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PCOS types, symptoms, diagnosis, and treatment approaches
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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.
Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder affecting around 10% of women.
Put simply, PCOS can cause irregular periods and unwanted physical symptoms.
Acne (often along the jawline)
Oily skin and hair
Excess hair growth on the face and body
Hair thinning on the head
Weight gain or trouble losing weight
Irregular periods
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 elevated, they can lead to acne, excess hair growth, irregular ovulation, and infertility.
⚠ PCOS cannot be diagnosed by ultrasound alone. It must be diagnosed with both an ultrasound and a blood test. If you've been diagnosed by ultrasound only, it’s time to get a second opinion.
In order to effectively treat PCOS, you need to know which type of PCOS you’re dealing with. The four types of PCOS include:
✔ Cause: High levels of insulin resistance in the body.
✔ Symptoms: Struggling with weight, weight gain around the abdomen, sugar cravings, fatigue, and brain fog.
✔ Effect: High insulin drives up androgen levels, leading to acne, excess hair growth, and hair thinning.
How to diagnose:
✅ Fasting insulin test
✅ Normal fasting insulin levels should be less than 10 mIU/L
How to manage:
✔ Improve insulin sensitivity through diet, exercise, and lifestyle changes
✔ Reduce processed sugar intake
✔ Consider supplements to support insulin regulation
✔ Cause: Some people experience PCOS symptoms after stopping the contraceptive pill.
✔ Symptoms: Acne, irregular periods, and excess hair growth that weren’t present before starting the pill.
✔ Effect: Coming off the pill causes a temporary surge in androgens (testosterone), triggering PCOS-like symptoms.
✔ Key Difference: No insulin resistance is present in this type of PCOS.
How to manage:
✔ Support hormone balance with nutrition, stress management, and supplements
✔ Allow the body time to naturally regulate hormone production
✔ Cause: Abnormal stress response affecting adrenal hormones.
✔ Effect: Elevated DHEA-S (an adrenal androgen), but normal testosterone and androstenedione levels.
✔ Key Difference: This type is stress-driven, rather than insulin-related.
✔ Testing: DHEA-S levels (often overlooked in standard tests).
How to manage:
✔ Focus on stress management techniques (meditation, deep breathing, yoga)
✔ Support adrenal health with adaptogenic herbs and proper sleep
✔ Cause: Chronic inflammation leading to excess testosterone production.
✔ Symptoms: Headaches, joint pain, unexplained fatigue, skin issues (eczema), IBS or digestive concerns.
✔ Testing: Raised CRP (C-reactive protein) levels above 5 in blood tests.
✔ Effect: Inflammation can affect ovulation and cause hormonal imbalances.
How to manage:
✔ Reduce inflammatory foods (processed foods, refined sugars, vegetable oils)
✔ Include anti-inflammatory foods (berries, turmeric, omega-3s)
✔ Address gut health and digestive function
⚠ Hypothalamic Amenorrhoea (HA) vs. PCOS
Symptoms of PCOS may actually be caused by Hypothalamic Amenorrhoea (HA), a condition where periods stop due to under-eating or over-exercising.
✔ PCOS: LH (Luteinising Hormone) is 2-3x higher than FSH (Follicle Stimulating Hormone).
✔ HA: LH is lower than FSH.
Misdiagnosing PCOS and HA can be problematic, as their treatments are very different!
Understanding your PCOS type is crucial for effective treatment. Getting the right blood tests, identifying symptoms, and making targeted lifestyle changes can make a huge difference in managing PCOS.
If you suspect you have PCOS but haven’t received the right tests or diagnosis, consider consulting with a PCOS-specialized healthcare provider for personalized guidance.
10 min read
10 min read
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