Polycystic ovary syndrome (PCOS) is a hormonal imbalance caused by the overproduction of androgens by the ovaries. It affects up to 15% of women. While PCOS symptoms can become evident any time after puberty, most women are diagnosed when trying to become pregnant in their 20s and 30s. Symptoms and outcomes can vary with different types of PCOS. A PCOS diagnosis is generally verified using a patient’s medical history, blood testing, and ovarian ultrasound. There are many types of PCOS, but the most common include inflammatory PCOS, insulin-resistant PCOS, Post-pill PCOS, and Adrenal PCOS.
INFLAMMATORY PCOS
Inflammatory PCOS is a broad form of PCOS that can include widespread chronic inflammation throughout the body that’s accompanied by classic PCOS symptoms. The underlying issue is that ovaries are producing excess amounts of testosterone.
Many people with inflammatory PCOS experience general inflammation-related pain that can include headaches and joint pain. There could also be digestive and bowel issues related to food sensitivities and irritable bowel syndrome (IBS). Inflammatory PCOS symptoms may even manifest as skin rashes and eczema. Fatigue is also common. Inflammatory PCOS symptoms can be present across all types of PCOS.
Lifestyle changes and anti-inflammatory diets can be beneficial for treating inflammatory PCOS. For example, cutting out refined carbohydrates, dairy, processed meats, alcohol, and specific food preservatives help many women to tame symptoms. Exercise has also been proven beneficial for improving ovarian function.
INSULIN-RESISTANT PCOS
Roughly 70% of women with PCOS have insulin-resistant PCOS. Insulin-resistant PCOS occurs when higher-than-normal amounts of insulin released by the pancreas trigger the body to drive up production of androgens.
Common symptoms of insulin-resistant PCOS include weight gain, stubborn excess fat in the abdomen and midsection, brain, fog, and sugar cravings. It’s also common to experience irregular or absent periods. Elevated androgen production can also produce excess hair growth, hair loss, darkening of the skin, and acne.
With insulin-resistant PCOS, getting blood-sugar levels under control is key. In fact, glucose testing to get a read on fasting insulin levels is commonly used to confirm insulin-resistant PCOS. Adopting a low-sugar, low-carb diet is often beneficial for managing symptoms. Exercise can also be beneficial. Certain supplements can also be used to aid in glucose metabolism. In cases where fertility is a concern, doctors often prescribe a medication called metformin that helps to regulate insulin levels to help restore regular periods and ovulation.
POST-PILL PCOS
Pill-induced PCOS symptoms begin after hormonal birth control methods are stopped. In some cases, pill-induced PCOS is caused by a surge in androgens that occurs as the body readjusts. Unlike other PCOS types, this form doesn’t involve insulin resistance. It may also resolve on its own after a few months. In other cases of pill-induced PCOS, symptoms may appear to come on out of the blue because hormonal birth control was actually hiding PCOS symptoms.
Like other types of PCOS, post-pill PCOS can cause irregular periods, excess hair growth, oily skin, weight gain, and acne. It’s also possible to experience enlarged ovaries or ovarian cysts that were not present before beginning birth control.
Treatment of post-pill PCOS varies based on the symptoms and underlying origins. Diet, exercise, and stress management can all be important for helping to stabilize hormone levels after coming off of hormonal birth control. Supplementation and medications may also be useful in balancing excessive androgens.
Related: 4 Common Reasons You Might Be Experiencing Irregular Periods
ADRENAL PCOS
Adrenal PCOS is also known as stress-induced PCOS. Unlike other types of PCOS, adrenal PCOS doesn’t actually start in the reproductive system. It’s caused by the excessive release of adrenaline, caused by an abnormal stress response. Overactive adrenal glands are responsible for the overproduction of androgens that create PCOS symptoms. With other types of PCOS, the ovaries produce excess androgens.
The most common adrenal PCOS symptoms include weight gain, hair loss, excess hair growth, and acne. Changes in the menstrual cycle are also common. Absent or inconsistent periods are considered telltale signs. However, it’s also possible that adrenal PCOS can cause heavier or more frequent periods.
Stress management is even more important for adrenal PCOS than other types of PCOS. It can be helpful to mitigate stressors using mindfulness or meditation exercises. In general, any mental or physical practices that support the nervous system can also benefit stress-induced PCOS. While exercise is recommended, excessive exercise or high-intensity workouts can actually tax the body’s stress response and adrenals. Lifestyle changes that include limiting caffeine and sugar may also be helpful. A provider may also recommend supplementing with vitamins, minerals, and botanicals that support and balance the nervous system.PCOS can signal a serious hormonal imbalance that is linked with insulin resistance or adrenal overload. Regardless of whether or not you are planning to become pregnant, PCOS should be treated. Dr. Michael Tahery is a Los Angeles obstetrician-gynecologist (OB-GYN) and urogynecologist specializing in women’s health. Dr. Tahery and his team offer several approaches for diagnosing and treating PCOS. Book a consultation today.