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Types of PCOS

Dariella Gonitzke, MS, RD, FMN • Jun 24, 2023

Discover the four types of PCOS and gain valuable insights to help navigate the complexities of the condition and learn about treatment options for better management.

If you’re one of the many women diagnosed with Polycystic Ovary Syndrome (PCOS), you may be wondering what type of PCOS you have. Understanding the various types of PCOS will be important to help guide your treatment for improved management of the condition. 

In this article, we will explore the four types of PCOS including Insulin Resistant PCOS, Post-Pill PCOS, Adrenal PCOS, and Inflammatory PCOS. I will also provide lifestyle tips to help restore hormonal balance within your body.

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What Is PCOS?

Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting 4%–20% of women of reproductive age worldwide. It is a complex condition that can potentially impact multiple body systems including your reproductive, endocrine, and metabolic systems.
 
If you have PCOS, your ovaries produce higher than normal levels of hormones called androgens, including testosterone and it's more potent counterpart dihydrotestosterone. When these delicate reproductive hormones are imbalanced, it can set the stage for various symptoms that affect the ovaries and ovulation. 

As a result, PCOS is characterized by a combination of high levels of androgens (male hormones), enlarged ovaries with small cysts, and irregular or missed periods. Other signs and symptoms of PCOS may include:

Infertility
PCOS is the leading cause of infertility among women of reproductive age. Since PCOS affects ovulation, there’s a strong link between the condition and fertility issues.
 
Abnormal hair growth
Up to 80% of women with PCOS may experience hirsutism, the excessive growth of facial and body hair on women as the result of excess androgens in the body.
Weight gain
Having PCOS makes it difficult for your body to use the hormone insulin which is responsible for converting glucose (sugars) into energy. This condition is known as insulin resistance and can lead to elevated insulin levels, which promotes fat storage and inhibits the breakdown of stored fat. This can contribute to stubborn weight gain, particularly in the abdominal area.

Acne
The hormonal imbalances related to PCOS can trigger acne flares on the lower face, including the jawline, chin, and upper neck.

Hair loss
High levels of androgens may generate male pattern hair loss, which is thinning hair on the top of the head or hair recession.
 

What Causes PCOS?

While the exact cause of PCOS is not fully understood, researchers believe it involves a combination of genetic and environmental factors. For example, insulin resistance appears to play a role in the development of PCOS. Having an increase in insulin levels can trigger your ovaries to make increased levels of androgens which can impact ovulation and contribute to other symptoms of the condition.
 
Additionally, there appears to be a link between PCOS and inflammation. Studies show that women who have PCOS may develop low-grade chronic inflammation which can further increase the production of androgens.

Types of PCOS

There are 4 types of PCOS which include Insulin resistant, Post-pill, Adrenal, and Inflammatory. Knowing which type of PCOS you have is important because that information can help guide your treatment plan.
 
Insulin Resistant PCOS

Insulin resistant PCOS is the most common type of PCOS and is characterized by insulin resistance, a condition in which your body's cells become less responsive to the effects of insulin.
 
The hormone insulin is responsible for regulating blood sugar levels. In insulin resistant PCOS, your body produces insulin, however, the cells do not efficiently use it, leading to higher levels of insulin in the blood (hyperinsulinemia). Hyperinsulinemia can contribute to hormonal imbalances by stimulating the ovaries to produce excess androgens. This can disrupt the normal functioning of the ovaries leading to irregular menstrual cycles, ovarian cysts, and fertility issues.
 
If you have insulin resistant PCOS you may experience weight gain or have difficulty losing weight, especially in the abdominal area. You may also have higher levels of triglycerides and lower levels of HDL (good) cholesterol which could impact your cardiovascular health.
 
How to treat insulin resistant PCOS

The key to treating insulin resistant PCOS involves lifestyle changes that will help to improve insulin sensitivity and reduce insulin levels. These lifestyle changes may include:

  • Eating a well-balanced diet rich in protein and healthy fats with a focus on low-glycemic index foods rather than simple, more processed carbohydrates.
  • Regular physical activity helps reduce insulin levels and balance hormones.
  • Working with a healthcare professional who specializes in hormonal disorders to create a personalized supplement protocol aimed at balancing hormones.
  

Post-Pill PCOS

Post-pill PCOS, also known as post-contraceptive PCOS, is a specific type of PCOS that occurs after discontinuing the use of hormonal contraceptives like “the pill”. PCOS-like symptoms can emerge in some women after stopping the pill, as the body adjusts to the change in hormones.
 
