PCOS Part 1: The 4 Types + Understanding the Root Cause
UNDERSTANDING YOUR PCOS DIAGNOSIS
I know I know, I’m no doctor, so what gives me the right to teach you about PCOS? Well, let’s see.
1. I’ve been where you are and I know how much it sucks
2. I’ve devoted 7 years to understanding the female body, hormones and PCOS because...refer back to point #1
3. My doctors never told me any of this information and thousands of women have reported to me that they’re in the exact same boat
So, my goal is not to doctor you. My goal is to educate you so you can take control of your health, be your own advocate and go out and do whatever you want with your bad self (have a baby, be healthy, have a full head of hair, protect yourself from diabetes, etc. you get the picture).
Now, this stuff fires me up (with anger if you were wondering) because there are HUNDREDS OF THOUSANDS of women walking around with a disorder that they don’t understand at all. And after this post, I hope you won’t be one of them.
Because how the heck do you go about reversing the symptoms of an issue you don’t know anything about? You don’t. Which leaves you stuck on meds, struggling with symptoms that leave you feeling like half of the woman you were before.
If you’ve been diagnosed with PCOS, you’ve probably been led to believe that Polycystic Ovarian Syndrome has something to do with cysts on your ovaries. Wrong-o.
The qualifier for PCOS includes 3 things:
1. Irregular Cycles, Anovulation and/or polycystic ovaries showing up on an ultrasound
2. High Androgens showing up on a blood test OR symptoms of high androgens like hirsutism
3. The ruling out of other reasons that could be causing clinically high androgens
Having “cysts” on your ovaries show up on your ultrasound is just ONE qualifier for getting the diagnosis of PCOS, but the real problem doesn’t lie in the cysts themselves, it lies in WHY those cysts are showing up.
You see, PCOS got it’s name from how your ovaries look and show up on an ultrasound. Normal ovaries are filled with ovarian follicles, these follicles are small normal “cysts.” Every month these “cysts” or follicles grow, burst and are reabsorbed.
If you progress to ovulation normally, your ovaries will have about a dozen of these follicles developing until one becomes dominant, outshining and suppressing all the others. This follicle contains an egg that will be released in a process called Ovulation.
But, if you don’t progress to ovulation normally like most women with PCOS, guess what? No one follicle becomes dominant enough to suppress the others, causing many (poly) developing follicles (cysts) to show up on an ultrasound. Hence the name Poly Cystic Ovarian Syndrome.
The problem is not these cysts, the problem is Anovulation, aka not ovulating.
PCOS is not a cyst problem, it is a lack of ovulation problem.
This is really freaking good news. Know why?
There are A LOT of barriers to ovulation, like:
+ Insulin Resistance
+ Not Eating Enough/Under Eating
+ Nutrient Deficiencies
+ The Birth Control Pill
+ Thyroid Issues
to name a few.
And it’s all about finding what those barriers to ovulation are for you and correcting the issue by working on them.
I’m not ovulating. What’s the big deal?
So, when you ovulate, the sac that held the egg turns into a gland called the corpus luteum. This amazing, wonderful gland produces the hormone progesterone for you for the next 11-14 days until your next menstrual cycle (or if your pregnant, you will continue to make progesterone).
You can only make progesterone if you ovulate.
Progesterone is my FAVE hormone for a few reasons::
1. It’s anti-aging
2. It’s anti-inflammatory
3. It’s needed for proper thyroid function (aka metabolism)
4. It chills you out by combatting anxiety + helping you sleep
5. Is amazing for skin and hair
6. IT SUPPRESSES ANDROGENS!!
Since high androgens are part of the problem behind many of the PCOS symptoms that suck so bad (hirsutism, acne, hair loss on head, etc.) goal numero uno for the woman with PCOS is to start ovulating so she can make progesterone.
I know what you’re thinking. How the heck do I go about figuring out what’s keeping me from ovulating? Girl, I got you.
Second thing you need to do is figure out your PCOS “type”. This simply means that every woman with PCOS has a different driving factor behind her PCOS symptoms. You’ll notice that a lot of the types can overlap, so if you’re feeling confused, I made a handy graph down at the bottom to help you figure it out.
