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The Many Faces of Polycystic Ovarian Syndrome

The Many Faces of Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) is considered to be the leading cause of female infertility, with nearly 5 million women in the United States alone carrying the markers for this disease.

Women diagnosed with PCOS typically fall into two categories; insulin resistant and non-insulin resistant, but did you know there may be up to 5 variations of PCOS?

Women diagnosed with PCOS typically fall into two categories; insulin resistant and non-insulin resistant, but did you know there may be up to 5 variations of PCOS?

Symptoms can include:

  • Excessive hair growth on the face, chest, stomach and back
  • Irregular or absent periods
  • Acne and oily skin
  • Ovarian cysts
  • Excessive weight carried around the stomach
  • Pelvic pain
  • Skin tags
  • Sleep apnea
  • Infertility

In order to meet the diagnostic criteria, a patient must present with at least two of the following three issues:

    1. Increased Testosterone
    2. Abnormal Ovulatory Patterns
    3. Polycystic Ovaries

For women with PCOS, this is all basic knowledge. What they may not fully understand, however, is how their presentation of PCOS may differ from the experiences of others.

Two Main Types of PCOS

Presentations of PCOS can typically be broken down into two categories: Insulin-Resistant PCOS and Non-Insulin-Resistant PCOS. The variations in these presentations can create confusion surrounding the disease, as well as the best treatment options.

Insulin-Resistant PCOS

Insulin-Resistant PCOS is also referred to as Type 1 PCOS, and it is what is most often associated with the classic symptoms of PCOS. These include weight gain, ovulatory interruptions, facial hair, hair loss and acne. Those with Insulin-Resistant PCOS also exhibit a greater potential for developing diabetes and increased testosterone levels – both of which are actually caused by the underlying insulin and leptin resistance.

In fact, the insulin and leptin resistance experienced by these patients is the culprit behind many of the unbecoming symptoms they face at the hands of this disease. It leads to the increased weight gain, for instance, and the resulting excess in testosterone is to blame for the combined hair loss and facial hair growth.

The goal for treating Insulin-Resistant PCOS is to improve insulin sensitivity. Often doctors will prescribe weight loss, but it can be difficult for patients with this type of PCOS to lose weight. It requires extra dedication to both diet and exercise, and an understanding that the weight will not come off as quickly as it may for others. However, when weight loss is achieved, symptoms do typically subside. Medications to lower blood sugar are also often prescribed, although there have been natural alternatives – such as Inositol – which have been found to be just as effective in some cases.

Non-Insulin Resistant PCOS

There are some women who meet the diagnostic criteria for PCOS, but who don’t present with insulin resistance. This is what is referred to as Type 2, or Non-Insulin Resistant, PCOS. There can be a variety of causes for this type of PCOS, including Vitamin D or Iodine deficiency, hormone-disrupting toxins, thyroid disease, and adrenal stress. For women experiencing Non-Insulin Resistant PCOS, blood sugar lowering drugs will have no effect on the condition, and neither will reducing weight or going on the pill.

The treatment options in this case tend to be more natural. Patients may be encouraged to avoid dairy while also being prescribed supplements such as Iodine, Vitamin D, Magnesium, and Zinc, along with herbal formulas to reduce testosterone. Natural progesterone may also be prescribed in an attempt to balance hormones and encourage ovulation.

Other Potential Combinations

While the two types of PCOS described above tend to be the most typical presentations, there are some who break the categories down to as many as five different types:

1. Type 1 PCOS:

    The classic PCOS presentation described above, with ovulatory issues, increased testosterone, and insulin-resistance.

2. Type 2 PCOS:

    The non-insulin-resistant PCOS we have already described, with ovulatory issues and increased testosterone levels.

3. Non-Traditional PCOS 1:

    Presents with ovulatory issues, normal testosterone levels, obesity and insulin-resistance.

4. Non-Traditional PCOS 2:

    Presents with normal ovulatory patterns, increased testosterone levels and mild insulin-resistance.

5. Idiopathic Hirsutism:

    Presents with normal ovulatory patterns, increased testosterone levels and no insulin-resistance.

As you can see, there are many variations when it comes to this condition, which can make finding the appropriate treatment for individual patients difficult. Understanding the factors behind your own case of PCOS, and finding a specialist you trust to help you seek the answers you need is the best way to combat this disease which affects so many others as well.

