Polycystic Ovarian Syndrome (PCOS) is a complex condition with different underlying causes. Researchers describe it as a diverse illness with various molecular pathways. In simpler terms, PCOS is a collection of symptoms, such as androgen excess and irregular menstrual cycles, which can be caused or worsened by various factors. 

To effectively address PCOS, it's crucial to identify the specific component or factors contributing to your symptoms. Let's dive into the different functional types of PCOS and discover which one might resonate with you.

Is it really PCOS? Understanding the Basics

PCOS primarily involves androgen excess, which refers to high levels of male hormones. If you have androgen excess as evidenced by:

a) high androgen levels (male hormones) in a blood test; and/or

b) substantial facial hair or jawline acne

Given that you’ve ruled out any other factors that may cause androgen excess, you probably have PCOS. 

You don't have PCOS if you don't have an excess of androgen, even if you’ve seen those cysts with your own eyes. Contrary to its name, PCOS has nothing to do with ovarian cysts. The so-called "cysts" seen on ultrasound are actually normal follicles or eggs in the ovary. That is true even if your periods are erratic or nonexistent. There are many factors that affect your period cycle, including hypothalamic amenorrhea, which is a lack of periods caused by undereating or carbohydrate restriction. And yes, it's possible that you were misdiagnosed with "lean PCOS" when you actually had hypothalamic amenorrhea.

Identifying Your PCOS Functional Type

There are four functional types of PCOS to consider: insulin-resistant PCOS, post-pill PCOS, inflammatory PCOS, and adrenal PCOS. 

Let's explore each type with their symptoms and underlying causes:

1. Insulin-Resistant PCOS

Symptoms: Irregular menstrual cycles, weight gain, increased hunger, skin changes (acne or dark patches), and hair thinning or loss. 

Causes: High insulin levels leading to androgen excess.

Insulin resistance, characterized by elevated insulin levels, is often associated with metabolic syndrome or pre-diabetes. To determine if you have insulin-resistant PCOS, a blood test measuring insulin levels is recommended. 

If your insulin levels are high, this likely drives the excessive androgen production in your body. 

Treatment Options: Treating insulin-resistant PCOS involves adopting a diet, exercise, and supplement regimen aimed at reversing insulin resistance. 

Key supplements like magnesium and inositol can be beneficial in this journey.

2. Post-Pill PCOS

 Symptoms: Irregular periods, acne flare-ups, mood swings, and mild hirsutism. 

Causes: Transient increase in androgens after stopping certain birth control pills.

Coming off certain birth control pills, such as Yasmin, Yaz, Diane, or Brenda, can result in a temporary increase in androgens. 

This transient increase is enough to diagnose a post-pill PCOS. 

Treatment Options: If you suspect post-pill PCOS, it's important to keep a cool head and understand that the symptoms you experience are a normal part of the drug withdrawal process. 

Natural anti-androgen supplements like zinc, DIM, or peony and licorice can provide support during this phase.

3. Inflammatory PCOS

Symptoms: Unexplained fatigue, bowel problems (IBS or SIBO), autoimmune disease (Hashimoto's thyroiditis), headaches, joint pain, and chronic skin conditions (psoriasis, eczema, hives). 

Causes: Chronic inflammation as the predominant factor leading to androgen excess.

Chronic inflammation can contribute to excessive testosterone production in the ovaries, playing a role in all types of PCOS. 

Treatment Options: Inflammatory PCOS occurs when chronic inflammation is the primary driver. Identifying and addressing the underlying source of inflammation is crucial for treatment. 

This might involve identifying food allergies, managing gastrointestinal issues, or addressing mast cell activation or histamine intolerance. 

Supplements like zinc and N-acetyl cysteine have shown promise in managing inflammatory PCOS.

4. Adrenal PCOS

Symptoms: Slightly elevated DHEAS levels, normal testosterone and androstenedione levels. 

Causes: Upregulated adrenal androgens through epigenetic factors.

In most women with PCOS, androgen levels are elevated from various sources, including the ovaries and adrenal glands. 

Adrenal PCOS, which accounts for about 10% of cases, specifically involves slightly increased DHEAS (a type of androgen) levels while testosterone and androstenedione levels remain normal. 

Adrenal PCOS is comparable to a hereditary disorder called congenital adrenal hyperplasia. 

Factors like insulin resistance and inflammation are not associated with adrenal PCOS. 

