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.
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!
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.