What type of PCOS are you?

PCOS is one of the most common causes of infertility. There are 4 different main causes of this cycle disorder. Based on these causes, PCOS is divided into 4 types.

Inhalt

Polycystic ovary syndrome (abbreviated to PCOS or PCO syndrome) is the most common hormonal disorder in women of reproductive age and thus also one of the most common causes of an unfulfilled desire to have children. But not every PCOS is the same. Did you know that there are different types of PCOS? They are also called phenotypes. Accordingly, there are also different main causes that need to be considered for treatment. It is not yet widely known that there are several types of PCOS. This makes it all the more important for those affected to learn that there are different types of PCOS and what distinguishes them.

PCOS – type 1:

PCOS aufgrund Insulinresistenz

This is the type of PCOS that is known to many doctors and has probably been studied the most. It is more or less the “classic PCO”, because insulin resistance is the most common characteristic of PCOS*.

How insulin resistance occurs

50-70% of women with PCOS are overweight or obese and show characteristics of the metabolic syndrome. In addition to obesity, this includes, among other things, a disorder of the sugar metabolism (insulin resistance) as well as of the fat metabolism, which promotes obesity. Insulin resistance is described in 30% of normal-weight and 70% of overweight women with PCOS. Insulin resistance can therefore also develop independently of body weight. It is assumed that, among other things, a hormonal imbalance between female and male hormones contributes to the development of insulin resistance. Furthermore, it is assumed that insulin resistance is also promoted by the intake of excess sugar, smoking, environmental toxins and the consumption of trans fats.

 

Women with anovulatory cycles are more affected by insulin resistance than women with ovulatory cycles. Insulin resistance is also a risk factor for the development of type 2 diabetes mellitus. In addition, the risk of gestational diabetes is increased during pregnancy.

How can insulin resistance lead to PCOS?

Carbohydrate-rich foods are broken down into sugar molecules and enter the bloodstream. To transport the glucose into the cells, the body needs the hormone insulin, which it secretes when blood sugar is elevated. With insulin resistance, the body’s cells no longer recognise insulin properly. Therefore, the sugar remains in the blood and the pancreas produces even more insulin. On the one hand, this promotes obesity, and on the other hand, the excess insulin simultaneously stimulates the cells in the ovaries to produce more androgens, i.e. male sex hormones. PCOS is the result. Since about 70% of women with PCOS have insulin resistance, every PCOS patient should be tested for it. This test should also be carried out in slim women.

What helps with insulin resistance?

The key here is to work on insulin resistance to reduce the symptoms of PCOS. The best way to do this is with your diet, avoiding sugar and getting enough exercise. Even a 5% weight reduction can lead to a reduction in androgens and insulin, as well as a normalisation of cycle behaviour and an increase in ovulatory cycles.

PCOS – type 2:

PCOS due to silent inflammation

Inflammatory processes play a key role in the body to protect it from foreign particles and pathogens and even stress. However, chronic inflammation can interfere with normal body functions, including ovulation, and lead to imbalanced hormones. Inflammation can also trigger the production of testosterone, which can lead to visible changes in the body. For example, in PCOS, markers of oxidative stress and inflammation have already been shown to correlate strongly with circulating androgens. The following symptoms may occur in this type of PCOS in addition to other PCOS symptoms: Extreme fatigue and tiredness, infections, skin problems such as eczema or psoriasis, joint pain, bowel problems, chronic headaches or a constantly blocked nose.

Silent inflammation is likely to be found in almost all types of PCOS; silent inflammation is almost always found in insulin resistance (Schultz 2020). But if you can pinpoint silent inflammation as the only factor, you probably have PCOS due to silent inflammation.

What helps with silent inflammation?

Here, the trigger of the inflammatory processes must first be sought. Possible triggers can be, for example, food intolerances, an imbalance of the intestinal flora or a histamine intolerance. It can also be helpful to reduce stress, avoid toxins such as BPA in plastic containers and water bottles, and eliminate inflammatory foods such as dairy products, wheat and sugar from your diet.

PCOS – type 3:

Adrenal-induced PCOS

This form of PCOS is mainly caused by too much stress. Male hormones, the so-called androgens, are not only produced in the ovaries, but also in the adrenal glands. The stress hormones cortisol and adrenaline are also produced there. If the adrenal glands are stimulated too much by stress, a simultaneous androgen secretion can be stimulated. However, in both men and women, only one hormone is produced exclusively in the adrenal glands: the sex hormone DHEAS. DHEAS belongs to the group of male sex hormones, but is produced by both sexes and serves as a precursor for testosterone and oestrogen production. If you only have elevated DHEAS levels, then it is likely that you belong to the type of adrenal-induced PCOS. In this case, the PCOS is driven by an increased stress response.

What helps with adrenal-induced PCOS?

Reduce stress and pay attention to better stress management overall. Relaxation techniques, meditation and gentle yoga are particularly helpful here. Be aware of your body’s needs.

PCOS – type 4:

Post-pill PCOS

This is a type of PCOS caused by taking the contraceptive pill. Common symptoms after stopping the pill are the absence of menstruation or very long or irregular cycles. Basically, this is not PCOS at all, it could rather be described as a temporary condition after stopping the pill and often leads to an erroneous PCOS diagnosis.

What causes post-pill PCOS?

Birth control pills with an androgenic effect can lead to elevated androgen levels still being detectable in the blood count up to six months after stopping the pill. After stopping the pill, your body needs a lot of time to adjust and to get rid of the hormone substitutes. This can take up to a year or even longer. In addition, your body has to learn to produce the hormones itself again and in the appropriate quantities. Sometimes too many androgens are produced in the first period until the body settles down again.

You may have post-pill PCOS if you do not have insulin resistance, silent inflammation or an abnormal stress response, and you had a “normal” cycle before taking the pill.

What helps with post-pill PCOS?

Give your body the time it needs to regenerate after stopping the pill. The absence of menstruation or irregular cycles for up to a year are not uncommon.

Can I have more than one type of PCOS?

It is quite possible that you can be assigned to different types of PCOS. However, the PCOS types are listed here according to priority of “treatment”. This means that if you find yourself in type 1 and type 4, you should first get your insulin resistance under control.

It can sometimes be quite difficult to classify your PCOS into different types, and it can be equally difficult to find the right solutions for you. Knowing which PCOS type you are will help you take the appropriate steps towards recovery. Lifestyle changes that are not suited to your PCOS type can actually make your PCOS symptoms worse. We recommend that you get a thorough check-up by a doctor and advice from a PCOS expert. In a coaching session with Julia Schultz, for example, you have the opportunity to identify your PCOS type and find suitable solutions for you.

These women have become pregnant despite PCOS

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Do you have PCOS cycles and still have questions about OvulaRing?

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Sources:

Anagnostis et al. 2018. Polycystic ovarian syndrome (PCOS): Long-term metabolic consequences. Female Reproductive Endocrinology. Volume 86, p. 33-43. https://doi.org/10.1016/j.metabol.2017.09.016

Briden L. 4 Types of PCOS. https://www.larabriden.com/4-types-of-pcos-a-flowchart/ Zugriff: 10.11.2020

González F. 2012. Inflammation in Polycystic Ovary Syndrome: Underpinning of insulin resistance and ovarian dysfunction. Science Direct.  https://doi.org/10.1016/j.steroids.2011.12.003

Insulite Health PCOS. The Phenotypes of PCOS. Which type are you? https://pcos.com/did-you-know/ Zugriff: 10.11.2020

Neumann K und Grisinger G. 2020. Polyzystisches Ovarsyndrom. In: Reproduktionsmedizin. 2. Auflage.

PCOS Living. 4 Types of PCOS and how to treat them. https://www.pcosliving.com/pcos-living-blog/types-of-pcos Zugriff: 11.11.2020

Randeva HS et al. 2012. Cardiometabolic Aspects of the Polycystic Ovary Syndrome. Endocrine Reviews. Volume 33. Issue 5. p. 812–841, https://doi.org/10.1210/er.2012-1003

Schultz J. Die 4 PCOS-Typen. https://www.juliaschultz.net/4-pcos-typen/ Zugriff: 10.11.2020

Stiefelhagen P. Bei PCOS besteht oft eine Insulinresistenz. Info Diabetol 1349 (2019). https://doi.org/10.1007/s15034-019-1482-x

Yu HF et al. 2016. Association between polycystic ovary syndrome and the risk of pregnancy complications. A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). doi: 10.1097/MD.0000000000004863

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