms, but it falls into this “other” category. Other drivers that can result in a hidden cause type of PCOS include thyroid disease because hypothyroidism affects ovulation and can worsen insulin resistance, deficiencies in vitamin D, zinc, or iodine, because your ovaries need these nutrients, or elevated prolactin because it can increase DHEA. It is important with this type to establish the cause as it can often rebalance the cycle.

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