Types of PCOS: The Ultimate Guide (2020)

When I was diagnosed with PCOS my doctor never told me of the different types of PCOS. I was led to believe PCOS is one condition and that every woman has the same PCOS.

But after hours upon hours of research, I found out the truth.

There is more than one type of PCOS.

This new knowledge changed everything for me. It allowed me to finally understand what was causing my symptoms and address it.

So, I get how you may be feeling. Learning there are different PCOS types may have come as a shock to you too. But the sooner you realize this, the quicker you can begin to make the necessary changes for your type of PCOS.

In this guide, we will look at the different types of PCOS. You will find out their possible causes, symptoms as well as the tests your doctor may do to find out your PCOS type. We will also look at how to naturally treat your PCOS type.

PCOS can be scary and confusing, so I want you to feel like you have all the information.

Let’s get started.

Table of Contents
1. What Is PCOS
1.1 Symptoms Of PCOS
1.2 What Causes PCOS
2. Insulin-Resistant PCOS
2.1 What Causes Insulin-Resistant PCOS?
2.2 How Do I Know If I Have Insulin-Resistant PCOS?
2.3 Treatment for Insulin Resistant PCOS
3. Adrenal PCOS
3.1 What Causes Adrenal PCOS?
3.2 How do I know if it’s Adrenal PCOS?
3.3 Treatment for Adrenal PCOS?
4. Pill Induced PCOS
4.1 How Do You know if it's Pill-Induced PCOS?
4.2 Treatment For Pill-Induced PCOS
5. Inflammatory PCOS
5.1 What Causes Inflammation?
5.2 How do I know if it’s Inflammatory PCOS?
5.3 Treatment for Inflammatory PCOS?
6. Hypothyroidism 'Hidden Cause of PCOS'
6.1 What Causes Hypothyroidism?
6.2 What’s the Link Between PCOS and Hypothyroidism?
6.3 How Do I Know If It's Hypothyroidism?
6.4 Treatment for Hypothyroidism
7. What Type of PCOS Do You Have?

Now, before we delve into the different types of PCOS, let's first talk about what PCOS is. If you already know this information, feel free to skip ahead to the different types of PCOS section.

What is PCOS?

Polycystic ovarian syndrome (PCOS) is a hormonal condition that affects 10-20% of reproductive-age women.

Doctors use the Rotterdam Criteria to diagnose PCOS. Women must show two out of the three signs from the criteria to be diagnosed with PCOS.

The three signs are

1. High Androgens (Male Hormones)
2. An Irregular Menstrual Cycle
3. Polycystic Ovaries

High androgens

All women produce small amounts of male hormones like testosterone. But women with PCOS produce higher levels than normal. You may show signs of this physically, growing excess body or facial hair.

Doctors will do a blood test to check your hormone levels and establish if you have high androgens. Your doctor will be looking out for higher than normal amounts of male hormones like testosterone. But also further signs of hormone imbalance such as low progesterone and low SHBG levels.

An irregular menstrual cycle

The average menstrual cycle is between 21 to 35 days (on average 28 days). A cycle is irregular if it lasts longer than 35 days or less than 21 days. A missed period would also be an irregular cycle.

Your doctor may ask questions about the length and health of your menstrual cycle to see if it’s irregular.

Polycystic Ovaries

Despite the name, these are not actually cysts the way you may think of them, but many small follicles. These follicles contain eggs.  When you don't ovulate the follicle does not break to release the egg. As a result, follicles stay in the ovary and the ovaries appear to contain many ‘cysts’. For an ovary to be polycystic, it must contain at least 12 of these 'cysts'.

An ultrasound of the ovaries can identify whether there are ‘cysts’ on your ovaries. The ultrasound will either be an abdominal or transvaginal scan.

As you can see, despite the name 'Polycystic Ovary Syndrome’, you don’t necessarily need to have polycystic ovaries to be diagnosed with PCOS.

Symptoms of PCOS

Now, based on the criteria, take a look at the symptoms below. Symptoms may appear at a young age, so early diagnosis and treatment for PCOS in teens is crucial. Keep in mind, you do not have to show all symptoms to have PCOS.

• Infertility
• Irregular or no periods at all
• Insulin resistance
• Fatigue
• Excess hair growth on the face, chest and back
• Acne
• Hair loss or hair thinning
• Weight gain or trouble losing weight
• Skin Tags
• Dark patches on the skin
• Depression and anxiety
• Sleep Apnoea
• ‘Cysts’ on the ovaries

As you can see, the symptoms are very broad. PCOS affects many aspects of a woman’s life.

PCOS not only changes a woman’s reproductive functions, but it can also affect her appearance. The increased levels of male hormones can cause acne, hair loss and excess hair growth.

Once you have formally been diagnosed with PCOS, the next step is to figure out your root cause and type of PCOS.

You are probably thinking, “how am I supposed to figure out my type of PCOS?! Heck, I didn’t even know there was more than one type!“

I hear you cyster! I understand this is all a little overwhelming. But I am here to support you and make it all a little less confusing.

So, are you ready?

Let’s begin.

What Causes PCOS?

There is no clear explanation for what causes PCOS. Researchers suggest PCOS is genetic. So, we are born with the PCOS gene. But just because we have the PCOS gene we don’t necessarily have to express it. Whether we do or not depends on epigenetics. Epigenetics is the study of how heritable chemical marks on our DNA can adjust the expression of our genes. In other words, epigenetics control which genes are turned on and off. But it's not just about the marks that we inherit. The science is showing, that environmental factors like diet and lifestyle can also impact our genes for better or worse.

Meaning you may be genetically predisposed to have PCOS and something in your diet or lifestyle triggers the gene to ‘turn on’ and the symptoms to develop.

So, here is where the different types of PCOS comes in. Contrary to popular belief, PCOS is not one condition. It is instead a set of symptoms and there are different types of PCOS. These types are possible root causes of PCOS.

In this section, we will look at the different types of PCOS. We will see the causes, symptoms and specific tests your doctor will do to find out your PCOS type. But we will also look at how to naturally treat each type of PCOS, so you can reverse it and live a symptom-free life.

Let’s get started with the first type of PCOS.

Insulin resistance is the most common root cause of PCOS, with about 70% of PCOS women suffering from this.

Our bodies main source of energy is glucose (sugar) and we get this from the food we eat. The sugar we get from food enters our bloodstream after digestion. Now insulin, a hormone released by the pancreas, has two processes in the body. Shuttle sugar to cells be used as fuel and store sugar in the liver for future use. But when someone is insulin resistant, the cells don't respond to the signal insulin is giving. As a result, there is a build-up of sugar in the bloodstream.

To reduce blood sugar levels, the pancreas releases even more insulin. High levels of insulin in the body then has the unwanted side effect of telling the ovaries to produce excess amounts of testosterone. This then causes the PCOS symptoms women experience.

Failure to treat insulin resistance increases the risk of Type 2 Diabetes.

Now you might be wondering.

What causes insulin resistance?

In PCOS women, insulin resistance is often a result of high blood sugar and insulin. This can occur for various reasons including a fatty liver, lack of sleep and exercise.

 A Fatty Liver can cause Insulin Resistance

Fatty liver disease is a build-up of fat in the liver. The white circles in figure 1 represent fat cells. If more than 5% of the liver is fat, it is considered fatty. Now contrary to what you may think, fatty liver disease isn’t caused by eating fat. But instead it is caused when someone overconsumes fructose (sugar).

Essentially, fructose (a natural sugar found in fruit) cannot be used as energy by the body until it is turned into glucose by the liver. But when fructose is overconsumed this can cause the liver to clog up. When the liver overflows with fructose, it starts turning the fructose into fat. Which over the long term can cause fatty liver disease.