References

  • Briden, L. (n.d.). Sensible-Alternative Hormone Clinic. Retrieved from http://www.sensible-alternative.com.au/female-hormones/polycystic-ovarian-syndrome
  • Disease Profile for Polycystic Ovarian Syndrome (PCOS). (n.d.). Retrieved from http://www.wdxcyber.com/dxinf001.htm
  • Takai, I., Taii, S., Takakura, K., & Mori, T. (n.d.). Three types of polycystic ovarian syndrome in relation to androgenic function. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1936318
  • Polycystic ovary syndrome. (n.d.). Retrieved from https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome

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[-] 37 Comments
  1. Hi there. I am 21 years old and have always had irregular cycles (since age 12). At 15, blood tests indicated high testosterone. An ultrasound also showed “almost” cysts. I was put on the pill briefly but stopped. I went on the pill again last fall, but once again stopped (4 months ago). I have been able to reduce inflammation in my body by incorporating healthy fats and eliminating sugars and refined carbohydrates (lost 10 lbs too), but I haven’t gotten my period since stopping bc. I will be getting an ultrasound in a few days to see if cysts are present. Is there anything else I can do to get a better diagnosis/treatment? (preferably a natural approach)

    Some more background: It was this past summer that I first started this healthier eating lifestyle, while I was still on BCP (6 months total). I immediately began to lose stubborn weight and got down to 118. My body looked healthy and feminine. This was with minimal exercise. Since going off birth control, however, I have been slowly gaining weight back despite eating healthily. There is no inflammation like before and it seems like mostly muscle (and some fat) in my legs and throughout my body. Again, with minimal exercise. However, the weight gain is not distributed in a feminine way. I don’t feel fat, but I don’t feel feminine. Is this a sign of insulin resistance?

    • Hello Elizabeth!

      Your doctor can test your insulin levels.

      Gaining weight is common for many women who stop birth control and if you are gaining muscle mass, this weighs more than adipose tissue (body fat) making scale numbers raise some. Perhaps it’s time to begin a more concerted exercise routine along with herbs, since things are going so well and diet is seemingly optimal. Consider learning more about the herbs:
      – Saw palmetto (Serenoa repens): Saw palmetto is known to help regulate excess testosterone.
      – Spearmint (Mentha spicata): Preliminary Turkish research finds drinking spearmint tea can lower free testosterone levels, without impacting DHEA or total testosterone.
      – Maca (Lepidium meyenii): Maca is known to nourish the endocrine system in both men and women.

      There may also be tips in our guide How to Reduce the Damaging Effects of PCOS on Fertility Through Diet and Herbs even in the absence of a diagnosis.

      I hope this is helpful and your test results prove hopeful!

  2. Hello, I am 21 years old and have recently been diagnosed with endometrial hyperplasia, endometriosis, fibroids, and PCOS. I am underweight and have no insulin resistance. I also do not have increased testosterone levels however I have 35 cysts and immature follicles on one ovary and a few on the other. I also have very irregular periods and don’t seem to be ovulating.
    I am borderline underweight and have a really hard time gaining weight. I am also extremely tired and have pretty severe pain and bloating for 2-3 weeks every month.
    Do you have any ideas or know what I should be doing differently?

  3. thanks a lot for your answer.No i didn’t use any supplements…

  4. Hi…i am 23 years old…..after starting weight training and 2 kg weight gain in my 21…..i missed my periods for 2 and 3 months…after 10 month with this condition… i start growing hair all over my upper body and cystic acne in face….then i did ultrasound showing cyst… and blood test…fsh and lh high…every thing else was normal…what type of pcos i am?
    and are we born with type 1 and type 2 pcos?

  5. I am 28 years old, I have had ovarian cysts since I was 15. I have children from a previous relationship and my husband and I have been ttc for 5 years. We saw an RE and my internal ultrasound showed multiple cysts on both of my ovaries, I don’t ovulate on my own, and my left tube is blocked. All my blood work came back normal and my cycles are regular but they diagnosed me with PCOS based on my acne, weight gain since having my last child, difficulty losing weight, not ovulating, and the cysts. We have done 3 cycles with Clomid and I responded well but unfortunately haven’t gotten pregnant yet. Which category would I fall into?