Treatment Options: Treatment for adrenal PCOS may include magnesium, zinc, licorice, adaptogen herbs, and vitamin B5.

Still Unsure? Consult a Professional

If you find yourself confused or seeking personalized guidance, don't hesitate to book a consultation with me. It's always beneficial to connect with a healthcare professional who specializes in PCOS to explore your specific situation and develop an effective treatment plan tailored to your needs.

Remember, understanding your PCOS functional type is the key to finding the right path towards symptom relief and improved quality of life.

Frequently Asked Questions (FAQs)

1. What are the common symptoms of PCOS?

PCOS can manifest with a range of symptoms, including irregular menstrual cycles, excessive hair growth (hirsutism), acne, weight gain, and fertility issues. Some women may also experience mood swings and skin changes like dark patches.

2. Can I have PCOS without ovarian cysts?

Yes, despite its name, PCOS does not always involve ovarian cysts. The "cysts" seen on ultrasound are actually follicles or eggs, which are normal for the ovary. A diagnosis of PCOS is primarily based on symptoms and hormone levels, not the presence of cysts.

3. What causes PCOS?

PCOS is a multi-factorial condition with various underlying causes. It may involve insulin resistance, chronic inflammation, and genetic factors. Each person's PCOS can have different contributing factors, which is why identifying the specific functional type is essential for personalized treatment.

4. Can PCOS be treated naturally?

Yes, depending on the type and severity, PCOS can often be managed with natural approaches. Lifestyle modifications such as adopting a healthy diet, regular exercise, stress management, and targeted supplements can help improve symptoms and hormone balance.

5. Is PCOS linked to fertility problems?

PCOS can impact fertility due to irregular ovulation or anovulation (lack of ovulation). However, with appropriate management and lifestyle changes, many women with PCOS can improve their chances of conception. Seeking guidance from a healthcare provider specializing in fertility and PCOS is recommended for those trying to conceive.

6. Is PCOS a hereditary condition?

While the exact cause of PCOS is not fully understood, there is evidence to suggest a genetic component. If a close family member, such as a mother or sister, has PCOS, it may increase your risk of developing the condition.

7. Can PCOS be diagnosed with a blood test alone?

Diagnosing PCOS typically involves a combination of factors, including medical history, physical examination, and blood tests. Hormone levels, such as androgens (male hormones), FSH, LH, and insulin, are commonly checked to aid in the diagnosis.

8. Can weight loss improve PCOS symptoms?

Yes, for some women with PCOS, losing weight can have a positive impact on symptoms and hormone balance. Weight loss can help reduce insulin resistance and androgen levels, leading to improved menstrual regularity and fertility.

9. Does PCOS increase the risk of other health conditions?

PCOS has been associated with an increased risk of certain health conditions, such as type 2 diabetes, high blood pressure, cardiovascular disease, and endometrial cancer. Managing PCOS through lifestyle changes and appropriate treatments can help mitigate these risks.

10. Can women with PCOS still get pregnant?

Yes, many women with PCOS can conceive and have successful pregnancies. However, PCOS can affect fertility due to irregular ovulation. If you are trying to conceive, seeking guidance from a fertility specialist or reproductive endocrinologist can be beneficial.

11. Are there any natural supplements that can help manage PCOS?

Yes, several natural supplements have shown promise in managing PCOS symptoms. These include inositol, berberine, omega-3 fatty acids, and cinnamon. Always consult with a healthcare provider before starting any new supplements to ensure they are safe and appropriate for your specific situation.

12. Does stress impact PCOS symptoms?

Yes, chronic stress can worsen PCOS symptoms and disrupt hormone balance. Stress management techniques, such as meditation, yoga, or counseling, can be helpful in reducing the impact of stress on PCOS.

13. Can PCOS go away on its own?

PCOS is a chronic condition, but its symptoms can often be managed effectively. For some women, lifestyle changes and targeted treatments can lead to a significant reduction in symptoms, and some may experience a remission of symptoms with time and proper care.

Empowered with knowledge about your PCOS functional type and the most effective natural treatments, you can embark on a journey of healing and symptom relief. Remember that PCOS is a manageable condition, and with proper guidance and lifestyle adjustments, you can take charge of your health and experience a better quality of life. Always prioritize your well-being by seeking support from healthcare professionals and embracing a holistic approach to healing.