But the problem is not the fruit. You see, over the last 50 years, people have been consuming a lot more fructose in their diets. This is due to synthetic sweeteners like High-Fructose Corn Syrup (HFCS) being added to processed foods and drinks.

It is the sugars from HFCS that are harmful to the body not the small amount of fructose in natural fruits. You can check out this list of foods that contain lots of HFCS. I suggest limiting the number of foods high in HFCS that you eat as they can lead to weight gain, which will not help your PCOS. Instead, try getting your sugars from fruit instead. It is far healthier for you and in my opinion tastier too!

Check out my in-depth post ‘Fruit for PCOS: Should You Avoid It?’ for more information on which fruits are best.

Now you might be wondering.

How Does Fatty Liver Disease Cause Insulin Resistance

Here’s the thing.

To decompress itself of all the fat, the liver releases some of it into the bloodstream and this causes inflammation in the cells. Inflammation is the immune systems natural response to protect the body from harm. In turn, this inhibits insulin signalling. If there is no change to the persons diet, the fatty liver will be constantly decompressing and the inflammation becomes chronic. And the constant inhibition of insulin signalling can lead to insulin resistance.

So, what this shows is that your dietary choices play a huge role on insulin resistance.

Now we often think poor food choices and eating too much sugar, is the only reason for insulin resistance. But, it can also be caused by our lifestyle choices.

Lack of Sleep

To a lot of people sleep isn't important. But it should be a priority is anyone’s daily life.

Cortisol Interferes with Insulin

A lack of sleep can decrease insulin sensitivity. This is because being sleep deprived can increase cortisol levels. Cortisol stops insulin from doing its job and as a result, insulin is unable to lower blood sugar levels, so they remain high.

Impacts Leptin and Ghrelin

As well as this, being sleep deprived can interfere with two hormones involved in energy balance. They are called leptin and ghrelin.

Leptin, also known as the ‘satiety hormone’, is produced by our fat cells. It influences how much food we eat and store as fat. While ghrelin, also known as the ‘hunger hormone’ increases appetite and promotes fat storage. Both hormones are released on and off to control feelings of hunger and fullness.

Now, a lack of sleep can lower leptin and increase ghrelin levels in the body. As a result, the body is made to think it is hungry and needs more food. So it begins to crave quick sources of energy like carbohydrates and sugar to keep you going through the day. Such dietary choices leads to high blood sugar and insulin levels. Additionally, elevated levels of ghrelin stops the body from burning calories because it thinks there's a shortage of energy. Which means there is more fat storage.

The cravings for sugar and the increase in body fat can impact insulin signalling causing insulin resistance.

Lack of Exercise

A further lifestyle factor that can increase the risk of insulin resistance is a lack of exercise.

A study found after 14 days of low exercise, insulin sensitivity decreased and abdominal fat increased.

Regular exercise is key to reducing the risk because exercise makes your muscles respond better to inulin. So it increases your insulin sensitivity and reduces fat storage.

How do I know If I Have Insulin Resistant PCOS?

To find out if high insulin levels are the cause your PCOS, look at your symptoms. Are you experiencing any of the symptoms listed below.

Symptoms of Insulin Resistance

• Abdominal obesity
• Difficulty losing weight
• Cravings for sugar or carbohydrate-rich foods.
• Fatty Liver
• Chronic fatigue or low energy
• Brain fog
• High blood sugar levels.
• Skin tags
• Dark patches on the skin
• High blood pressure
• Frequent urination
• Thirsty all the time

As you can see, there are a range of symptoms associated with insulin resistance. Weight gain and having a greater waist to hip ratio is a sign of insulin resistance. It is caused because the body is storing the sugar as fat in the liver and cells.

But, you don’t have to be overweight or obese to be insulin resistant or have PCOS. Researchers have found that insulin resistance affects around 30% of lean PCOS women. To find out more about lean PCOS check out my post ‘Lean PCOS: What Causes It and How To Treat It’.

How to Test for Insulin Resistance?

Now, if you are experiencing any of the symptoms mentioned above, it may be a sign of insulin resistance. But to know for certain, you need to visit your doctor so they can do the necessary insulin resistance tests. Your doctor may look at a range of health markers because no one test can detect insulin resistance.

I understand seeing all these tests may be a little overwhelming, but this isn’t something you have to worry about. Your doctor will decide which test(s) you need to do. These tests are to be done under medical supervision. But I have listed them below for your information.

Fasting Insulin

This test requires an overnight fast and doctors are looking to see the amount of insulin your body is producing.

• Normal Range: 3–8 uIU/mL
• Slight Insulin Resistant Range: >8 uIU/mL
• Moderate Insulin Resistant Range: >10uIU/mL
• Severe Insulin Resistance Range: >12uIU/mL

The homeostatic model assessment (HOMA)

This is one of the most common ways of spotting insulin resistance. The test is done after an overnight fast. Doctors are looking at glucose and insulin levels, and estimating the function of the part of the pancreas that secretes insulin. The HOMA is calculated using this formula, HOMA/IR=Glucose X Insulin/405.

• Normal Range: Near 1 (0.5-1.5)
• Slight Insulin Resistant Range: >1.5
• Moderate Insulin Resistant Range: >2.5
• Severe Insulin Resistance Range: >3

Fasted Glucose Test

This test looks at blood sugar levels before food or liquids have been consumed. So, you cannot eat or drink anything at least eight- twelve hours before the test.

• Normal Range: 75–95 mg/dL
• Slight Insulin Resistant Range: >95 mg/dL
• Moderate Insulin Resistant Range: >100 mg/dL
• Severe Insulin Resistance Range: >110 mg/dL
• Diabetes: >125 mg/dL

Oral Glucose Tolerance Test

This test must also be perform on an empty stomach. Your doctor will first draw some blood to measure your blood sugar levels. This will be used as a baseline reference. You will then drink eight ounces of fluid containing 75 grams of sugar. After two hours, a second blood test will be taken to assess blood glucose levels.

• Normal range: > 140 mg/dl
• Pre-Diabetes: 140-200 mg/dL
• Diabetes: >200 mg/dL

Hemoglobin A1c (HbA1c) Test

The HbA1c test looks at your blood sugar levels over the past three months which is more effective.

• Normal Range: < 5.6%
• Slight Insulin Resistant Range: >5.5%
• Moderate Insulin Resistant Range: >5.7%
• Severe Insulin Resistance Range: >6.0%
• Diabetes: >6.4%

Now, keep in mind that you can still have insulin resistance if your HbA1C result is normal. 

Quantitative insulin sensitivity check index (QUICKI)

The QUICKI test puts the individuals fasted glucose and insulin levels into a math formula. Depending on where the value from the formula lies in the QUICKI index, an insulin resistance diagnosis is made. A range of 0.30 and below indicates insulin resistance.

Oral Glucose Tolerance test with Insulin

Experts say this is the best way to test for insulin resistance because it measures both glucose and insulin.

Now, this test is similar to the oral glucose tolerance test. Patients must not eat or drink at least eight-twelve hours before the test. On the day of the test patients will drink eight ounces of fluid containing 75 grams of sugar.

The main difference is that there are intervals, during the 2-4 hour length of the test, where glucose is measured along with insulin.

The oral glucose tolerance test with insulin is also often used to assess reactive hypoglycaemia which is common in lean PCOS women.

 

You now know the causes, symptoms and the link between insulin resistance and PCOS. Let’s talk about how you can treat this type of PCOS.

Treatment for Insulin Resistant PCOS

A holistic approach is needed to treat this type of PCOS. Meaning you need to look at both your diet and lifestyle.

Let’s start off by looking at what dietary changes you can make to help reverse your insulin resistance.

Diet Tips for Insulin Resistant PCOS

First off, there is no best or standardised diet for insulin resistant PCOS. But below are some dietary tips that can help lower blood sugar and insulin levels to treat insulin resistance

Carbs and Insulin Resistance

The most common question insulin resistant patients find themselves wondering is, ‘should I avoid carbohydrates?’

Well, some experts recommend cutting back on the amount of carbohydrates consumed. They say that if too much sugar in the blood is the problem, the most obvious response would be to stop eating it.

Two popular diets that are often recommended for insulin resistance, because of their low carb intake, are the ketogenic and low carb diet.

Let’s first look at the ketogenic diet.

How and Why does the Keto Diet help insulin resistance?

The Ketogenic Diet was developed in the 1920's as a treatment for epilepsy. It is a high fat, moderate protein and very low carb diet (70% fat, 25% protein and 5% carbs).

Now, the keto diet is believed to be an effective way to lower insulin levels because it puts your body into "fat burning mode." Meaning it switches from burning glucose to fat. This process can only occur when the body is in a state of ketosis.

Ketosis is a metabolic process that happens after 3-4 days of eating low carb (less than 50g a day). Because there is no sugar in the blood, the body burns stored fat to create energy.

This then allows insulin levels and insulin resistance to decrease.

The Low Carb Diet

The low carb diet is the second popular diet. Similar to the keto diet, the low carb diet emphasises more meat, healthy fats like fish, nuts and seeds. But unlike, the keto diet, the carb intake is not as low. On a low carb diet, individuals are allowed between 75-150g of carbs a day. Compared to the keto diet which advises anything below 50g. Now, because the carb intake isn’t low enough you won’t be in ketosis. But a low carb diet may still help because eating less carbs will lower the amount of insulin released. So, it may help

• Prevent high blood sugar levels
• Lower HbA1c levels
• Boost weight loss
• Reduce cravings for sugary foods
• Boost mental clarity

You might be thinking, "I love carbs! Please don't tell me I have to cut them out completely!”

So here’s the truth.

You Can Still Eat Carbs

Get this.

A plant-based diet (only eating plant foods like beans, vegetables and fruits) can help improve insulin levels.

Let me explain.

Not all carbs are created equally. Meaning not all carbs are ‘bad’ for you.

The problem is not the carbs. You see, over the last 50 years, people have been consuming a lot more refined/processed carbs.

Now, there are two types of carbohydrates, natural and refined.

Natural Carbohydrates

Natural carbohydrates have not been processed and remain in their natural state. They are a source of vitamins and minerals. Natural carbs include plant foods such as sweet potatoes, legumes, vegetables and fruits.

These natural carbs are also known as complex carbs. The body breaks them down slowly because of their high fibre content. Studies show fiber can lower blood sugar levels. It does this by slowing down digestion and the release of sugar. This then prevents huge spikes in blood sugar and insulin.

Refined Carbohydrates

Refined carbohydrates are man-made. They use sweeteners and preservatives to change the way they taste and stop them from going bad. Examples of refined carbs include bread, cereals, pasta, artificial sweeteners.

An overconsumption of these refined/processed carbs is harmful to the body. This is because they contain a synthetic sweetener called High-Fructose Corn Syrup (HFCS).

Now, the amount of carbs you consume depends upon your own tolerance to them and the severity of your insulin resistance. So it is important to work with a medical professional to work this out.

Always combine carbohydrates with a protein and fat. By combining all three food groups, blood sugar levels will not spike causing a surge in insulin.

Choose the Right Fats for Insulin Resistance

Fat is another important macronutrient to include in your PCOS diet. But unfortunately, there is tons of contradictory information about fat. As a result, people are left feeling overwhelmed and afraid to eat fat.

But fats should not be feared because not all types of fats are created equally. There are ‘good’ and ‘bad’ sources of fat.

The ‘Good’ Sources of Fat

Saturated and monounsaturated fat are the healthy sources. Saturated fats include milk, grass-fed butter, ghee, coconut oil, coconut cream. Foods high in monounsaturated fat include avocados, olive oil.

As well as adding good sources of fat to your PCOS diet. You also want to avoid the bad sources of fat.

Fats You Should Avoid

Vegetable oils such as sunflower, canola and corn oil are high in omega 6 fatty acids. Now, omega-6 is an essential fatty acid needed by the body for growth and development, but an excess consumption can cause inflammation.

Margarine should be avoided because not only is it made using vegetable oils, but some also contain trans-fat. Trans fat creates inflammation and increases the risk of heart disease.

Avoid Artificial Sweeteners for Insulin Resistance

Artificial sweeteners like aspartame, Splenda and Xylitol add sweetness to foods. But without the extra calories and sugar.

But are artificial sweeteners a healthier alternative to sugar?

Here's what the research says:

Researchers suggest artificial sweeteners are no better than sugar. Many believe they can still raise blood sugar and insulin levels. So, unfortunately, artificial sweeteners have the same impact as sugar on the body. It is best to avoid all forms of processed sugars including artificial sweeteners.

Supplements for Insulin Resistant PCOS

Now, these dietary changes are fundamental to treating insulin resistance. But there are also certain vitamins and minerals that may also help. They include

Magnesium

Magnesium has many roles in the body including managing cortisol and blood sugar levels.

A study found taking 2.5g of magnesium improved insulin sensitivity. Meaning less insulin will needed to lower blood sugar levels.

So, less insulin in the blood means the ovary won't be producing excess testosterone.

Chromium

Experts say chromium is an essential mineral that help insulin work better. Chromium picolinate, taken at a dose of 200-1,000mcg a day, can improve blood glucose levels and reduce insulin resistance.

Inositol

Inositol is a substance that is often referred to as Vitamin B8. It is naturally found in most foods but highest in whole grains and citrus fruits.

There are nine forms of Inositol, but MYO and D-Chiro Inositol are most common in the PCOS community.

Inositol has the ability to create an insulin-like effect in the body. Meaning it can act like insulin and help it to work better. A study found Myo-inositol lowered insulin and testosterone levels.

Now, the inositol I personally use is Ovasitol. This is because it is a combination of both Myo-Inositol and D-chiro Inositol found in the body’s normal ratio of 40:1. Such a combination is more beneficial than taking either alone.

The combined approach significantly reduced free testosterone and fasting insulin. But it also increased insulin sensitivity in PCOS women.

I love Ovasitol so much I became an affiliate. Because I am now affiliated with Theralogix's Ovasitol. You can use discount code 144N11 for $10 off your order!

Intermittent Fasting for Insulin Resistant PCOS

You may be wondering why I didn’t mention intermittent fasting in the diet section. Well because intermittent fasting isn’t a diet, it is a way to schedule your eating. The whole premise of intermittent fasting is to not eat for an extended period of time and then eat all your food in a short and specific time window. So it does not dictate what foods to eat, but instead when to eat.

Researchers say fasting is the quickest way to increase insulin sensitivity. This is because during your fasting period, blood sugar levels are stable. As a result, insulin isn’t being released.

To find out more about the benefits of intermittent fasting for PCOS and if you should follow it. Read my in depth guide 'Intermittent fasting for PCOS: Is it Healthy?'

Now, let’s move onto another key component to treating your insulin resistance.

What Exercise is Best for Insulin Resistant PCOS?

While all forms of exercise can help treat insulin resistance. Resistance training and High-Intensity Interval Training (HIIT) are said to be better.

Resistance Training Increases Insulin Sensitivity

Resistance training is any type of exercise that causes the muscles to contract. Resulting in increased strength, muscle mass and endurance.

A study found each 10% increase in muscle was associated with an 11% relative reduction in insulin resistance. So, the more muscle you have, the better insulin works in the body.

How High-Intensity Interval Training (HIIT) Helps Insulin Resistance

HIIT is a vigorous form of exercise that involves short bursts of energy followed by less intense recovery periods. It has been found to be an effective way to increase insulin sensitivity. This is because during the intense intervals, your muscles use lots of glucose. As a result, levels change. Then during the recovery period, insulin is activated. This allows more glucose to enter the muscles to be used as energy.

The final lifestyle component I want to discuss is sleep.

The Importance of Sleep for Insulin Resistance

As discussed, a lack of sleep increases cortisol and this can counteract insulin. In turn stopping insulin from lowering blood sugar levels. But being sleep deprived also wreaks havoc on leptin and ghrelin levels. As a result we feel hungrier and our body stores more fat.

So, if you are someone who doesn’t take sleep seriously and goes to bed late at night. I highly recommend creating a healthy sleep hygiene routine. Make an effort to go to bed at a reasonable time, between 9-11pm and to get at least 7-8 hours of good quality sleep. To improve sleep quality, avoid all blue light, so no looking at your phone or any screen at least 1 hour before bed. Meditate, do yoga or go for a walk to help your body relax. It is all about getting your body in a state of relaxation. So by giving your body these signals it is letting it know it is time to wind down and get to sleep.

Start taking your sleep seriously. This component is just as important as your diet. Sleep is critical for hormonal balance and treating your insulin resistance.

In Summary

As discussed, insulin resistance is a possible root cause of PCOS. The high insulin levels cause the ovary to produce excess amounts of testosterone. As a result, causing the PCOS symptoms women experience. Insulin resistance can occur for various reasons including fatty liver disease, genetics, a lack of sleep and exercise.

If you are gaining weight around the midsection, craving carbs and feeling fatigue, visit your doctor immediately. But remember you can be lean and suffer from insulin-resistant PCOS.

Dietary changes that can help lower insulin levels involves focusing on eating whole foods. These are foods that have been minimally processed and are closest to their natural form. All carbs do not have be avoided from your diet. Simply choose natural carbs like sweet potatoes, quinoa, beans, legumes, vegetables and fruit. But all processed sugar and artificial sweeteners must be avoided.

Eating ‘good’ sources of fat like avocado and salmon. As well as supplementing with magnesium, chromium and inositol.

Additionally, certain lifestyle changes can help. Exercises like Resistance training and HIIT have been shown to be most effective . As well as getting better sleep can help treat insulin resistance

Excess male hormones released by the adrenals (an organ found on top of the kidneys) is the root cause of about 20-30% of women’s PCOS.

You see, the ovary is not the only organ that releases male hormones.

 

What Causes Adrenal PCOS?

As discussed, the adrenal glands release male hormones. But in order for you to understand how, I must first explain what the Hypothalamic Pituitary Adrenal Axis (HPA Axis) is.

The HPA axis is a set of interactions between the hypothalamus, pituitary and adrenals. Its role in the body is to regulate stress.

Here’s how it works.

As you can see in figure 2, the hypothalamus releases a hormone called corticotrophin-releasing hormone (CRH). This sends a signal to the pituitary gland, another major hormone producing gland in the brain, to produce the adrenocorticotropic hormone (ACTH).

ACTH then triggers the adrenal glands to release cortisol, adrenaline, and noradrenaline. These stress hormones provide the body with glucose (our main source of energy) which raises blood sugar levels so we can respond to the stressor by fighting or fleeing.

But as well as the release of stress hormones, ACTH also stimulates the adrenals to produce male hormones including DHEA, DHEA-S and androstenedione. These male hormones are released to protect the brain from the high levels of cortisol. But also cause PCOS symptoms like hair loss, acne and excess hair growth.

What Causes Stress

We often associate stress as running late for work or studying for an exam. But stress is more than that. Below are a list of possible stressors that you may be experiencing on a daily basis.

• Over-exercising
• Dieting/low calories
• Environmental toxins
• Autoimmune disease
• Illness
• Chronic Infections
• Inflammation
• Gut problems
• Food intolerance or Sensitivity
• Not sleeping enough

Researchers have found that a lack of sleep can increase cortisol levels. So, getting enough sleep is important for lowering cortisol levels.

Low calorie dieting is yet another common cause of high cortisol levels. A study found that restricting calories increased total daily cortisol. This is because when you eat less food your blood sugar levels drop, triggering the fight or flight response. As a result, cortisol and blood sugar levels increase. Overtime this chronic stress and blood sugar imbalance effects your hormones.

Now, you might be wondering.

How do I know if it’s Adrenal PCOS?

To find out if chronic stress is causing your PCOS, you can look at the symptoms you are experiencing.

Symptoms of Adrenal PCOS

• Fatigue or "burnout"
• Acne
• Tired even after a good night’s sleep
• Weight gain around the belly
• Blood sugar imbalances
• Irritable or 'hangry'
• Anxiety
• Depression
• Drop in energy levels around 11 am, 1 pm and 4 pm
• Low blood pressure
• Dizziness
• Cravings for salt and sugar
• Heavily reliant on caffeine for energy
• Trouble sleeping

If you can relate to a few of these symptoms, there is a strong indication the root cause of your PCOS is chronic stress. So, the next step is to undergo the necessary tests as discussed below.

How Do I Test For Adrenal PCOS?

To know for certain if your PCOS is due to adrenal androgen excess, your doctor your doctor may test these hormones.

Total DHEA

This test looks at your overall DHEA value. Including DHEA-S, etiocholanolone and androsterone.

But here’s the thing, you can have a low total DHEA but a high DHEA-S. So, you must also test your DHEA-S.

DHEA-S

Doctors test DHEA-S because it is only produced by the adrenals and it remains in the body longer than DHEA. So it is a great way to measure adrenal androgen excess.

The result is relative to age. This means if the value is high for your age, it’s sign your producing too many male hormones from your adrenals.

Age 18-29 years= (lower limit) 44-332µg/dL (upper limit)

Age 30-30 years= 31-228µg/dL

Age 40-49 years= 18-244µg/dL

Androstenedione

Test results will show how much androstenedione is released by the adrenals. As well as how much is transformed into a form of estrogen called estrone.

Normal results should be between 0.7 to 3.1 ng per mL. Higher levels may indicate PCOS.

Free Testosterone

This test shows you the amount of active testosterone in the body.

Normal levels range between 0.7 and 3.6 pg permL. Women with PCOS will have higher levels of free testosterone.

Total Testosterone

Results from this test will show total amounts of testosterone in your body and free testosterone.

Total testosterone levels should be between 6.0 and 86 ng per dl. If levels are higher, this can suggest PCOS.

Cortisol Test

As well as testing the level of male hormones in the body, doctors will look at your cortisol levels. The cortisol tests include

Early morning Cortisol levels should be high in the morning, helping us wake up, and low at night to help us fall asleep. The opposite may be the case in women with adrenal PCOS.

Urinary test

Urine is collected over 24 hours and is then measured to see the level of cortisol.

Salivary diurnal

This cortisol test looks at 4 saliva measurements taken throughout the day.  Measuring saliva cortisol levels at 4 different times provides greater data on adrenal function.

So, you now know what adrenal PCOS is, what causes it, the symptoms and how to test for it. Let’s talk about how you can start treating this type.

Treatment for Adrenal PCOS?

The focus for this type of PCOS is on lowering cortisol levels. But to do this you must first identify your stressors. Once you have identified your stressors you can begin to lower them.

Now, let’s take a look at some dietary and lifestyle changes you may have to make to lower your cortisol levels.

What’s the Best Diet for Adrenal PCOS?

A common question I get asked is, what is the best diet for adrenal PCOS. The answer is, there is no best or specific diet. What you should be looking to do is nourish your body with enough food so your body does not feel stressed.

Fuel your body with enough food

Chronic low-calorie dieting is a huge stressor on the body. To protect itself and conserve energy, the body increases cortisol levels to keep blood sugar levels stable. So, constantly restricting your food can cause high levels of stress. Put an end to the low calorie and yo-yo diets and focus on feeding your body.

Eat at least every 3-4 hours, or when you feel hungry. Don’t suppress your appetite because this is only going to stress the body out.

Stop Low Carb Dieting

A low carb diet can be adding extra stress to your body. Despite what you may have heard about carbs, our body and hormones need them. A woman needs carbs for various reasons including ovulation, healthy hair and restful sleep. So don't be afraid to eat carbs, experiment to find your unique carb tolerance.

Supplements for Adrenal PCOS

Along with these dietary changes, there are supplements that can support your adrenals. Below are the top 4 supplements that can help alleviate some of the PCOS symptoms.

Magnesium

Magnesium calms your nervous system and prevents excessive cortisol. But stress burns through it because it helps support the adrenal glands which get exhausted when making cortisol. Low levels of magnesium can cause energy depletion. As a result causing fatigue and a weakened ability to manage stress.

B Vitamins (B5, B6, B12)

All the B vitamins work together in the body, but each vitamin also has its own specific role. B vitamins support energy production and your adrenals so you don't feel fatigued.

Vitamin B6 has an important role in adrenal functioning. It is involved in the production of our adrenal hormones and in the conversion of food to energy. So, low levels of vitamin B6 can affect the body’s ability to process food into energy. Resulting in symptoms like fatigue and muscle weakness.

B12 creates energy, repairs cells and helps to make red blood cells. The creation of red blood cells helps to deliver oxygen around the blood, which will help with energy levels and PCOS fatigue.

Adaptogens

Adaptogens are plant based supplements known for their ability to support adrenal function.

Adaptogens protect the body from stress by regulating the release of cortisol. As a result, preventing the HPA axis from being constantly active. This, therefore, protects the body from adrenal fatigue and the depletion of key vitamins and minerals.

Popular adaptogenic herbs include Ashwagandha and Rhodiola.

Visit a medical professional before including any of these supplements in your diet.

Now, let’s move on to some lifestyle factors that may need to change to help you reverse your adrenal PCOS.

The first lifestyle factor we will look at is exercise.

How to Exercise with Adrenal PCOS

Exercise is great for relieving stress and boosting mood because it increases endorphins. But, all good things can become bad when they are overdone and exercise is one of them.

So, here’s the thing.

Endurance and intense workouts are great for our cardiovascular health and burning fat. But, if you suffer from chronic high cortisol levels, these types of exercises will not help.

Why?

Because both endurance and high-intensity workouts produce high levels of cortisol.

What Should You Do Instead?

I recommend doing more low-intensity exercises. This is because they do not significantly raise cortisol levels. Instead they help lower them. Examples of low-intensity activities include walking, yoga, swimming, Tai-Chi.

What If I Have No Energy to Exercise?

I understand that your current hormonal situation may not allow you to exercise. You may feel super fatigued and the thought of exercise just doesn’t seem like an option for you at the moment. But here’s the thing, any form of movement can help.

Begin by assessing your limit, find out how much you can do and work from there. If all you can do is walk for 5-minutes that is fine. Start somewhere and then gradually increase the duration every single workout. Work with your body, not against it.

The second lifestyle factor I want to talk about is sleep.

Sleep More

A lot of women with adrenal PCOS have an out of whack circadian rhythm (the body clock). A normal circadian rhythm should look like this,

As soon as light enters the room and you begin to open your eyes. Your adrenal glands receive a message that they need to release cortisol. This helps you get out of bed and have energy for the day.

During the day, cortisol levels start to fall until it is low at night so you feel tired.

But women with adrenal PCOS may suffer from low cortisol in the morning, making them feel tired. Then high cortisol at night which makes them have all this energy. If this is you, creating a bed time routine can help fix this out of whack rhythm.

Create a Bed Time Routine

Look at your current sleep routine.

Are you using your phone late at night? Drinking alcohol to relax? Exercising intensely late in the evening?

If you are doing any of these things, it is time to stop.

Here’s what you need to do

• Avoid looking at any blue light at least 1 hour before bed. Meaning no electronic devices e.g. phone, tablet, computer, etc.
• Don’t exercise late in the evening
• Don’t drink alcohol
• Go to bed between 9-11pm
• Aim for 7-8 hours of good quality sleep.
• Eat enough food so you are not hungry when you go to bed
• Add some carbs at night to help you fall asleep
• Eat foods that contain tryptophan like salmon, nuts, seeds, spinach, eggs, turkey.

The final factor I want to talk about is stress management.

Manage Your Psychological Stress

Find ways to lower your stress, whether it's stress from work, a relationship or school. These are daily stressors, if not managed, can become chronic. That can in turn impact the balance of your hormones.

To manage your stress you will have to figure out what you need to do to improve your current situation. This may mean finding a new job or leaving a toxic relationship.

Do You Suffer from Adrenal PCOS?

In summary, the ovary is not the only organ that releases male hormones, so do the adrenals. This happens as a result of chronic stress which may have been caused by over exercising, inflammation, low calorie dieting or a lack of sleep? Take a look at your symptoms. Are you experiencing fatigue, anxiety, cravings for salt and sugar or do you have trouble falling asleep. If so visit your doctor to test your adrenals. This will help you establish if you are suffering from adrenal PCOS.

Depending on what is causing stress to your body, dietary and lifestyle changes may help. So, look at everything in your life that may be causing you stress. This may mean you need to eat more food and carbs. Or it may mean exercising less and improving your bedtime habits. As well as supplementing with magnesium, vitamin C and B’s and apoptogenic herbs may help. But before you make any changes to your diet and lifestyle always consult your doctor.

Moving onto the next PCOS type.

This type of PCOS may come as a shock to you, but it is actually fairly common.

PCOS can develop in women who have been on the Birth Control Pill for several years and then decide to come off. They often find when they stop the pill their period does not return. But also they experience PCOS symptoms like acne and polycystic ovaries.

Now, some women find their lost period to be temporary, but others struggle to regain it.

Before I explain why the birth control pill is a possible root cause of PCOS, let’s take a look at what the Birth Control Pill (BCP) is.

What is the Birth Control Pill?

The Birth Control Pill is a daily pill containing man-made hormones. These man made hormones act like a female’s real hormones.

There are two types of birth control pills. The combined contraceptive pill which is a combination of progestin and estrogen and the progestin-only pill. Progestin is made to act like the body's natural progesterone. As a result, it is able to do some of progesterone's tasks in the body. But it does not fully resemble progesterone. So in some situations, it may act differently to the real hormone.

How Do You know if it's Pill-Induced PCOS?

As discussed, doctors use the Rotterdam criteria to diagnose PCOS. Women must show two out the three 1) high androgens, 2) irregular menstrual cycle 3) polycystic ovaries.

A key indication of pill-induced PCOS is whether a woman had a regular period before starting the birth control pill. If she did, but hasn’t had one for at least 3 months after coming off, she may be suffering from pill induced PCOS.