Post-pill PCOS is characterized by irregular or absent periods, similar to traditional PCOS. Other symptoms may include hormonal imbalances, such as elevated androgen levels, acne, hirsutism, and difficulties with fertility. It is important to note that not all women who discontinue the pill will develop post-pill PCOS, and the duration of symptoms and severity of the condition can vary from person to person.

How to treat post-pill PCOS

Managing post-pill PCOS involves addressing the underlying hormonal imbalances and supporting the body's natural hormonal regulation. This can be accomplished by:

  • Prioritizing sleep which can help balance your hormones while a lack of sleep may impede hormone balance by increasing stress hormones and insulin resistance.  
  • Engaging in regular exercise to reduce insulin and cortisol levels.
  • Managing stress levels which will help support hormone balance.
 
Adrenal PCOS

Adrenal PCOS, also known as non-classic adrenal hyperplasia (NCAH), is a type of PCOS that is associated with adrenal gland dysfunction. Your adrenal glands, located on top of the kidneys, produce hormones such as cortisol and androgens. In adrenal PCOS, there is an overproduction of androgens, specifically from the adrenal glands, which contributes to the hormonal imbalances seen in PCOS.
 
Additionally, high levels of stress can trigger your adrenal glands to produce more cortisol which can result in increased androgen production.

How to treat adrenal PCOS

Lifestyle modifications play an important role in managing adrenal PCOS. Treating adrenal PCOS may involve:

  • A variety of stress management techniques including meditation, deep breathing exercises, yoga, and engaging in activities that promote relaxation. These activities can help reduce stress levels and improve adrenal function.
  • Engaging in regular low-impact physical activity like walking briskly and strength training. These activities can help enhance insulin sensitivity without placing further stress on your adrenals like high-impact exercise can.
  • Getting plenty of sleep to help restore hormone balance.
 
Inflammatory PCOS

Inflammatory PCOS is a specific type of PCOS that is characterized by chronic low-grade inflammation within the body. Inflammation is your body's response to injury or infection, but in the case of inflammatory PCOS, this immune response becomes persistent and dysregulated, leading to a state of chronic inflammation.
 
Chronic inflammation in inflammatory PCOS can disrupt normal ovarian function and hormone balance. It can lead to increased androgen production, insulin resistance, and impaired glucose metabolism. These factors all contribute to the classic symptoms of PCOS, including irregular menstrual cycles, ovarian cysts, and metabolic disturbances such as weight gain.

How to treat inflammatory PCOS
The treatment approach for inflammatory PCOS aims to reduce inflammation, improve hormone balance, and manage associated symptoms. Treating inflammatory PCOS may include:
 
  • Implementing an anti-inflammatory diet rich in fresh fruits, vegetables, whole grains, lean protein, and healthy fats.
  • Engaging in some type of exercise like walking, cycling, or swimming, can help reduce inflammation, improve insulin sensitivity, and promote overall well-being.
  • Stress management techniques in the form of meditation, yoga, or deep breathing can reduce inflammation and support overall hormonal balance.
 
The Bottom Line

Recognizing and understanding the four different types of PCOS can provide valuable insights into how to best manage the condition. If you have PCOS, it’s important to consult with a knowledgeable healthcare professional that can provide tailor-made treatment plan to address the root causes and manage symptoms effectively.
 
At Eat Freely Nutrition, we offer one-on-one programs as well as group programs to help you balance your hormones, improve symptom management, and enhance the quality of your life. Book a call with today

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References
 
1. Deswal R, Narwal V, Dang A, Pundir CS. The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. J Hum Reprod Sci. 2020 Oct-Dec;13(4):261-271. doi: 10.4103/jhrs.JHRS_95_18. Epub 2020 Dec 28. PMID: 33627974; PMCID: PMC7879843.
 
2. Bani Mohammad M, Majdi Seghinsara A. Polycystic Ovary Syndrome (PCOS), Diagnostic Criteria, and AMH. Asian Pac J Cancer Prev. 2017 Jan 1;18(1):17-21. doi: 10.22034/APJCP.2017.18.1.17. PMID: 28240001; PMCID: PMC5563096.
 