    • Hi Alex!

      It seems like a type on non-traditional PCOS if insulin levels are fine. With that, each type can greatly benefit from dietary and lifestyle changes, as well as natural therapies. How to Reduce the Damaging Effects of PCOS on Fertility Through Diet and Herbs is our main educational guide on this fertility health issue if you are interested. Consider also a vitamin D supplement and B-Complex, and asking your doctor about your insulin levels.

      Once ovulation begins again, know that with one healthy fallopian tube, conception can still happen when ovulation occurs from the ovary on the side of that tube. So down to road, consider learning how to detect ovulation.

      I hope offers a helpful place to start learning what you can do to support your fertility health naturally.

  6. I was diagnosed with pcos in 1991, I was 16 years old., in 1997 I had my left ovary removed to a dermoid cyst. Could not fall pregnant, put on clomid, had first child in 2002, then second child in 2008, with double strength clomid. My hormones have been havoc to my life. In 2016 went to endocrinologist in Sydney, first visit he put me on metformin 500mg one morning and one at night. Did not do blood test to see if insuline resistance. So why on metformin? Only benefit I have on meds is that I have suffered with constipation all my life, tried everything, had tests, nothing worked. But metformin makes me regular. ????? I am so confused, don’t know what to do. ???

    • Dear Sindy,

      What is your diet and lifestyle like? Are you hoping to balance hormones naturally or be able to stop Metformin? I would encourage you to ask your doctor why he put you on Metformin and if it’s truly necessary. What were the indicators that you may need it if no tests were done?

      PCOS presents differently in each woman who has it. It is a truly challenging fertility health issue (not that most of them aren’t) that requires dietary and lifestyle change as a #1 step. Many healthcare providers of all schools of thought feel PCOS can be remedied by dietary changes alone. So, certainly consider the tips shared in this guide as you move forward.

  7. I have just been diagnosed with PCOS by having an internal ultrasound. Apparently just on my left ovary. I have now had the insulin resistance test and the results were normal. I have also previously had a hormone test (saliva) and my testosterone is normal. I have however got low vitamin D and cortisol is extremely high. Could this be the reason for my PCOS?

    • Dear Jenny,

      Both may be at play. There is a connection between low vitamin D and PCOS. We share more in our guide Fertility and Vitamin D – The Connection.

      There are also many signs and symptoms of PCOS that could be related to elevated cortisol levels. Cortisol is produced by the adrenal glands, but it is controlled by the hypothalamus. Its primary function is to increase blood sugar, aid in fat, protein and carbohydrate metabolism, and suppress the immune system. Cortisol is released in response to stress.

      Increased cortisol can:
      – inhibit the proper production of leptin and dopamine.
      – lead to weight gain, particularly in the abdominal region. Not only is this weight difficult to take off, it is also hormonally active, meaning that it’s the perfect place to store excess hormones such as “bad” estrogen.
      – raise blood sugar
      – contribute to estrogen dominance, which can present as a variety of symptoms including PMS, irritability, breast tenderness, bloating, headaches, anxiety, decreased libido and of course, an irregular cycle.
      – directly inhibits something in your brain called the hypothalamus, which can inhibit the release of thyroid hormone.

      Research shows that stress boosts levels of stress hormones such as cortisol, which inhibits the body’s main sex hormones GnRH (gonadotropin releasing hormone) and subsequently suppresses ovulation (common in PCOS), sexual activity and even sperm count for men. Therefore stress management is key! You may appreciate our stress-reduction tips share here… PCOS Infertility: Using Positive Visualizations On Your Journey to Pregnancy.

      I hope this is helpful as you keep moving forward!

  8. I was diagnosed with PCOS and it appears I have (somehow) both type 1 and type 2. Before I was diagnosed with PCOS I had a fainting issue and was diagnosed with hypoglycemia because of the extra insulin. I am also, however, overweight, vitamin D deficient, have hypothyroidism, and high testosterone. What category am I?

    • Dear Tamara,

      I’m sorry for all that is going on! So hard! This is best discussed with your doctor as one can’t be insulin resistant and not insulin resistant at the same time. It sounds to me from what I know (not a medical doctor though) like this is fairly traditional Type 1 PCOS. Perhaps you’ve seen our guide How to Reduce the Damaging Effects of PCOS on Fertility Through Diet and Herbs, yet if not I think that will be helpful.

