The Different Types of PCOS (Polycystic Ovarian Syndrome)

Polycystic ovary syndrome (called PCOS for short) is one of the leading causes of female infertility. It is a lifelong health condition that affects approximately 5 million women in the US. In this article, we will take a closer look at the different types of PCOS.

What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a hormonal disorder that frequently occurs during the women’s childbearing years. It is associated with prolonged or irregular periods and signs and symptoms such as acne and excess hair growth (hirsutism) due to high androgen (male hormone) levels. Additionally, the ovaries can develop numerous follicles (fluid-filled sacs) and fail to regularly release eggs, leading to infertility.

Doctors do not know exactly what causes polycystic ovary syndrome, but low-grade inflammation, excess insulin, and excess male hormones are believed to play key roles. Certain genes are also involved, and there is a hereditary component to this condition.

Left untreated, PCOS can lead to complications such as infertility, miscarriage or premature birth, gestational diabetes, type 2 diabetes, high cholesterol levels, metabolic syndrome, heart disease, sleep apnea, depression, nonalcoholic steatohepatitis (liver inflammation), abnormal uterine bleeding, and endometrial cancer.

Early diagnosis, treatment, and weight loss are key for PCOS management.

What are the different types of PCOS?

Insulin Resistant PCOS

Around 70% of women with polycystic ovary syndrome have insulin-resistant PCOS, which is the most common type. Insulin resistance, also called hyperinsulinemia, is a condition in which there are higher than normal insulin levels in the body. Insulin is a hormone that plays a key role in blood sugar control. When insulin levels are high, the cells in the body become insensitive to its effects, i.e., they stop responding to insulin or become insulin resistant. In response, the pancreas makes more and more insulin in an attempt to get the cells to respond.

Symptoms of insulin-resistant PCOS include weight gain, especially abdominal weight gain around the mid-section, dark skin folds (acantosis nigricans), sugar cravings, brain fog, and unexplained fatigue. High insulin levels can also lead to adrenal androgen excess (high levels of male hormones), which can cause problems like excess hair growth and acne.

Doctors can diagnose insulin-resistant polycystic ovary syndrome by measuring fasting insulin and performing an oral glucose tolerance test (OGTT). Fasting insulin is a blood test. OGTT is an office-based test that provides information about glucose tolerance and insulin resistance.

Post-Pill PCOS

Some women develop a type of PCOS called post-pill PCOS 3-6 months after stopping birth control pills. Doctors believe it occurs because the ovaries experience a natural surge in the production of male hormones after coming off hormonal contraception. However, in this type of PCOS, there is no insulin resistance.

Symptoms of post-pill PCOS include irregular periods or no periods, acne, and excess hair growth. Notably, these typical PCOS symptoms are not present before starting the pill. Examples of oral contraceptives that have been implicated in post-pill polycystic ovaries include Yasmin, Ginet, and Yaz (they contain certain types of synthetic progestins).

PCOS diagnosis for pill-induced PCOS is based on medical history and blood tests such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

Adrenal PCOS

In this type of PCOS, DHEA-S (a type of androgen made by the adrenal glands) is elevated, while androstenedione and testosterone are normal. It is believed to occur due to an abnormal stress response.

Typical PCOS symptoms in adrenal PCOS include menstrual dysfunction, unwanted hair growth, acne, weight gain, and mood disorders.

Adrenal PCOS is relatively difficult to diagnose and requires specialized testing by an endocrinologist or some other specialist.

Inflammatory PCOS

Inflammatory PCOS occurs due to chronic inflammation which causes the ovaries to make more testosterone, resulting in problems with ovulation and other symptoms.

Signs and symptoms of inflammatory PCOS may include fatigue, headaches, joint pain, skin problems like eczema, and irritable bowel syndrome (IBS), all of which are related to the ongoing inflammation in the body.

Women with inflammatory PCOS often have elevated inflammatory markers such as C-reactive protein (CRP) that show on blood tests.

Treatment for PCOS

Treatment for insulin-resistant PCOS involves improving insulin sensitivity. This can be accomplished through:

Regular exercise to burn sugar and maintain a normal weight.
Avoidance of sugary foods and beverages.
A low-carbohydrate, high-protein diet.
Adequate sleep.
Stress management.

Treatment for post-pill PCOS involves patience, as it can take some time to correct itself. Like insulin resistance PCOS, it is important to eat a healthy diet, exercise regularly, get enough good quality sleep, and manage stress through yoga, mindfulness, meditation, and journaling.

To treat adrenal PCOS, you should follow the same advice listed above. In addition, it’s important to avoid high-intensity exercise and training, which can put stress on the adrenal gland and raise androgen levels.

Treatment for inflammatory PCOS includes improving gut health and taking steps to reduce inflammation overall. This includes removing food triggers and inflammatory foods from the diet, balancing gut bacteria, improving digestive enzymes, repairing leaky gut tissue, and improving overall digestion.

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