3. Peng, G., Yan, Z., Liu, Y. et al. The effects of first-line pharmacological treatments for reproductive outcomes in infertile women with PCOS: a systematic review and network meta-analysis. Reprod Biol Endocrinol 21, 24 (2023). https://doi.org/10.1186/s12958-023-01075-9
 
4. Spritzer PM, Barone CR, Oliveira FB. Hirsutism in Polycystic Ovary Syndrome: Pathophysiology and Management. Curr Pharm Des. 2016;22(36):5603-5613. doi: 10.2174/1381612822666160720151243. PMID: 27510481.
 
5. Ajmal N, Khan SZ, Shaikh R. Polycystic ovary syndrome (PCOS) and genetic predisposition: A review article. Eur J Obstet Gynecol Reprod Biol X. 2019 Jun 8;3:100060. doi: 10.1016/j.eurox.2019.100060. PMID: 31403134; PMCID: PMC6687436.
 
6. Aboeldalyl S, James C, Seyam E, Ibrahim EM, Shawki HE, Amer S. The Role of Chronic Inflammation in Polycystic Ovarian Syndrome-A Systematic Review and Meta-Analysis. Int J Mol Sci. 2021 Mar 8;22(5):2734. doi: 10.3390/ijms22052734. PMID: 33800490; PMCID: PMC7962967.
 