      I hope the guide is helpful, but I can’t help but wonder if you may benefit from personalized support through a Fertility Consultation. By booking a Natural Fertility Consultation you will have access to: an herbalist who is assigned to you, answers to all of your questions, a detailed plan created specifically for you to get the best results with your Natural Fertility program.

      My best!

  9. Hello Elizabeth,

    I am a fit 22-year-old, and still unsure whether or not I have PCOS. My ultrasound said I “show multiple developing follicles up … impression: probable PCOS.” My symptoms were acne and irregular periods. After trying about everything I went on Diane-35. Got off and acne and cramps worsened incredibly. I found that I was growing harder hairs on my chin and upper lip as well. I went back on Diane-35 for 6months then transitioned on Yaz for the last 7months. I love what the pill does although do not want to be on it forever. I am so scared for my acne to come back or PCOS symptom worse. What do you recommend in getting off the pill to avoid acne and easy transition?

  10. Hi
    This is really helpful. I always wondered why my symptoms of PCOS are a lot different. I am 18, thin and short. My periods are irregular, I have skin problems, hair loss and digestive issues. I am not insulin resistant. My thyroid and free testosterone levels are normal but my DHT test showed a slightly raised value (361 pg/mL with normal range being 24-368) From what I read I feel I have type 2 PCOS. It makes sense because I was diagnosed with vitamin D deficiency a year ago so I take supplements now. My biggest concern is my hair loss, is it because of DHT?

  11. I have always had excessive facial hair (only one in the family, am blonde) that keeps regrowing after laser treatment & electrolysis, plus irregular periods and endometrisis that probably led to an ectopic pregnancy. No weight issues, no high levels of male hormones (according to several tests), no insulin levels. I had an ovarian cyst as a teenager, which resolved naturally. Could I have PCOS, in another form? I am now post-menopausal, still the hair keeps coming and coming.

    • Dear Katharine,

      That is a great question that I honestly do not have an answer to. My thinking is that it seems impossible to have PCOS when the ovaries have essentially stopped working post menopause. I know when estrogen production wanes/stops naturally in menopause and after, that facial hair growth and head hair thinning can be issues. It may help to work with a natural practitioner skilled in working with postmenopausal women. Consider reaching out to Dr. Aviva Romm or Dr. Tori Hudson to ask either of them maybe.

      My best to you as you seek answers!

  12. Hi there!
    I’m 17 and have recently been diagnosed with pcos. I have inbalances in my LH and FSH hormones, normal testosterone, normal blood sugars, but many cysts. I’ve been put on the combined pill as to regulate my period, I’ve never had a normal pattern and I don’t know if I even ovulate. My doctor thinks I’m too young to do tests. I’ve been trying hard to change my diet cutting out all unhealthy fats and refined sugars, but I’m finding it difficult as I’m a very picky eater and trying to plan meals around college is hard.Basically my question is, if I’m not insulin resistant, do I need to put so much pressure on myself to change my diet so quickly, if I am a healthy weight (110 lbs,5ft1)

    • Dear Emily,

      While I completely understand from personal experience meal planning and prep in college, yes having a healthy diet is key. Even the body of a lean woman who has PCOS can have trouble regulating insulin levels. Beyond helping the body properly manage insulin levels, a healthy diet helps the liver properly detoxify and metabolize excess hormones (a culprit with PCOS) and provides quality, healthy fats for proper hormone production and cholesterol (both necessary for hormonal balance), helps you stay hydrated and provides a variety of nutrients like antioxidants to boost cell health (eggs are cells).

      That said, should you keep putting pressure on yourself, I don’t know. This may truly depend on your current diet and whether its causing you undue stress on top of college stress. The other important part about striving to make dietary changes now is that the longer you stick with them, the more likely they are to become habit and then your normal way of eating. This is a good thing!

      Perhaps some guidance from a nutritionist would help. Your college’s student services or health services departments may be able to guide you to someone to offer support. If there is a dietetics or nutrition program major, the program may offer free student nutritional counseling as well.

      Best wishes as you keep moving forward!