This is because the birth control pill suppresses a woman’s natural cycle of ovulation to prevent a pregnancy. It does this by shutting down communication between the brain and the ovary. As a result, the female no longer ovulates or menstruates.

Now, when you come off the pill the communication between the brain and the ovary are still not connected. So, the female still doesn’t ovulate or have a period.

Due to a lack of ovulation the follicle (a sac that contains the eggs) does not break to release the egg. As a result the follicles stay in the ovary and the ovaries appear to contain many ‘cysts’. Hence the polycystic ovaries, number 3 in the Rotterdam Criteria.

Symptoms of pill-induced PCOS tend to appear after 3-6 months of coming off the pill.

So, you now know what pill-induced PCOS is. Let’s look at how you can treat this type of PCOS.

How to Treat Pill-Induced PCOS

Pill-induced PCOS tends to be a temporary condition. It requires time to allow the body heal from the hormonal havoc caused by the pill.

There is no set diet to follow for pill-induced PCOS. But there are dietary changes that can be implemented to help support hormonal balance. They include

Replenishing Depleted Vitamins and Minerals

The pill depletes the body of magnesium, selenium, folic acid, zinc, vitamin B6 and 12. So it is important to replenish those depleted nutrients.

Dr Lara Briden, a naturopathic doctor, recommends a peony and licorice combination. This is because research has shown it can reduce androgen levels in the body.

But consult your doctor before adding new supplement to your diet.

Healing the Gut

Researchers have found the pill can cause changes to the bacteria found in the gut. An imbalance of good and bad bacteria can lead to, bloating, constipation, diarrhoea, acne and a weak immune system.

To help heal the gut and increase the amount of good gut bacteria, include fermented foods like sauerkraut, kombucha and kimchi. Or take good probiotic supplement.

Following an Anti-Inflammatory Diet

Researchers have found the birth control pill can cause inflammation in the body. Inflammation must be reduced to prevent problems like chronic infections and skin conditions.

So, following an anti-inflammatory diet which involves eating foods that reduce inflammation in the body can help. Anti-inflammatory foods include salmon, walnuts, bone broth, turmeric, ginger and green leafy vegetables.

Are you Suffering from Pill-Induced PCOS?

Unfortunately, pill-induced PCOS is very common but rarely spoken about.

If you had a regular period before the pill but no period since coming off, this may be a sign of pill-induced PCOS.

Pill-induced PCOS tends to be a temporary condition and can be reversed. There are certain dietary changes that can be made to help rebalance hormones. They include supplementing with magnesium, selenium and vitamin B6 to replenish depleted nutrients. Healing your gut by eating fermented foods to increase the good gut bacteria. As well as eating anti- inflammatory foods to lower the inflammation caused by the birth control pill.

Now, moving onto the next type of PCOS.

Inflammatory PCOS is the fourth type and it is caused by inflammation.

Inflammation is a response the immune system takes to protect us from viruses and bacteria.

Researchers have found that PCOS women suffer from chronic inflammation. This inflammation occurs when the immune system believes it is always under threat.

A study found inflammation directly stimulates the ovary to produce male hormones. And as a result PCOS symptoms.

You might be wondering.

What Causes Inflammation?

There is no clear answer to this question, inflammation can be caused for various reasons. Below are just a few of the possible causes of inflammation in women with PCOS.

Obesity Causes Inflammation

Experts have found obesity can cause inflammation and vice versa.

Get this.

Our adipose tissue is a connective tissue consisting of both fat and immune cells. There are two categories of immune cells, inflammatory and anti-inflammatory. Our body needs these anti-inflammatory immune cells because they help lower inflammation.

As body fat increases, the number of anti-inflammatory immune cells decrease and inflammatory immune cells increase.

When these inflammatory immune cells increase in number, your body is in a state of chronic inflammation.

As you can see, obesity can trigger inflammation in the body. So, maintaining a healthy weight is important for lower inflammation and hormonal balance.

Stress Causes Inflammation

Stress is a huge driving factor for the development of PCOS. Research shows chronic stress over-activates the immune system causing high levels of inflammation. Meaning long term stress causes the immune system to always be on high alert. As a result, inflammation never goes down.

So, this evidence reinforces the importance of managing stress to keep levels of inflammation low. Which may ultimately help reverse PCOS.

Inflammation caused by an Inflammatory Diet

A third very common cause of inflammation is eating an inflammatory diet.

You see, the foods we eat can have a huge impact on levels of inflammation in the body.

Foods that trigger inflammation include

• Fried and processed foods- Doughnuts, cookies, crackers and fast foods contain trans-fat. Results show trans-fat activates the inflammatory response causing major health risks.
• Dairy- Cow’s milk contains two types of Casein (a protein), A1 and A2 Casein. A study found A1 casein can cause inflammation in the body. The researchers suggest choosing dairy that contains A2 casein to avoid triggering inflammation.
• Sugar- A guilty pleasure for most but a huge driver of inflammation in the body. Research shows that processed sugar triggers the release of proinflammatory cytokines.
• Gluten-Gluten is a protein found in wheat and other grains such as barley, oats, Kamut, rye and spelt. It triggers the release of zonulin (a protein found in our gut). Zonulin makes the tight holes in our intestine bigger, creating intestinal permeability also known as ‘leaky gut’. This then makes it easier for large proteins like gluten to make their way into the bloodstream. The immune system sees it as an outside invader and attacks it creating inflammation.
• Seed oils- Seeds oils like canola, sunflower, corn, peanut and soybean oil contain omega-6 fatty acids. Omega-6 is an essential fatty acid needed by the body for growth and development. But an excess consumption can trigger the release of pro inflammatory chemicals. The body needs a healthy balance of both omega-6 and omega-3 fatty acids (e.g. foods like salmon).

As you can see, there are a few inflammatory foods on the list that you may be consuming on a daily basis. Be aware of the foods that cause inflammation in the body because they can have a huge impact on your health and hormones.

The Link Between an Unhealthy Gut and Inflammation

An unhealthy gut can trigger the release of inflammation within the gut and throughout the whole body.

Here’s how.

Our intestines have small holes on the outter surface. These holes allow nutrients from food to pass through the gut into the rest of the body to be absorbed. But they also block the entry of toxins.

Now, the gut needs a balance of good and bad bacteria to be healthy. However, taking the birth control pill and antibiotics can disrupt this balance.

Dr Amy Myers, a functional medicine physician, says antibiotics can protect the body against infections. But chronically overusing them or taking them unnecessarily can cause harm. This is because antibiotics cannot differentiate between ‘good’ bacteria and ‘bad’ bacteria that may be causing the infection. They simply destroy everything.

Now, this imbalance in gut bacteria can cause these small holes to expand in size. This is known as ‘leaky gut’. As these holes open up more, toxic substances like bacteria and partially digested foods enter the bloodstream. The immune system recognizes them as outside invaders and responds by increasing inflammation.

You see, a healthy gut is important for a healthy immune system.

Over-exercising Causes Chronic Inflammation

Look.

Regular exercise can help lower levels of inflammation in the body. But over-exercising can increase inflammation.

You see the body experiences short term inflammation from the stress of the workout. This type of inflammation will subside in a few days once you have given your body time to recover.

The problem occurs when this short term inflammation becomes chronic. This happens when the stress is never taken away from the body.

Here are 3 signs you are over exercising:

1. You feel fatigued (need to take a nap) after training.
2. You’re not recovering as fast enough (constant muscle soreness).
3. You are not performing as well during your workouts because you lack the energy.

So you know what inflammation is and how it affects women with PCOS. Let’s take a look at how you would find out if inflammation is the root cause of your PCOS.

How do I know if it’s Inflammatory PCOS?

