I invite you to think differently about polycystic ovary syndrome (PCOS) and the types of PCOS.
PCOS is not one thing. It is not one disease. Instead, PCOS is a set of symptoms, with the key symptom being impaired ovulation which leads to androgen excess or a high level of male hormones. Androgen excess then causes the common PCOS symptoms of hair loss, hirsutism, and acne.
To treat PCOS you must first ask: “Why, in your particular case, do you not ovulate?”
I say “in your particular case” because your reason may be different than someone else’s reason. That’s why there are so many different natural treatments, and that’s why only some will work for you.
👉 Tip: Don’t be too quick to accept a PCOS diagnosis. Read PCOS cannot be diagnosed by ultrasound.
4 Different Types of PCOS
This is the classic type of PCOS and by far the most common. High insulin and leptin impede ovulation and stimulate the ovaries to make testosterone. Insulin resistance is caused by sugar, smoking, trans fat, and environmental toxins.
Is this you? You have been told that you are borderline diabetic, or you had an abnormal glucose tolerance test. You probably have elevated insulin, and you may also have elevated LH (luteinizing hormone). You are probably overweight, although you may be a normal weight. Normal-weight insulin resistance can occur in the years following dieting or eating disorder.
Treatment ideas: The first step is to quit sugar because high-dose fructose is a major contributor to insulin resistance. Please also consider gentle intermittent fasting, which works well to improve insulin sensitivity. The best supplements for insulin resistance are magnesium, lipoic acid, inositol, and berberine. The pill is not a treatment for this type (or any type) of PCOS because it impairs insulin sensitivity. Improvement for Type 1 PCOS is slow and gradual over six to nine months. Read How to reverse insulin resistance.
Hormonal birth control suppresses ovulation. For most women, it’s a temporary effect, and ovulation will usually resume fairly soon after the Pill is stopped. But for some women, ovulation-suppression can persist for months or even years. During that time, it is not unusual to be given the diagnosis of PCOS. Some experts deny the existence of Pill-induced PCOS, but it is very real. It is the second most common type of PCOS that I see. I have spoken to many other clinicians who are seeing the same thing. We desperately need more research into it.
Is this you? You had regular periods before starting the Pill, although you may have had acne. You probably now have elevated LH on a blood test, although you may have normal LH and high-normal prolactin.
Treatment ideas: If your LH is elevated, the best herbal treatment is peony & licorice combination (see my book for more information). If your prolactin is high-normal, then the best herbal treatment is Vitex (also called chaste tree or chaste berry). Do not use Vitex if your LH is elevated. Vitex stimulates LH so it will make things worse. Indeed, many of my PCOS patients report feeling worse on Vitex. See my Vitex post.
Both peony and Vitex work on your pituitary-ovarian axis, and they are powerful herbs. I recommend you do not use them too soon or for too long. Do not take them if you are a teenager, or if you have just come off the Pill. Give yourself at least 3-4 months off the Pill. Do not use Peony or Vitex for more than 10 months in a row. They should not need to be used that way. If they are the right herbs, they will work fairly quickly (within 3-4 months). And then, your periods should stay regular after you stop the herbs. Do not take licorice if you have high blood pressure. Please seek professional advice.
Inflammation—or chronic immune activation—results from stress, environmental toxins, intestinal permeability and inflammatory foods like gluten or A1 casein. Inflammation is a problem for PCOS because it impedes ovulation, disrupts hormone receptors, and stimulates adrenal androgens such as DHEA and androstenedione.
Is this you? You have other symptoms of immune dysfunction such as recurring infections, headaches, joint pain or skin conditions. Your blood test shows inflammatory biomarkers such as vitamin D deficiency, abnormal blood count, elevated C-RP, thyroid antibodies, or gluten antibodies. You may have elevated DHEA or androstenedione, and a positive urine test for intestinal permeability.
Treatment ideas. Reduce stress and exposure to environmental toxins like pesticides and plastics. Eliminate inflammatory foods such as wheat, dairy, and sugar. Treat intestinal permeability with zinc, berberine, and probiotics. Supplement magnesium because it is anti-inflammatory and normalizes adrenal hormones (HPA axis). Improvement is slow and gradual over 6-9 months.
Adrenal PCOS means that you have elevated adrenal androgens such as DHEAS (dehydroepiandrosterone sulfate). You have normal levels of testosterone and you may ovulate regularly. Adrenal PCOS accounts for about 10 percent of PCOS diagnoses.
Is this you? You do not exactly fit the criteria for the first three types of PCOS. You have tried a number of natural PCOS treatments and nothing seems to work. Look deeper.
Know when it’s time to let go of your PCOS Diagnosis. In most cases, PCOS is not a permanent condition. With the right diagnosis and the right treatment, PCOS can become a thing of the past.
There is some overlap between these four types. For example, inflammation is a major driver in both the insulin-resistant and inflammatory type of PCOS.
**See the updated 2019 version of this blog post: 4 types of PCOS (a flowchart) **