PCOS Explained

You may have heard of PCOS and have wondered what the acronym means. Maybe you have never heard of it but you are curious to learn more. Perhaps you suspect you have it. Maybe you have been told you have some elements of PCOS but you don’t fit the classic picture.

Read below for the definition of this complex syndrome and the four unique types of PCOS.

What is PCOS?

To begin, let’s talk about what PCOS is. PCOS is short for Polycystic Ovarian Syndrome. This is a common and complicated syndrome that women of reproductive age can experience. A woman may suspect she is experiencing it or I may suspect a patient is experiencing it if they exhibit any of the following symptoms:

• Hirsutism, which is increased hair growth on the face, nipples, back, or thighs

• Acne, especially along the jawline and chin or on the back and chest

• Delayed ovulation leading to irregular cycles or amenorrhea (lack of a period)

• Insulin resistance 

• Weight gain or stubborn weight loss

• Increased testosterone

• Exceptionally increased sex drive (from increased testosterone)

• Multiple follicles in the ovaries on ultrasound

• Infertility

It is called a syndrome because it isn’t a specific disease with a clear pathophysiology, genetic marker, or repeatable symptom picture. PCOS is actually a diagnosis of exclusion, meaning nothing else can explain the symptoms a woman is experiencing so when there is this group of imbalances with no other explanation, she would be considered to have the “syndrome” of PCOS.

The name is also misleading because not all women with this syndrome experience multiple cysts on their ovaries. The name will change one day to be more inclusive of the whole spectrum of imbalances we see, but until then it’s a complicated syndrome with a somewhat misleading name.

Diagnosing PCOS

To make things more complicated, not all PCOS presents the same way. There are actually four different categories of PCOS.

Some women have no issues with weight, some have no acne or hair growth. Some have regular periods. This is why it is complicated. We will break those down for you in a bit.

The actual diagnosis of PCOS is based off something called the Rotterdam Criteria. This means only two of three following conditions need to be present to be diagnosed with this syndrome:

1. Hyperandrogenism- Excess levels of androgens (hormones, such as testosterone and DHEA), which can be found on blood tests or evidenced in symptoms such as acne, hirsutism, or an exceptionally high sex drive

2. Oligomenorrhea - Irregular or infrequent menstrual cycles

3. Polycystic ovaries- multiple follicles or cysts in ovaries

The Four Different Types of PCOS

Since you only need two of the three symptoms to be diagnosed with PCOS, this lends itself to four separate types of PCOS. I will share the four types laid out beautifully in the book 8 Steps to Reverse Your PCOS by Dr. Fiona McCulloch, ND.

When this syndrome was first discovered, it was thought that all women fell into the first and second categories we will talk about, category A and B. The “classic” picture of PCOS is a women with excess weight, acne and hair growth on her chin, and irregular cycles. However, as more investigation and experience has shown, it isn’t that simple. There are many thin or average weight women with PCOS, and even women who show no signs of high androgens.

The diagnostic criteria for the four types are as follows:

Type A: Delayed ovulation, hyperandrogenic, and polycystic ovaries on ultrasound

Type B: Delayed ovulation, hyperandrogenic, with normal ovaries on ultrasound

Type C: Hyperandrogenic, with polycystic ovaries on ultrasound, and with regular ovulation

Type D: Delayed ovulation, with polycystic ovaries on ultrasound, and without androgenic signs

As you can see, women can present very differently.

Functional Perspectives on PCOS

Although the Rotterdam Criteria is the main diagnostic marker for PCOS, in functional and naturopathic medicine, we dig deeper into the why behind PCOS and see a few common underlying issues.

Insulin Resistance

The first underlying factor is insulin resistance.

Insulin resistance is when the cells in the body become less sensitive to the hormone insulin, which is what allows us to take in carbohydrates and sugar into our cells. Not all women experience this, however insulin plays a big role in increasing androgens made by the ovaries and disrupting the hormones that signal to the ovaries, resulting in high follicle production and issues with ovulation.

Insulin resistance also is a factor in weight gain or stubborn weight loss. Working on insulin resistance is a key factor in reversing this syndrome.

Ratio of FSH and LH

The other clue we look for in labwork to rule in or out a possible PCOS case is the ratio of two hormones on day 3 of a woman’s cycle: FSH and LH. These are the hormones that come from the pituitary gland and signal the ovaries to make follicles (FSH) and ovulate a dominant follicle, or egg (LH).

In a women with a PCOS imbalance, often her LH is much higher than her FSH, usually 2x higher. This increase in LH means there isn’t an obvious surge in LH before ovulation, meaning ovulation is delayed. This is often why women with PCOS have irregular cycles.

Again, not all women have this pattern, but it often is present in those who have delayed ovulation.

So What Now?

If you frequently experience these symptoms or are curious about a potential PCOS diagnosis, consult your healthcare practitioner. It’s important to get a professional diagnosis to appropriately and effectively treat this syndrome and prevent further health consequences, such as infertility or diabetes. 

I recommend working with a naturopathic doctor or functional medicine practitioner who is well versed in PCOS. The typical route of treatment in the conventional medical model is often medication for diabetes. There is a lot more to it than that and I am a big fan of healing the whole person from the root.