Chronic inflammation occurs within the body. So it does not show common signs of inflammation like swelling or redness. To find out if its chronic inflammation, you must look closely at how you are feeling. But some signs of inflammation within the body include

Symptoms of Inflammatory PCOS

• Allergies
• Muscle Stiffness
• Asthma
• Skin conditions like Eczema
• Chronic Infection
• Always ill
• Irritable Bowel Syndrome
• Headaches
• Fatigue
• Puffy Face
• Brain fog

How to Test for Inflammatory PCOS

So, if you are experiencing any of the above symptoms, it may be a sign of chronic inflammation. But to know for certain you must visit your doctor to do the necessary tests. The tests mentioned below will help you find out if your PCOS is a result of inflammation in the body.

• C-reactive protein (CRP)- CRP is made by the liver and increases in response to inflammation in the body. High CRP levels in the blood would indicate inflammation.
• Interleukin-18(IL 18)- Researchers have found a link between Interleukin-18 and insulin resistance. As discussed inflammation can cause insulin resistance.
• Monocyte chemoattractant protein-1- Similar to (IL 18), this marker of inflammation has also been linked to insulin resistance.
• White blood count- An increase in inflammation, leads to a rise in white blood cells to protect the body. A high white blood count may suggest inflammation.

As well as these inflammatory markers, doctors may also test

• Intestinal permeability- This is a condition where toxins and partially digested food pass through the wall of the gut and into the bloodstream. The immune system sees them as outside invaders and attacks them. As a result, increasing inflammation in the body. Doctors will request a urine test and if the result is positive, it will confirm intestinal permeability.

Now, let’s take a look at how you can treat inflammatory PCOS.

Treatment for Inflammatory PCOS

Once you have found inflammation is your root cause, there are dietary and lifestyle changes you can make to lower it.

Dietary Changes to Lower Inflammation

Certain foods can either lower inflammation or increase it. So, if you are looking to reduce inflammation you need to consume foods that contain anti-inflammatory properties.

Avoid Inflammatory Foods

Avoid the foods that cause inflammation. These include processed meats, fried food, vegetable oils and refined flours.

Fiber lowers Inflammation

Fiber is a form of carbohydrate and it is needed in any PCOS diet. A study found that the risk of inflammation was 63% lower in the high fiber group.  To know that increasing your daily fiber intake can lower inflammation is encouraging for PCOS women.

High fiber containing foods include fruits, vegetables, oats, and legumes.

Heal Your Gut

A healthy gut means a healthy immune system. So, increasing your good gut bacteria and strengthening the gut lining may help keep levels of inflammation low. This can be achieved by adding fermented foods (sauerkraut, kimchi, kombucha, miso), bone broth (I love Kettle & Fire's bone broth) and collagen.

Avoid Over-exercising

As discussed, over-exercising can cause inflammation. So to help reduce inflammation in the body avoid over-exercising.

You can do this by listening to your body and scheduling rest days into your workout program. Rest days are so important to allow your body to recover from the stress put upon it during the workout.

Are you Suffering from Inflammatory PCOS?

As discussed, inflammation is a response your immune system makes to protect you. But when inflammation becomes chronic, it is a serious problem that must be addressed.

Inflammation can occur for various reasons including eating inflammatory foods, an unhealthy gut and over exercising. So, take a look at your diet and lifestyle to see where you can make some changes to help lower inflammation.

Levels of inflammation can be reduced by following an anti-inflammatory diet and eating fibre rich foods. As well as taking care of your gut and not over exercising.

We have reached the final PCOS type.

Researchers have found that up to 25% of women with PCOS have a thyroid condition. Unfortunately problems with the thyroid are often missed in women with PCOS. This is why this type of PCOS is known as a ‘hidden cause’.

Before I explain what hypothyroidism is, let’s first look at what the thyroid is. The thyroid is an organ in the body that is often referred to as a ‘hormone powerhouse’. This is because it plays a role in various functions in the body including metabolism, ovulation and heart rate.

Now, hypothyroidism is a condition where the thyroid is underactive. Meaning it is not producing enough of the thyroid hormones. As a result, key functions like metabolism begin to slow down as discussed.

You can think of the thyroid like a car engine. As the car runs out of fuel, it begins to slow down. The same happens within the body. When the thyroid isn’t producing enough of the hormones, the body begins to shut down.

What Causes Hypothyroidism?

There are two possible causes for an underactive thyroid, they include,

• Hashimoto's thyroiditis- This is an autoimmune disease where the body attacks and destroys the thyroid gland. It does this because it believes the thyroid is an outside invader.
• Thyroid Surgery- Removing all or a large part of your thyroid gland can impact the production of thyroid hormones.

So you now know what hypothyroidism is and what causes it.

So you might be wondering.

What’s the Link Between PCOS and Hypothyroidism

Hypothyroidism is described as a hidden cause of PCOS because it often goes undiagnosed. This is because women with hypothyroidism also show high levels of testosterone and polycystic ovaries.

High Male Hormones

Women with hypothyroidism also suffer from high levels of testosterone because it can decrease sex hormone binding globulin (SHBG) levels.

Here’s the thing.

Thyroid hormones stimulate the release SHBG, a protein made by the liver. SHBG’s role in the body is to bind together with three sex hormones; estrogen, testosterone and dihydrotestosterone (DHT). It then carries these hormones throughout the body to reduce the level of free hormones. Testosterone bound to SHBG isn’t used by the body. However, low thyroid hormone production impacts the release of SHBG. So a decrease in SHBG means the amount of free testosterone increases.

Polycystic Ovaries

Now, the accumulation of cysts on the ovaries can happen because of the high male hormones.

The high male hormones stop the follicles (sacs that contain the immature eggs) from developing into a dominant egg. So this leads to a build-up of small follicles in the ovary. This is what causes the polycystic ovary (one of the criteria doctors use to diagnose PCOS).

Because of the similar symptoms doctors may confuse one condition for another. So, hypothyroidism should be tested first before a PCOS diagnosis is given.

How Do I Know If I Have Hypothyroidism?

To find out if you have hypothyroidism, you can look at the symptoms you are experiencing. This may give you an indication. But to know for sure, you need to run the necessary thyroid tests as mentioned below.

Symptoms of Hypothyroidism

• Hair Loss or thinning
• Eyebrows thinning
• Dry hair and skin
• Brittle nails
• Cold hands and feet
• Weight gain
• Fatigue
• Constipation
• Slower reaction time

How Do I Test My Thyroid?

So here’s the thing. There are various tests your doctor needs to do to find out if your symptoms are a result of hypothyroidism. But unfortunately, doctors often only test Thyroid Stimulating Hormone (TSH). However, this test is not accurate enough to diagnose hypothyroidism. To get an accurate look at your thyroid health, your doctor must get a full thyroid panel test.

Thyroid Stimulating Hormone (TSH)

TSH is released by the brain and its job is to stimulate the release of thyroid hormones from the thyroid gland. So, the TSH test measures how much TSH is in your blood.

Normal TSH range: 0.4-4.0 mU/l (milliunits per litre).

Mild hypothyroidism: 4.0 mU/l (milliunits per litre).

Hypothyroidism: 10.0 mU/l (milliunits per litre).

Free T4

This test measures the amount of free T4 in your blood. T4 is the inactive thyroid hormone. It purpose is to be converted to T3.

A free T4 test indicates how well your thyroid gland is functioning. The normal free T4 range is 9.0-25.0 mU/l (milliunits per litre). A low T4 level is a sign of hypothyroidism, that your thryoid is not producing enough hormones.

Free T3

T3 is the active thyroid hormone and all cells in the body need it to work.