By Dariella Gonitzke, MS, RD, FMN 14 Feb, 2024
Can eating certain foods really improve your hormones? Yes! There are foods that provide our body with the nutrient necessary to make healthy hormone levels. There are also foods that support the liver and the proper metabolism of our hormones, which helps to prevent accumulation of certain hormones. Incorporating these hormones supportive foods in your diet can help keep your hormones in balance and prevent/reduce period problems. Although there is limited research on nutrition and hormones, this doesn’t mean these holistic health practices have no benefits. It just means that these benefits haven’t been studied and proven effective. Scientific research is expensive and time-consuming. These two factors make it easy for pharmaceutical companies or hospitals to get funding to research a new drug or treatment protocol. But this also makes it fairly prohibitive for studies on food or other alternative medical treatments to occur. There just aren’t many people who will provide funding to study whether or not seed cycling can help support women’s menstrual cycles. It’s well known that there is a massive gender bias in clinical research and it’s only been about 20-30 years since women were even required to be included in clinical trials. Studying the menstrual cycle and the factors that influence it just isn’t a high priority on the list of medical research topics. Because of this, we frequently have to rely on anecdotal evidence, along with our own best judgment, to determine if these holistic practices have any benefit. With all that said, let’s move on to my favorite go-to hormone balancing foods! Let’s go! Favorite #1: Seeds
By Dariella Gonitzke, MS, RD, FMN 12 Feb, 2024
“I’ve been dealing with this annoying migraine all day and it won’t go away! Nothings helping!” If you have found yourself saying the same thing, you're not alone. Migraines affect millions of people worldwide, impacting their ability to work, socialize, and enjoy daily activities. But what you might not know is how to manage your migraines or prevent them. I struggled with migraines for years and have found several solutions that have helped. So here’s my go-to strategies that can help you effectively manage and reduce the frequency of your migraines (and don’t worry, it’s not just saying drink a glass of water when you are already feeling it.) The Importance of Hydration and Magnesium Glycinate So no, I’m not telling you to drink water when it’s already too late, BUT it’s still very important to STAY hydrated! Key word there, but let's discuss the critical role of hydration and magnesium glycinate in migraine management. Hydration is key for maintaining overall health, and it plays a significant role in migraine prevention. Dehydration can trigger migraines or worsen their severity. By ensuring you stay adequately hydrated throughout the day, you can reduce the likelihood of migraine attacks. Additionally, magnesium glycinate has emerged as a promising supplement for migraine relief. This essential mineral helps regulate neurotransmitters and reduce inflammation, both of which are implicated in migraine development. By incorporating magnesium glycinate into your daily routine, you may experience relief from migraine symptoms by targeting the underlying inflammatory processes contributing to pain. Prioritizing Sleep and Rest Another crucial aspect of migraine management is prioritizing sleep and rest. Lack of sleep can act as a trigger for migraines or exacerbate their severity. It's essential to establish a consistent sleep schedule and ensure you're getting enough rest each night. Additionally, if a migraine strikes during the day, don't hesitate to take a quick break. Stepping away from your tasks and allowing yourself to rest can help alleviate migraine symptoms and prevent them from escalating. Start a Food Journal Migraine triggers can vary from person to person, and identifying specific trigger foods often involves keeping a detailed headache diary to track patterns. While certain foods are commonly reported as migraine triggers, it's important to note that triggers can be individualized. Here are some foods that are commonly associated with triggering migraines: 1 . Caffeine : While some people find relief from migraines with caffeine, for others, it can be a trigger. It's essential to monitor your caffeine intake and be consistent with your consumption. 2. Chocolate : Chocolate contains compounds like phenylethylamine and tyramine, which are thought to contribute to migraines in some individuals. 3. Alcohol: Certain alcoholic beverages, especially red wine, beer, and whiskey, may trigger migraines. Sulfites and other compounds in alcohol are potential culprits. 4 . Aged Cheese: Cheeses that are aged, such as cheddar, blue cheese, and Parmesan, contain tyramine, a compound that may trigger migraines in some people. 5. Processed Meats : Nitrites and nitrates in processed meats like bacon, hot dogs, and deli meats are potential migraine triggers for some individuals. 6. Monosodium Glutamate (MSG) : Found in some savory snacks, Chinese food, and processed foods, MSG is often associated with triggering migraines. 7 . Artificial Sweeteners : Aspartame, found in many diet sodas and sugar-free products, is a reported trigger for some people. 8. Citrus Fruits : Oranges, lemons, and other citrus fruits contain histamine, which may contribute to migraines in sensitive individuals. 9. Nuts: Certain nuts, especially peanuts and tree nuts, contain tyramine and other migraine-triggering compounds. 10 . Onions and Garlic : These vegetables contain sulfites and can be problematic for some migraine sufferers. 11. Avocado : Avocado contains tyramine and can be a trigger for some individuals. 12 . Pickled or Fermented Foods : Sauerkraut, pickles, and other fermented foods contain tyramine and may trigger migraines. It's crucial to keep in mind that individual responses to these foods vary, and not everyone will be sensitive to the same triggers. Keeping a headache diary, working with a healthcare professional, and gradually eliminating or reintroducing potential trigger foods can help identify specific dietary factors contributing to migraines. Additionally, maintaining a well-balanced diet and staying hydrated may contribute to overall headache prevention. Could It Be My Hormones? Hormones can also play a significant role in triggering migraines for some individuals. Changes in hormonal levels, particularly fluctuations in estrogen, are commonly associated with the onset of migraines, and certain periods in a person's life may be particularly prone to hormonal influences. Here are some key stages and factors related to migraines and hormones: 1. Menstrual Migraines : Many women experience migraines related to their menstrual cycle. These migraines often occur in the days leading up to menstruation or during the first few days of the menstrual period. The drop in estrogen levels that occurs during this time is thought to be a contributing factor. 2. Menopause : Hormonal changes during menopause, specifically the decline in estrogen levels, can also trigger migraines in some women. The transition to menopause may be associated with an increase in migraine frequency or intensity for some individuals. 3. Pregnancy : Hormonal changes during pregnancy can have varying effects on migraines. While some women experience relief from migraines during pregnancy, others may find that their migraines become more frequent. It is essential to consult with a healthcare professional for guidance on managing migraines during pregnancy. 