THE FOUR TYPES:
THE INSULIN RESISTANT TYPE
This is the most common, as about 70% of women with PCOS have symptoms that are fueled by insulin resistance.
Insulin is a hormone that acts as a “key” that tells the cells to open up and use glucose (aka sugar). When our cells become resistant to insulin, insulin begins to stick around in the bloodstream, wreaking its havoc.
Insulin is a powerful hormone and when chronically elevated, can:
1. Raise LH levels (luteinizing hormone)
2. Raise Free Testosterone Levels
3. Lower Estrogen
4. Lower Sex Hormone Binding Globulin (SHBG) – keeps testosterone in check
How do you know if you’re insulin resistant?
Usually, high insulin causes “apple shaped obesity” or weight gain specifically in the waist and belly. But, you can be insulin resistant while fit or at a healthy weight. Some other signs of insulin resistance include:
+ Inability to lose weight:
+ Irritability (especially when going for long period without food)
+ Dizziness and lightheadedness when fasting
+ Extreme cravings for sugary foods
Make sure you ask your doctor for a fasting insulin test, hemoglobin A1c and test your blood glucose with a monitor.
Insulin This should be < 5 (note that < 5 does NOT rule out insulin resistance)
Hemoglobin A1c < 5.3 (note that Hgb A1c is not a perfect test by itself and a number of conditions can falsely elevate or decrease this value)
Fasting glucose should be below 85
Post Meal Glucose 2 hours after meals should be below 120
Best ways to reverse insulin resistance: avoid all sugar, eat full, satisfying meals that contain protein, carbs, veggies and fat, make sure you have plenty of magnesium and SLEEP.
Yes. You heard this right. Symptoms post-pill can look a lot like PCOS. Why?
1. Hormonal Birth Control can cause or worsen insulin resistance
2. Hormonal birth control suppresses ovulation (aka why you don’t get pregnant)
3. Coming of a low androgen index pill (like Yasmin) can cause a temporary surge in androgens as your ovaries start making them again
Good news is if you give it time, make sure you go back to ovulating and take care of your body properly, your symptoms should subside overtime.
The biggest reason women don’t regain their cycles post pill or develop amenorrhea is stress. Primarily stress caused by under eating and/or overexercising. Eating enough and well should be the number one goal post-pill.
Primarily, inflammation and environmental toxins fuel this type. Now, remember, chronic insulin resistance will cause inflammation. So, if you feel like you have a lot of inflammatory issues but also struggle with insulin resistance, you can absolutely have insulin-resistant PCOS that’s being made worse by inflammation in the body.
Some signs of chronic inflammation:
+ Digestive Issues: constipation, diarrhea, acid reflux
+ Body pain, muscle aches & joint pain
+ Constant fatigue and insomnia
+ Depression, Anxiety & Insomnia
+ Frequent Infections
Reducing inflammation is all about healing the digestive system. Avoiding wheat, dairy and other things you may be sensitive to. Also, exposure to environmental toxins will worsen inflammation.
About 10% of women suffer from this stress-fueled PCOS. Now, you can have a different type of PCOS being further fueled by stress and adrenal issues, as adrenal issues will make any type of PCOS worse.
This type is unique in that the only androgen that is high is your adrenal androgen, DHEAS.
When it comes to telling the adrenals to chill, its all about lowering stress, both internal and external. Make sure to look at this guide to eliminate the stressors that can be fueling stress inside your body.
SOME HIDDEN DRIVERS OF PCOS
Having low T3 or Hashimoto’s can prevent ovulation and make you more insulin resistant.
Your ovaries and corpus luteum have a high need for certain nutrients. Specifically, vitamin D, selenium, iodine and zinc, amongst others.
High Prolactin Levels:
This can be caused by pituitary issues.
Too Little Food Or Carbs:
Undereating and/or not eating enough carbohydrates tells your body you are starving. When in survival mode, do you think your body is gonna let you cycle properly so you can make a baby? Nope.
Still confused about your type? Check out this flow chart: