What’s Driving Your PCOS Symptoms?
Understanding Types of PCOS and the driving forces behind your symptoms.
First, let’s review what PCOS is…
Polycystic ovary syndrome (PCOS) is a complex genetic disorder. There appears to be many different gene mutations that cause PCOS symptoms, which is part of the reason it can be difficult to diagnose, and research. PCOS affects approximately 6-10% of women worldwide, with even higher numbers in some populations, making it the most common endocrine disorder in women of reproductive age. That being said, the majority of people with PCOS present with reproductive abnormalities – including symptoms of irregular periods, infertility, polycystic ovaries, and/or symptoms of hyperandrogenism (high ‘male’ sex hormones).
But some other common symptoms you may notice include:
Insulin resistance
Difficulty loosing weight
High blood lipids
Anxiety/depression
Acne
Thinning hair
Increased facial hair (hirsutism)
Digestive issues
and Low energy
How is PCOS dignosed?
The most widely accepted diagnostic criteria for PCOS is the Rotterdam criteria. For a PCOS diagnosis under this criteria, only 2 of the following 3 are needed:
Oligoovulation or anovulation. This means delayed or irregular menstrual cycles - typically cycles that are longer than 35 days (sometimes much, much longer), though occasionally cycles will also be too short (less than 21 days). Either way, there is some form of ovulatory dysfunction, and ovulation is not happening regularly.
Hyperandrogenism, either through bloodwork or symptoms. Hyperandrogenism means that there are high androgen hormones – androgens are typically reffered to as “male” hormones, but they are present in everyone, regardless of sex. However, in those with PCOS these hormones are sometimes present in higher than normal amounts. The most common androgen is testosterone, but androstenedione, DHT, DHEA, and DHEA-S are others that can be elevated. High androgens can cause irregular menstrual cycles, increased acne, loss of hair on your scalp and increased hair growth on other body parts (face, chest, back, abdomen, shoulders), as well as trouble with fertility.
Polycystic Ovaries – these would be seen by ultrasound, and would be diagnosed when there are at least 10 small follicles present on each ovary. It is also possible to make the diagnosis if only one ovary has multiple follicles present, but this is rarer.
Yes, you read that right – you do not need to have polycystic ovaries to have PCOS. In fact, around 10-30% of those with PCOS do not show cysts on their ovaries . Some people may also have polycystic ovaries, without a PCOS diagnosis if they are missing both of the other criteria.
What’s the driving force behind your PCOS symptoms?
You’ve probably heard that there are different types of PCOS. This isn’t wrong, but it may not be the types you’ve read about on Instagram or google. So let’s break it down a bit.
PCOS can really be categorized into 4 types based on symptoms:
Androgen excess and ovulatory dysfunction
Androgen excess and polycystic ovarian morphology
Ovulatory dysfunction and polycystic ovarian morphology
Androgen excess and ovulatory dysfunction and polycystic ovarian morphology.
But these are not very fun or trendy to say, so instead we often hear about how your PCOS might be “Inflammatory type”, “Environmental” or “Post-Birth Control PCOS”. The truth is, these are all things that can exacerbate symptoms, but they are both oversimplifying and over-categorizing PCOS.
So instead of looking at ‘types’ of PCOS, I find it more practical to examine what your root causes might be that are exacerbating your PCOS and causing symptoms. There are four of these main root causes, or more accurately – drivers, or aggravators, of PCOS, and you can absolutely have more than one. These are:
Insulin Resistance
Inflammation
Hormone Imbalances
Gut Imbalances
Insulin Resistance
Insulin is a hormone that plays a key role in getting energy from food. Its main role is getting glucose (or sugar) inside cells to provide them with energy. When we have insulin resistance, there is an issue with our bodies ability to recognize insulin and allow it to do its job properly. Often we see this leading to blood sugar issues, but not always immediately.
Insulin resistance is one of the main drivers for many with PCOS, and many PCOS symptoms can be attributed to high levels of Insulin – including weight gain, dark patches of skin, skin tags, rough or reddened hair follicles, and imbalances of blood sugars
You may also notice that you're having frequent carb cravings, trouble sleeping, or low energy and these can all also be a result of underlying insulin resistance.
Inflammation
Inflammation is a normal body response when experienced in the short term as a result of an injury or infection, but with PCOS this response can often be heightened, and we may start to see chronic, or long term inflammation.
Ongoing inflammation can play into a vicious cycle of high blood sugar and weight gain (both of which, in turn, can increase inflammation).
With chronic inflammation related to PCOS, we may also see increased symptoms of fatigue, acne, upset digestion, eczema, or difficulty losing or gaining weight. Autoimmune conditions are also often tied to inflammation, so while these are not necessarily a direct symptom, you may notice a pre-existing autoimmune condition is flaring up more or is less well managed as a result of the inflammation.
Hormone Imbalances
Androgens are the most common hormone that is out of balance with PCOS, and again Androgens are those hormones like testosterone or DHEA, but hormones like estrogen or thyroid hormones can also get out of whack as a result of PCOS.
When these hormones are out of balance, we often see symptoms of increased acne, a condition called hirsutism which is essentially where a female has increased hair growth in typically "male" areas like the face, chest, or back, or we might also see thinning hair on your head, as well as things like thyroid imbalances, anxiety, depression or fatigue.
Gut Imbalances
Those with PCOS commonly have a less diverse gut microbiome (bacteria that live in our digestive tract and often have a beneficial impact on our health), which may impact hormones, blood sugar, metabolism, digestion and more .
The gut is an interesting one because not only can issues hear lead to digestive symptoms or issues with weight gain or loss, but it can also increase some of the other symptoms drivers like inflammation, hormone imbalances, and blood sugar issues.
Want to learn more about PCOS and what you can do to help manage it? Reach out to book in for a call or check out our self-paced online course here.
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