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(Which type of PCOS are you?)

PCOS is a hormonal disorder that can cause irregular periods and unwanted physical symptoms. Common signs include acne, oily skin and hair, excess hair growth, hair thinning or loss, weight gain or difficulty losing weight, darkened skin patches, irregular or absent periods, and fertility issues. PCOS symptoms are caused by hormonal imbalances, particularly high levels of androgens (male hormones) such as testosterone and DHT. These imbalances can lead to acne, excess hair growth, issues with ovulation, irregular periods, and infertility.

Do I have cysts on my ovaries?

Contrary to the name, the "cysts" seen in PCOS are not actually cysts. They are an increased number of follicles, which can be a normal occurrence in women even without PCOS. The term "polycystic" is misleading, leading to debates about changing the name to something more accurate. It's important to note that PCOS cannot be diagnosed based on ultrasound alone, and seeking a second opinion is recommended.

PCOS Treatment

Treatment approaches for PCOS often adopt a one-size-fits-all approach, which can be problematic. Simply suggesting weight loss or taking the contraceptive pill to regulate cycles oversimplifies the condition. Weight loss can be challenging for individuals with PCOS due to weight gain being one of the symptoms. The contraceptive pill only masks symptoms temporarily and does not address the underlying cause of PCOS. It can be problematic when symptoms return after discontinuing the pill, especially for those trying to conceive. Additionally, there are four different types of PCOS, and understanding the specific type is crucial for successful symptom management and healing.

Type 1. Insulin Resistant PCOS

This is the most common type, affecting around 70% of individuals with PCOS. It is characterized by insulin resistance, leading to higher insulin levels in the body. Symptoms may include weight struggles, abdominal weight gain, sugar cravings, fatigue, and brain fog. Elevated insulin levels drive up androgen production, resulting in issues like excess hair, hair loss, and acne. Testing fasting insulin levels is essential to diagnose insulin resistance. Treatment focuses on improving insulin sensitivity through regular exercise, a low-sugar and balanced diet, sufficient sleep, stress reduction, and targeted supplementation.

Type 2. Post-pill PCOS

This type occurs in some individuals after discontinuing oral contraceptive pills. Symptoms like acne, irregular periods, and excess hair growth may emerge after stopping the pill. There is no insulin resistance in this type. Treatment involves patience, as it may take time to naturally reverse. Supplementation with nutrients such as magnesium, vitamin E, vitamin B6, zinc, and specific herbs can support ovulation and reduce androgens. Adequate sleep and stress management are also crucial.

Type 3. Adrenal PCOS

This type is caused by an abnormal stress response and affects around 10% of those with PCOS. Elevated DHEA-S (a type of androgen produced by the adrenal glands) is observed, while high levels of testosterone and androstenedione are not typically seen. Managing stress, getting sufficient sleep, avoiding high-intensity exercise, and reducing caffeine intake are recommended. Herbal medicine and supplementation with nutrients like magnesium, vitamin B5, and vitamin C can help the body adapt and recover from stress. 

Type 4. Inflammatory PCOS

In this type, chronic inflammation leads to excessive testosterone production in the ovaries, causing physical symptoms and ovulation issues. Signs of inflammation may include headaches, joint pain, fatigue, skin issues, and bowel problems. Elevated inflammatory markers can be seen in blood tests. Addressing gut health, eliminating inflammatory foods, and incorporating natural anti-inflammatories such as turmeric and omega-3 fatty acids are important steps in managing this type. Seeking guidance from a nutritionist is recommended to determine individual food triggers and correct supplementation dosages.

Remember: obtaining the right diagnosis and understanding which type of PCOS you have is crucial for receiving personalized treatment, managing fertility challenges, monitoring health risks, accessing psychological support, and contributing to ongoing research efforts. It empowers you to make informed decisions about your health and enhances the effectiveness of your PCOS management plan.

 

References:

  1. Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: The complete task force report. Fertil Steril. 2009;91(2):456-488.
  2. Carmina E, Campagna AM, Lobo RA. A 20-year follow-up of young women with polycystic ovary syndrome. Obstet Gynecol. 2012;119(2 Pt 1):263-269.
  3. Dumesic DA, Oberfield SE, Stener-Victorin E, et al. Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome. Endocr Rev. 2015;36(5):487-525.
  4. Escobar-Morreale HF, Roldán B, Barrio R, et al. High prevalence of the polycystic ovary syndrome and hirsutism in women with type 1 diabetes mellitus. J Clin Endocrinol Metab. 2000;85(11):4182-4187.
  5. Javed Z, Papageorgiou M, Deshmukh H, Kilpatrick ES, Atkin SL, Sathyapalan T. The effect of metformin and orlistat on body mass index in adolescents with obesity and insulin resistance: a randomized controlled trial. J Obes. 2019;2019:5782932.
  6. Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014;371(2):119-129.
  7. Panidis D, Tziomalos K, Misichronis G, et al. Insulin resistance and endocrine characteristics of the different phenotypes of polycystic ovary syndrome: A prospective study. Hum Reprod. 2012;27(2):541-549.
  8. Patel SS, Carr BR. Ovulation induction in polycystic ovary syndrome. Obstet Gynecol Clin North Am. 2019;46(4):593-608.
  9. Rostami Dovom M, Ramezani Tehrani F, Djalalinia S, et al. Adrenal PCOS: Clinical and hormonal characteristics. Horm Mol Biol Clin Investig. 2019;38(2).
  10. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72(3):690-693.

 

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