  13. This is indeed really tricky. Looking at it I wouldn’t fall into any category, but I know I’m type 1 even though I don’t have insulin resistance. I have high testosterone levels, problems with facial and body hair and ovulatory issues. The difference is that I’m lean and instead of insulin resistance I “only” have reactive hypoglycemia that is also a problem with insulin.

  14. Hi! I am thin, no acne, long but regular cycles 32-38 days (ovulating 14 days before period always), normal total testosterone levels in blood tests, polycystic cysts on ovaries seen on ultrasound and only mild hirsutism. Testosterone levels are normal <0.69 nmol/l. What type of PCOS do i have? I am confused and thanks for your reply. I appreciate the help you are giving. I am taking maca, turmeric, omega 3 vitamins and trying to add a healthy lifestyle already. Thanks

    • Dear Charlene,

      There are so many ways PCOS presents itself from what I hear from those who reach out to us. Be sure to ask your healthcare provider to explain to you what type of PCOS it is that you have. It may be non-insulin resistant PCOS (with long cycles, cysts and mild Hirsutism).

      It is great that you have begun taking herbs, supplements and making lifestyle changes. Diet is known to be key! Our guide to
      Important Natural Health Tips for Women with Lean PCOS may be helpful to you.

  15. Hay! I am 25 year old and I have PCOS. I have regular periods. I have never missed my period. I am have excessive hair growth. I went for blood tests and they showed normal ovulation and high testosterone levels. My doctor put me on Metformin. I took it for a few months, then I left it. I want to ask, is it possible to get pregnant with PCOS easily if I am ovulating? What type of PCOS do I have?

    • Dear Nena,

      I can not know if pregnancy with any fertility health condition will be easy. Each case is so very different. If the menstrual cycle, ovulation, uterine lining and eggs, and of course hormone balance are healthy, there may be a chance of natural conception.

      Given what you have shared here and the information in this article, the PCOS experienced most closely resembled #5 Idiopathic Hirsutism. Idiopathic Hirsutism presents as excess hair growth in the pattern of male hair growth (face, chest, back, groin, inner thighs etc.), eleveated testosterone levels, but the women who experience this have normal menstrual cycles including ovulation.

      I am not a medical doctor to determine this specifically, but again based on what you have shared and this article, it may be worth asking your healthcare provider about. Consider also learning about the herb Saw Palmetto as a natural option for women with Hirsutism due to PCOS.

      I hope this is helpful!

  16. I used your Fertility Cleanse and it brought back my period after so many months. I am using your guide for my diet, but what should be my next step?

    • Dear Reishma,

      It is great to hear of how the Fertility Cleanse supported you. If you are interested in sharing your success story, it may encourage others.

      It is difficult for me to answer your question based on just knowing a small piece of the bigger picture of your fertility health. Consider booking a Fertility Consultation to be guided in how to best support your fertility health needs. This allows you to work one on one with our fertility herbalist who will create a natural fertility program for you.

  17. How exactly does PCOS affect fertility?

  18. Hi There can you take Evening Primrose and your natural progesterone cream together, as they are both natural hormones ?

    • Elizabeth Willett, MA, CH

      Hello Hope!

      Fertilica Evening Primrose Oil and Fertilica Natural Progesterone Cream can be taken together yes.

      Take care!

  19. Hi there :),
    Im 30, I had ultrasound and was told I have cyst few years ago, them developed acne, for a while hot flashes, and facial hair. Trying to conceive now, reading everything on the web, Im taking following:
    Cinnamon
    Vitex
    DIM
    Evening Primrose oil
    Hemp Oil
    l tyrosine
    Vit D 30000iu
    Maca
    Just ordered:
    Gymenna, Burdock root, Tribulus, and more Organic vitex to change brands.
    Im coming from an extremely high diet on fruit now eating with your recommendations.
    I dont know which type of PCOS I fall into, would these supplements contraindicated to any type of PCOS??

    I never knew these categories…

    Thanks in advance.

    • Elizabeth Willett, MA, CH

      Hello Maria!

      Without knowing the proper dose or combination that may be right for you, it would really be best to consider a Fertility Consultation with an herbalist or natural healthcare practitioner, such as a naturopath, someone who can help you determine if these herbs and supplements are right for you.

      Best wishes!