Types of PCOS - Which Type Of PCOS Do I Have?
As complex as PCOS already is, it gets even more confusing when you see that there are individual types of PCOS. Generally, we acknowledge there are 4 specific types of PCOS. Well, 5 if you consider a combination of all four as the fifth type.
It is important to note that these PCOS types are not all 100% recognized in the scientific literature. Researchers and doctors all agree that there are many drivers that result in the symptoms that a woman with PCOS may experience. But, what is not known is why certain women with PCOS present differently than others.
1️⃣ INSULIN RESISTANT PCOS
IR PCOS is by far the most common, affecting up to 70% of all women with PCOS. These women will generally be overweight, suffer from symptoms of excess androgens such as acne, male-like hair growth, male-like hair loss, and irregular periods.
Insulin resistance occurs when your cells become resistant to the normal effects of insulin. Basically, they don't recognize that insulin is there. This causes insulin levels to rise and as insulin levels get higher and higher they start to cause other issues and problems.
Among these problems include an imbalance to your sex hormone (including estrogen, progesterone, and testosterone) and the signs and symptoms of PCOS. High levels of insulin have been shown to result in high levels of testosterone (6) (both free and total) which is the hallmark of PCOS.
Because of this, most of the therapies are directed at reducing insulin levels and improving blood sugar. This is why medications such as metformin are often prescribed to women with PCOS. Metformin is a diabetic medication that helps reverse insulin resistance.
Testing for insulin resistance PCOS:
💉 Free and total testosterone
💉 Fasting blood glucose
💉 Hgb A1c (which stands for hemoglobin A1c)
💉 Fasting insulin
Typical Lab Testing Results
📊 Typically elevated free OR total testosterone (or high normal)
📊 Elevated fasting glucose
📊 Elevated Hgb A1c, typically higher than 5.7%
📊 Elevated fasting insulin
📊 Normal DHEA
2️⃣ LEAN PCOS
Lean PCOS is a form of PCOS which can occur in women who are generally not overweight. This is why it's named "lean" PCOS after the fact that women with this PCOS type have a normal body weight compared to the most common form of PCOS.
If you do feel that you might have lean PCOS it's very important that you first differentiate your condition from hypothalamic amenorrhea, a condition that stops your body's ability to have a menstrual cycle or period.
Lean PCOS isn't as easy to diagnose as other forms of PCOS such as IR PCOS or adrenal PCOS because in those conditions we know exactly what is causing the imbalance. Women with lean PCOS have obvious signs and symptoms of PCOS but their lab tests are largely "normal".
While they don't show signs of elevated DHEA or insulin resistance, some of these women do have elevated inflammatory markers. We know that inflammation is a key component in the development of PCOS
Testing for lean PCOS:
💉 CRP (C-reactive protein)
💉 ESR (erythrocyte sedimentation rate)
3️⃣ ADRENAL PCOS
Women with adrenal PCOS will have many of the same symptoms as women with IR PCOS but their lab tests will be different. The main difference will be these women typically do NOT have elevated free and total testosterone.
Instead, women with adrenal PCOS will have elevated levels of DHEA which is another androgen predominately produced by the adrenal glands. The main trigger for this is thought to be stress-related, either emotional stress or physical stress.
Testing for adrenal PCOS:
💉 Free and total testosterone
💉 Serum DHEA
💉 8 am serum cortisol
💉 Insulin resistance
Typical Lab Testing Results
📊 Normal free and total testosterone
📊 Elevated serum DHEA levels
📊 High or normal serum cortisol
📊 Normal insulin resistance and blood sugar studies
4️⃣ POST-PILL PCOS
This is the type of PCOS that is not really recognized by conventional medical experts but, coming off of birth control does appear to cause a temporary PCOS-like state in some women.
This doesn't mean that all women will get this condition if they come off of birth control but it does mean you should be aware of it if you are considering using birth control.
In order for your PCOS to be caused or related to birth control, you must have had normal periods before you started the pill.
Women in this position should be very careful to avoid a premature diagnosis of PCOS without first looking at LH and FSH levels as the pill can actually cause suppression of your FSH and LH levels and lead to hypothalamic amenorrhea after you discontinue taking it.
Women who have post-pill PCOS after stopping the pill have abnormally elevated LH levels which would differentiate this condition from hypothalamic amenorrhea.
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About Drew Baird:
Drew Baird is the founder and owner of Drew Baird Fitness and Healthy PCOS. Drew has worked with over 23,800 clients on his online weight loss programs and helped his clients lose over 263,000kgs. He's known for his realistic, no bullshit approach to getting results.
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