What type of PCOS do I have?
So you’ve been told you have PCOS, but do you know which type you have?
Let’s run through the four different types of PCOS, and what is occurring in each.
PCOS (Polycystic Ovarian Syndrome) is a hormonal disorder affecting around 10% of women.
Firstly, what is PCOS?
Put simply, PCOS is a hormonal disorder which can cause irregular periods as well as unwanted physical symptoms. Common signs and symptoms of PCOS include:
Acne - often jawline
Oily skin and hair
Excess hair growth on the face and body
Hair thinning on the head
Weight gain or trouble losing weight
Lack of ovulation
Difficulty falling pregnant
PCOS symptoms are caused by an imbalance in hormones, particularly high levels of androgens (‘male’ hormones in the body) such as testosterone and SHBG. When these hormones are higher than they should be, this can lead to common signs like acne and excess hair growth as well as issues with ovulation, irregular periods and infertility.
PCOS cannot ever be diagnosed by ultrasound alone. It can only be diagnosed with ultrasound AND a blood test. If it has, it’s time to get a second opinion.
So, what type of PCOS do I have?
In order to effectively treat PCOS you need to know the type of PCOS you’re dealing with. The 4 types of PCOS include:
Insulin resistant PCOS
This is the most common type of PCOS. Insulin resistance is basically where there are higher levels of insulin than normal in the body. This happens when our cells become a bit “numb” to the effects of insulin, which causes the pancreas to pump out more and more insulin until the cells get the message. In this type of PCOS, you may be struggling with your weight, holding weight around the stomach/abdomen, have sugar cravings as well as symptoms like fatigue or brain fog. It’s high levels of insulin that drives up androgen levels which cause issues like excess hair, male pattern hair loss and acne.
To rule out insulin resistance, you NEED to have your fasting insulin tested.
Normal fasting insulin levels are less than 10 mIU/L
To help manage insulin resistant PCOS, the key is down to improving your insulin sensitivity. You can work on this through:
Post-pill PCOS occurs in some people after they stop taking the oral contraceptive pill. In this type, symptoms like acne, irregular periods and excess hair growth were not present prior to starting the pill at all.
After coming off the pill, there is a huge surge in androgens (testosterone) which can cause typical PCOS symptoms, however in this type there is no insulin resistance.
This type of PCOS is due to an abnormal stress response and affects around 10% of those diagnosed. Typically DHEA-S (another type of androgen from the adrenal glands) will be elevated alone, and high levels of testosterone and androstenedione are not seen. This type of androgen unfortunately isn’t often tested.
In inflammatory PCOS, chronic inflammation causes the ovaries to make excess testosterone, resulting in physical symptoms and issues with ovulation. Signs of inflammation in this type of PCOS include headaches, joint pain, unexplained fatigue, skin issues like eczema and bowel issues like IBS. Typically, you will see raised inflammatory markers on a blood test, such as a high CRP (C reactive protein) above 5. Other tests such as fasting glucose and insulin are in the normal range, but can sometimes be affected as inflammation can affect these numbers.
Could it be something else?
Symptoms that seem like they are being caused by PCOS can often be from something else called Hypothalamic Amenorrhoea. In hypothalamic amenorrhoea (HA), your period can stop due to under-eating and/or overexercising, and similarly to PCOS can present itself with mild acne, excess hair growth and a polycystic ovary appearance on an ultrasound. This misdiagnoses is problematic as treatment of the two conditions are very different.
The main difference when in comes to PCOS vs hypothalamic amenorrhoea is what is known as the LH:FSH ratio. In PCOS, luteinising hormone (LH) can be 2-3 times higher than follicle stimulating hormone (FSH) when they should be at about a 1:1 ratio. In hypothalamic amenorrhoea however, the opposite is true, and LH can be much lower than FSH.