The 5 Types of PCOS

PCOS, it’s not easy... especially in the beginning when you don’t know what is causing it and you’re bombarded by terrifying information on google. Trust me, I’ve been there!

I had appointments with every doctor’s office, from the gynecologist who just prescribe birth control and told me I was infertile to the holistic doctor who overloaded me with expensive supplements. Neither doctor had any idea what the root of the cause was and whenever I begged for answers, they would say that research is inconclusive, there is no cure, it’s either birth control or testing a bunch of expensive supplements out until you hopefully figure out the solution.

It took a lot of trial and error to find the right doctor, and to think I was studying nutrition, telling everyone I wanted to be a dietitian at the same time as struggling with weight, mood swings and acne!

Luckily, I didn’t give up and one day in grad school, while I gave a presentation on PCOS, someone came out and said that she was insulin resistant and an acupuncturist was able to bring her period back. Thanks to somehow fearless standing in front of the class telling everyone I have PCOS... I found my solution. I took control of my insulin resistance and my inflammation through acupuncture and a gluten free diet and have been having regular periods ever since! I recently got an ultrasound just to be sure I don’t have an ovarian cyst that I’m unaware of, and they told me my ovaries look MUCH improved.

PCOS can be caused by many factors and to make it become dormant, you will need to treat the root of the cause. Remember, you can have several causes at once since they are all correlated. For example, insulin resistance can be exacerbated by stress hormones which can be triggered by chronic inflammation. Here are the most common causes that can be tested and addressed with a Registered Dietitian, acupuncturist or endocrinologist.

1. Insulin Resistance

This is the most common cause of PCOS. If you are one of the 70% of women with insulin resistance-related PCOS, your doctor may have prescribed you metformin. My route to healing insulin resistance was acupuncture by Erica Docimo as well as significantly reducing carbohydrates from my diet.

Insulin helps our cells store glucose. When glucose is left in the bloodstream, it causes damage to the cells in our brain, liver, pancreas, eyes etc and leaves us susceptible to type 2 diabetes. In order to prevent that, insulin tries to store glucose in our cells if they are not insulin resistant. When cells have been bombarded by glucose too much, low grade inflammation occurs and the cells start to get resistant. High insulin ends up stimulating the ovaries to produce more androgens, resulting in two contributing causes of PCOS: insulin resistance and adrenal dysfunction.

When our bodies have too much glucose in the blood, it can be toxic and the glucose will store as fat. This is why it is so easy to put on weight with insulin resistance and very hard to lost it. Everything you eat, whether it is a healthy balanced diet or junk food, can stick to your body.

The best test is the oral glucose tolerance test, which is when glucose is given and blood samples are taken to measure how quickly the glucose was cleared out of the blood. If this is not possible at your healthcare facility, your doctor will likely ask for a fasting blood glucose test and HbA1c, which are not as accurate. It is important to know that test results that are still in the “normal” range may be deceiving. Medical normal range does not signify optimal blood glucose range, which is what I refer to when looking at my patient’s lab results.

2. Post Birth Control

For some women, it is easy to get regulated after getting off the pill, but for others it is difficult. The pill disrupts the communication between your brain and ovaries and sometimes it’s difficult for our bodies to bounce back after getting off the pill. You want to get two hormones to function properly and those are Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH). If the ratio of LH to FSH becomes greater than 3:1, ovulation will not be able to occur. Unfortunately, your body’s ability to bounce back could take some time and patience as well as the help of an endocrinologist.

3. Adrenal Dysfunction and Stress

When taking a blood test, DHEA-S, cortisol or cortisone will be especially good indicators. If they are high, then stressors affecting adrenal dysfunction is likely the cause of PCOS. Adrenal dysfunction can be triggered by many factors, some of them being controllable. I see patients who work long hours, with stressful deadlines on top of over-exercising daily to try to keep their weight off. These patients are only to see discouraging results because it’s causing adrenal fatigue and exacerbating the PCOS. As mentioned previously in number 1, adrenal dysfunction stems from having too much insulin left in the blood stream, so it is important to address insulin resistance at the same time.

I could definitely fit myself into the “exacerbated” category while I was in college and you may be able to too. I realized I had to make a change. That was when I started to practice mindful meditation, yoga and read The Power of Now by Eckhart Tolle every night.

4. Chronic Inflammation

Inflammation starts with the gut and can be triggered by the mediator response to certain foods. One possible test for inflammation in the body is C-reactive protein (CRP). Inflammation has shown to increase androgens and prevent you from ovulating. If you find yourself getting sick all the time or having sore joints, IBS and skin problems, these could be indicators. One way to reduce diet induced inflammation is to take a food sensitivity test and change your diet with the help of a Registered Dietitian.

Even if you have a genetic predisposition to PCOS, the right environmental conditions must be present for those genes to show. The good news is that we can do our best to figure out what those triggers are and once we remove those triggers, PCOS can be reversed. Don’t waste another minute jumping between diets, supplements and medications. Try to find your causes and treat those specifically.