4. Hormonal Contraceptives: Some women may experience changes in migraine patterns when using hormonal contraceptives. For some, it may lead to an improvement, while for others, it might worsen migraines. 5. Perimenopause : The period leading up to menopause, known as perimenopause, is characterized by hormonal fluctuations. Migraines may become more frequent or severe during this time for some individuals. Perimenopause can start as early as mid-30’s for some women and last over 10 years. It’s important to meet with a hormone specialist if you’re struggling with symptoms. If you suspect your hormones may be playing a role and are seeing a cyclical pattern to your migraines, I recommned getting your hormones checked. There are many natural solutions to balancing your hormones that don't involve birth control or other medications. Conclusion Managing migraines requires a multifaceted approach that addresses hydration, nutrition, sleep, stress management and hormone balance. By incorporating these strategies into your daily routine, you can take control of your migraines and improve your quality of life. If you're struggling to manage your migraines or would like a more personalized guidance on implementing these strategies, I’d be happy to help! Together, we can work towards finding effective solutions and helping you live a life free from the grip of migraines. I've had great success with my clients over the last 15 years, helping them to identify their triggers and givng them a tailored plan that was realistic to their lifestyle. Schedule a call with me today!
By Dariella Gonitzke, MS, RD. FMN 25 Oct, 2023
Food sensitivities can affect you in so many ways. And they’re a lot more common than most people think. I'm not talking about anaphylaxis or immediate allergic reactions that involve a strong immune response. Those can be serious and life-threatening. If you have any allergies, you need to steer clear of any traces of foods you are allergic to, and speak with your doctor or pharmacist about emergency medication, if necessary. What I'm talking about, is a sensitivity, meaning you do not tolerate a specific food very well and it causes immediate or chronic symptoms anywhere in the body. Symptoms can take hours or even days to show themselves. And symptoms can be located just about anywhere in the body. This is still an immune response that can increase inflammation (hence the aches and pains), but different than an allergy. This is what makes them so tricky to identify. Symptoms of Food Intolerances There are some common food intolerances and immune reactions that have immediate and terribly painful gastrointestinal symptoms, such as lactose intolerance or celiac disease. These can cause stomach pain, gas, bloating, and/or diarrhea; symptoms can start immediately after eating lactose or gluten. On the other hand, other more insidious symptoms may not be linked to foods in an obvious way. Symptoms like: ● Chronic muscle or joint pain ● Sweating, or increased heart rate or blood pressure ● Headaches or migraines ● Exhaustion after a good night's sleep ● Autoimmune conditions like Hashimoto's or rheumatoid arthritis ● Rashes or eczema ● Inability to concentrate or feeling like your brain is "foggy" ● Shortness of breath If your body has trouble digesting specific foods, it can affect your hormones, metabolism, or even cause inflammation and result in any of the symptoms listed above. And these can affect any (or all) parts of the body, not just your gastrointestinal system. How to Prevent These Symptoms The main thing you can do is to figure out which foods or ingredients you may be reacting to and stop ingesting them. I know, I know...this sounds so simple, and yet it can be SO HARD. The best way to identify your food/ingredient triggers is eliminate them. This can be done by trial and error, or by testing. The trail and error method requires you to eliminate all traces high reactive foods for three full weeks and monitor your symptoms. If things get better, then you want to slowly introduce them back one at a time, every 3 days, while still looking out to see if/when symptoms return. The second option is to test for food sensitivities using a reliable blood test called the Mediator Release Test (MRT). This test measures the inflammatory mediators released by your white blood cells in response to food exposure. It tests for 176 foods and chemicals such as dyes and additives. One huge benefit to testing, is knowing exactly which foods to cut out and for how long based on their level of reactivity. The dietitians here at Eat Freely Nutrition are knowledgeable in both methods and offer guidance and support. We can also order the MRT test for you and help you with personalized recipes and meal ideas based on your results. Start Here: Two common food intolerances Here are two of the most common triggers of food intolerances: ● Lactose - eliminate dairy altogether, or look for a "lactose-free" label – try dairy-free alternatives made from oat, nuts or coconut instead. ● Gluten - in wheat, rye, barley and other common grains - look for a "gluten-free" label - try gluten-free grains like rice, quinoa & gluten-free oats. This is by no means a complete list, but it's a good place to start because lactose intolerance is thought to affect up to 75% of people, while "non-celiac gluten sensitivity" can affect up to 13% of people. So, if you can eliminate all traces of lactose and gluten for three weeks, it can confirm whether either or both of these, are a source of your symptoms. Yes, dairy and grains are a part of many government-recommended food guidelines, but you absolutely can get all of the nutrients you need if you focus on replacing them with nutrient-dense foods. A reliable way to monitor how you feel after eating certain foods is to track it. After every meal or snack, write down the foods you ate, and any symptoms so you can more easily spot trends. And, as mentioned earlier, symptoms may not start immediately following a meal. You may find, for example, that you wake up with a headache the morning after eating bananas. You might be surprised what links you can find if you track your food and symptoms well! IMPORTANT NOTE: When you eliminate something, you need to make sure it's not hiding in other foods, or the whole point of eliminating it for a few weeks is lost. Restaurant food, packaged foods, and sauces or dressings are notorious for adding ingredients that you'd never think are there. You know that sugar hides in almost everything, but did you also know that wheat is often added to processed meats and soy sauce, and lactose can even be found in some medications or supplements? When in doubt you HAVE to ask the server in a restaurant about hidden ingredients, read labels, and consider cooking from scratch. What if it doesn’t work? If eliminating these two common food intolerances doesn’t work, then you can go one step further to eliminate soy and corn for three weeks. They are the next most common culprits. You may need to see a qualified healthcare practitioner for help, and that's OK. I don't want you to continue suffering if you don't need to! If you’d prefer to use the “test, not guess” method, give us a call and we can discuss the MRT in more detail. If you’ve had an MRT test in the past and it’s been more than a few years, it might be time to retest. Your food sensitivities can change over time.
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