The normal free T3 range is 3.5-7.8.0 mU/l (milliunits per litre). If you suffer from hypothyroidism, the test result will show low T3 production.

Reverse T3

This is the complete opposite of what T3 does in the body. Reverse T3 binds to the T3 receptor and slows everything in the body down. Normal reverse T3 ranges is below 250 pg/ml (10 to 24 ng/dL). A reverse T3 above the normal range is what causes weight gain, constipation, cold hands and feet, etc. The body does this to conserve energy because it is too stressed.

Your doctor will interpret your tests results, together with your symptoms and how you are feeling, to diagnose whether you have a thyroid disorder, its severity, and how to treat it.

Now let’s take a look at how to treat hypothyroidism.

Treatment for Hypothyroidism

The standard treatment for hypothyroidism is oral medications. Doctors commonly prescribe synthetic thyroid hormones like levothyroxine and Liothyronine. These act like thyroid hormones in the body and help restore the normal functioning of the thyroid.

Besides medication, there are dietary and lifestyle changes that can help treat hypothyroidism.

Diet Tips for Hypothyroidism

There is no set diet for treating hypothyroidism. But there are key nutrition tips that can help improve the health of your thyroid. They include

Add Probiotics- Dr Datis Kharrazian, a functional medicine health care provider, says that 20 percent of thyroid function depends on a healthy gut to help convert T4 to T3. So, adding some probiotics to your diet, to improve the health of your gut, may help support your thyroid.

Up Your Protein- Protein delivers thyroid hormones to the cells of the body. So, an adequate consumption of protein can ensure your thyroid is working optimally.

But avoid eating soy protein because it acts like estrogen in the body. Too much estrogen can stop the release of thyroid hormones.

Be aware of goitrogens- Goitrogens are plant-based substances that can interfere with thyroid function. They are found in broccoli, kale, Brussels sprouts, cauliflower, cabbage, spinach and strawberries. Experts state they inhibit the intake of iodine by the thyroid gland. The thyroid needs iodine because it helps to make thyroid hormones.

With that said Dr Izabella Wentz, a leading thyroid expert, says vegetables that contain these goitrogens do not have to be avoided entirely. This is because they contain key vitamins and minerals that are important for thyroid health. She recommends cooking, steaming or fermenting the vegetable will help reduce the goitrogens.

Avoid inflammatory foods

As discussed, hashimotos thyroiditis is a possible cause of hypothyroidism. Now, inflammation is a huge driver of autoimmune conditions like hashimotos. Certain foods can trigger inflammation in the body. So inflammatory foods like seed oils, sugar, gluten and junk foods must avoided.

Supplements for Hypothyroidism

Along with the above nutrition tips, there are also several supplements that can help the thyroid. But as always, consult a medical professional before taking any new supplement.

Selenium- Selenium is an antioxidant that supports thyroid function.
Healthy levels of selenium are necessary for the conversion of T4 to T3. Which as discussed, is needed for the body to function properly.

Iodine- Iodine is an essential mineral needed for the production of thyroid hormones. So a deficiency in iodine causes a decrease in thyroid hormone release.

Iodine rich foods include seaweed, fish, eggs, dairy and prunes. Or you can add iodized table salt to your meals.

But before you increase your iodine intake, consult a doctor because taking too much can have the opposite effect. It can instead damage the thyroid.

Now, moving onto lifestyle factors.

Lower Stress

When stressed your body release cortisol. Chronic cortisol levels can interfere with the production of thyroid hormones. This can in turn cause hypothyroidism.

So, lowering stress levels is a key part of treating hypothyroidism.

What Exercise is Best for Hypothyroidism?

Research shows regular exercise can help increase T3 and T4 production. However, experts recommend avoiding high-intensity exercises because they can lower T3 levels.

So, focus on including healthy amounts of regular low-intensity exercise like yoga, walking and swimming.

Avoid Fluoride and Chlorine

Fluoride and chlorine are endocrine disruptors. Meaning they disrupt the normal functioning of your hormones.

So here’s the thing.

As discussed above, iodine is a crucial mineral needed to make thyroid hormones. However, both fluoride and chlorine affect the normal functioning of the thyroid.

How Chlorine Effects The Thyroid

Amy Myers MD, a functional medicine physician, says chlorine shares similar properties to iodine. As a result, it can override iodine, which leads to a decrease in thyroid hormone production.

Fluorides impact on the Thyroid

Dr. Izabella Wentz, The Thyroid Pharmacist, explains that in the body fluoride is seen as iodine. Because the body thinks fluoride is iodine, our organs absorb it. Dr. Wentz states that we don’t remove much fluoride through urine or sweat. As a result, fluoride builds up in the body and becomes toxic. The increase of fluoride then begins to cause damage to major organs like the thyroid.

Now you may not know this, but fluoride and chlorine are in your tap water. Check out my blog post ‘Reverse PCOS Naturally: Eliminate Endocrine Disruptors in Water’ to find out how to remove them from your water.

Is Your PCOS a result of a Thyroid Condition?

Hypothyroidism is a hidden cause of PCOS because it often goes undiagnosed. This is because both conditions share similar symptoms such as high testosterone and polycystic ovaries. If you suffer from hair loss, fatigue, constipation, cold hands or feet visit your doctor immediately to test your thyroid..

To treat hypothyroidism you must support your thyroid. You can achieve this by adding probiotics, eating more protein, being aware of goitrogens. Lowering stress levels, supplementing with selenium and iodine and avoiding chlorine and fluoride. As well as avoiding high intensity workouts.

What Type of PCOS Do You Have?

As discussed, researchers suggest PCOS may be genetically inherited. But despite PCOS being genetic, it does not mean you will show signs or symptoms of the condition. Epigenetics says our environment, including our diet and lifestyle, can alter which genes are expressed.

Meaning, the foods we eat, whether or not we exercise, if we are chronically stressed, etc. can ‘turn on or off’ the PCOS gene. Resulting in us experiencing the symptoms of PCOS like hair loss, excess hair growth, weight gain and more. But this means that even if you are suffering from PCOS currently you can reverse it!

Address your Root Cause

You no longer have to feel like a victim to your genes or PCOS. By addressing the root cause you can 'turn off' your PCOS gene and live a symptom free life.

PCOS is not one condition. There are different types including insulin resistant, adrenal, pill-induced, inflammatory and hidden cause (thyroid related). Each type is triggered by a different root cause.

Now, I understand this is a long post and learning there are multiple types of PCOS can be overwhelming. I don’t expect you to identify your root cause on your own. This is something you need to do with a health professional. But I highly recommend that you spend time reading this post so you fully understand the types. This way you will feel more empowered and confident at your next doctor’s visit.

Be Patient

I understand that living with PCOS can feel like a daily struggle. You may find yourself wanting to give up because you are not seeing any progress. But reversing PCOS takes time. PCOS doesn’t just happen overnight and so treating it won’t either. You must be patient.

Now, I want to end this post with a little piece of advice that I wish someone told me when I was first diagnosed.

The first piece of advice is, don't compare your PCOS journey to anyone else's.

Understand that everyone’s situation is different. It doesn’t matter how easy or fast one woman reversed her PCOS. Her situation and hormonal status may have been completely different to yours. But the time it takes does not matter. Stay focused, be patient and committed to your journey.

My final piece of advice is, don't copy another woman's PCOS treatment plan.

Why?

Well, as discussed, there is more than one type of PCOS and we are all individuals. Copying what someone else is doing, even if they have the same type of PCOS, there is no guarantee it will work for you.

Your treatment plan must tailored to addressing your root cause and lifestyle.