A couple of weeks ago, I wrote about the diagnostic criteria for diagnosing polycystic ovarian syndrome (PCOS). As a follow-up to that post, I wanted to outline the different categories of PCOS as the treatment does vary depending on the presentation of the condition in each woman.

As a recap, a woman may be diagnosed with PCOS if two of the three following criteria are met:

Oligo- or anovulation. This is characterized by a lack of ovulation, irregular menstrual cycles or an absence of a menstrual cycle.
Clinical and/or chemical hyperandrogenism. Hyperandrogenism is a state where there is too many male hormones (androgens) in the body. For a PCOS diagnosis you can either have high levels of androgens in the blood or symptoms suggesting high androgen levels such as acne, abnormal body hair growth or thinning hair.
Polycystic ovaries.  Polycystic ovaries are present if there are 12 or more follicles present on a single ovary OR if there is an increase in size of at least one ovary.

The Five Types of PCOS

PCOS, in general, can be divided into two main types based on the presence of insulin resistance. This is important to know as the presence or absence of insulin resistance does change the treatment protocol for this disorder. However, some people do break down the condition into five separate categories based on both insulin resistance as well androgen levels.

Insulin-Resistant PCOS

Insulin-resistant PCOS is by far the most common presentation of this condition. The women suffering from type I PCOS can present with all of the classic symptoms of PCOS such as irregular periods, excessive hair growth (hirsutism), acne, weight gain and hair loss. Due to the presence of insulin resistance, these women are also at an increased risk of one day developing type II diabetes.

The key to treating this type of PCOS is treating the insulin resistance which is often the culprit behind all of the symptoms. If excess weight is part of the symptom picture, even a 10% loss of body weight can restore ovulation in some women. Sometimes doctors will prescribe medications such as metformin to lower blood sugars and help restore insulin sensitivity.

Non-Insulin Resistant PCOS

Some women reach the diagnostic criteria for PCOS but do not have the classic insulin resistance associated with the condition. This presentation is referred to as type II PCOS, or non-insulin resistant PCOS.

In these women, weight loss and blood sugar lowering medications or supplements will have no effect on their symptoms or their fertility. For women with PCOS type II, the cause of their symptoms tend to be a bit more complicated. For instance, disorders of the thyroid or adrenal gland may be to blame as well as nutrient deficiencies such as iodine, vitamin D and zinc. In some women, environmental hormone disrupting toxins such as BPA, phthalates, and dioxins may be at the root cause of their symptoms. This results in a type of PCOS which is sometimes dubbed Inflammatory PCOS. These women often have other signs of inflammation such as headaches, acne, joint pain, autoimmune disease, or elevated CRP levels on blood testing.

1. Insulin-Resistant PCOS (Type I PCOS)

  Ovulatory dysfunction
✓  Insulin resistance
  Elevated testosterone

2. Non-insulin Resistant PCOS (Type II PCOS)

  Ovulatory dysfunction
✗  Insulin resistance
  Elevated testosterone

3. Non-traditional PCOS I

  Ovulatory dysfunction
✓  Insulin resistance
  Elevated testosterone

4. Non-traditional PCOS II

Ovulatory dysfunction
✓  Insulin resistance
  Elevated testosterone

5. Idiopathic Hirsutism

 Ovulatory dysfunction
✗  Insulin resistance
  Elevated testosterone

Testing

If you have been diagnosed with PCOS, there are several important tests that I recommend to help determine an effective treatment strategy in your particular case.

  1. Fasting insulin and fasting glucose levels
  2. Serum androgens (testosterone, DHEA, androstenedione)
  3. Thyroid panel (TSH, T4, T3)
  4. Zinc tally test
  5. Urine iodine and selenium
  6. 25-OH vitamin D
  7. Adrenal Stress Panel

Your naturopath has access to in-depth thyroid and adrenal tests, testing for nutrient deficiencies, as well as environmental toxins levels. These tests are crucial for the correct implementation of a treatment plan that is specific to your needs.

Yours in health,

About Dr. Nicole Hartman

Dr. Nicole Hartman is a naturopathic physician, a world traveler, a hiker, and a blogger. She focuses her practice in fertility and women's health and takes an integrative, evidence-based approach to healthcare.