The 4 Different Root Causes and Types of PCOS

4 Different Root Causes and Types of PCOS

By Megan Perez, dietitian at Nourishing Minds Nutrition

Note from Megan before we begin today’s blog post: I know what it’s like to assume you have a myriad of negative health conditions. I know what it’s like to feel so desperate for an answer. I have probably “diagnosed” myself with more ailments than I can count. I remember thinking that I for sure have adrenal fatigue, leaky gut, SIBO, and even PCOS. Many of my clients share that they feel the same way. It’s not because of a lack of knowledge on these topics either. It seems like the more research you do, the more you convince yourself it’s true. It wasn’t until I did the tough work of healing my relationship with myself and learning to trust my body that I finally realized I did not have any of these conditions. My intention for this article is not to downplay your feelings at all. I chose to write this article to provide knowledge, but I also encourage you to work on body trust prior to jumping to conclusions. Also, it is very important to work with qualified health professionals to determine diagnoses. 

How many of you have believed at one time or another you had PCOS? How many of you think that you may have it right now? While this article should not be used to diagnose, I hope that it will help to clarify a few misconceptions.

Polycystic Ovary Syndrome (PCOS) is not a disease but a group of symptoms related to anovulation (lack of ovulation) and hormonal imbalances. It is a very common endocrine disorder affecting up to 10% of women, and it is also very complex. Symptoms may include:  anovulation, menstrual irregularities, infertility, increased production of androgens (such as testosterone), hirsutism, acne, and insulin resistance. Some women with PCOS will experience all of these symptoms, while others may only experience a few. In order to be diagnosed with PCOS, you must meet specific criteria, and your health care provider must rule out all other causes for these symptoms. The most commonly used method of diagnosis is to meet at least 2 of the 3 following criteria: 

  1. Anovulation

  2. Elevated androgens or symptoms of elevated androgens

  3. Polycystic ovaries on an ultrasound

While a true cause for PCOS is unknown, it is most likely related to genetics and environmental factors. Women are not born with PCOS, however their genes determine how susceptible they are to symptoms. Specific genes may put a woman at a disadvantage in her current environment. Environmental triggers could include geographical location, exposure to toxins or chemicals, or the Western pattern diet. Please keep in mind that weight gain is not a cause of PCOS.

Most women I talk to associate insulin resistance with PCOS, and they aren’t wrong. Insulin plays a large role in PCOS, along with testosterone and progesterone. It is common that women with PCOS have high levels of insulin along with insulin resistance, however this is not that case in all women with this syndrome. Insulin is a hormone that allows our cells to absorb glucose, which is used for energy. Insulin resistance is a condition where cells aren’t able to absorb glucose for energy, which causes your cells to be “starved” even after you have eaten a meal. This is why many women with PCOS have difficulty losing weight and feel defeated by dieting efforts. If this is resonating with you right now, I want you to know that this is not your fault.

As I mentioned above, there are different types of PCOS and some that do not include insulin resistance. The four types of PCOS are insulin-resistant, post-pill, inflammatory, and adrenal.

Insulin-resistant PCOS: This includes about 70% of PCOS cases and should be treated by a professional due to the increased risk of long term health problems such as diabetes and heart disease. Your doctor can test for fasting insulin levels.

Post-pill PCOS: This type is usually temporary and is caused by a surge in androgens after coming off the birth control pill. If you did not have any PCOS symptoms prior to starting the pill and you do not have insulin resistance, this could be you.

Inflammatory PCOS: This type is driven by inflammation and environmental toxins. Chronic inflammation can stimulate the ovaries to make excess testosterone. Symptoms may include: fatigue, bowel issues (IBS or SIBO), headaches, joint pain, or skin conditions.

Adrenal PCOS: About 10% of PCOS cases fall into this category. If your lab work shows normal ovarian androgens (testosterone and androstenedione) but elevated adrenal androgens (DHEAS), you may have this type. The first step in treatment is to reduce stress and regulate the HPA axis.

Although there is not a cure for PCOS, there are many ways to manage it. In addition to various types of treatment, there are lots of changes you can make to your lifestyle that can help. A common theme I hear when it comes to treatment is to “just lose weight.” I believe this advice is not helpful, and can in fact be potentially harmful knowing the consequences and failure rate of diets. 

If after reading this article, you believe you have PCOS, here is what we at Nourishing Minds Nutrition recommend: 

  1. Seek out a health professional and have blood work drawn, along with a comprehensive assessment (history, physical, ultrasound) in order to receive a diagnosis.

  2. Work with someone on individualized lifestyle changes, stress management techniques, and possibly herbal supplements to treat the root cause of your specific PCOS type. You may also choose to work with a doctor with prescription medications, and that’s okay, too!

  3. We encourage you to look into Intuitive Eating over dieting, and make sure you are eating enough.

  4. Be kind to yourself, have patience, and be positive.

    If you have been diagnosed with PCOS, I have so much compassion for you. Please know that your body is not broken. It can be frustrating to feel as if this is out of your control. There is a way to work WITH your body and WITH your PCOS.

Thank you Megan for that blog post! We also want to encourage you to ensure you do not have hypothalamic amenorrhea (HA) before being diagnosed with PCOS, as the two have similar symptoms. If you have a history of disordered eating, restrictive eating and/or excessive exercise, it is much more likely your missing or irregular period is caused from HA. Work with your health care provider to ensure correct diagnosis.

Tell us: We know it can be confusing to learn about how to eat intuitively to support your hormones and health, even with a diagnosis of PCOS. What questions do you have for us?