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Types of PCOS

September 10, 2018
types of PCOS, toronto naturopath, naturopathic doctor toronto

The previous post about PCOS was about the criteria involved in diagnosing someone with PCOS. Many clinicians follow the Rotterdam criteria, which require 2 out of 3 criteria to be met in order to be diagnosed with PCOS. 

They are: 
  1. Delayed ovulation or menstrual cycles (anovulation)

  2. High androgenic hormones like testosterone

  3. Polycystic ovaries on ultrasound

Because you need to meet 2 criteria, your PCOS presentation may be slightly different than someone else’s. This brings us to the four types of PCOS.

The 4 PCOS types

Type A

Classified by:

  • Hyperandrogenic

  • Anovulation

  • Polycystic ovaries

Known as the classic type of PCOS. Signs and symptoms include: high BMI, increased weight circumference, highest androgens values, increased LH/FSH, AMH, low progesterone, and menstrual irregularity. Insulin resistance is also a factor – leading to an increased risk of diabetes and heart disease. 

Type B

Classified by:

  • Hyperandrogenic

  • Anovulation

Another classic form of PCOS. Signs and symptoms include: increased BMI, weight around the waistline, menstrual irregularity, signs of high androgens (ie. hirsutism, acne, and hair loss). Insulin resistance is also a factor in this type. In addition, this type may include older women. 

Type C

Classified by:

  • Hyperandrogenic

  • Polycystic ovaries

Signs and symptoms include: Medium BMI score, weight around the waistline, high androgens (ie. testosterone), polycystic ovaries, and while periods may be regular – ovulation may not be occurring (therefore, be sure to get your progesterone checked around day 21)! 

Type D

Classified by:

  • Anovulation

  • Polycystic ovaries

Considered the ‘lean’ PCOS. Signs and symptoms include: menstrual irregularities, polycystic ovaries, androgen levels are optimal – no physical signs of androgen excess, normal BMI, normal waist circumference, may be signs of insulin resistance. 

Rule these conditions out

Before you jump aboard the PCOS train, you want to rule out certain conditions first, as they may be the cause of some of your symptoms:

  • High prolactin (found on blood work)

  • Hypothalamic amenorrhea

  • Hypothyroidism – this can occur with PCOS

  • Non-classical congenital adrenal hyperplasia

A note about insulin resistance

As you might have noticed, insulin resistance is predominant in many of the types of PCOS. So how do you measure for it?

  • Fasting insulin

  • Fasting glucose

  • Oral glucose tolerance test

You can use these first two values (which you can get assessed through blood work) to calculate your HOMA-IR score. Ideally your score should be less than 1.5. 

Too much insulin can lead to excess androgens being formed (in various ways) and it may also impair ovulation. 

Final Thoughts

If you’re thinking that you have some of these signs and/or symptoms, and have yet to get any of your blood work done – do it! Because there are different types of PCOS, you want to get solid evidence of which type you may be. This will ultimately help determine the best type of treatment for you!

Find out your PCOS type with this blood work:

  • Total testosterone

  • Free testosterone

  • DHEA

  • Androstenedione

  • DHT

  • Fasting insulin

  • Fasting glucose

  • TSH

  • Free T4

  • Free T3

Don’t forget that Naturopathic Doctors can also requisition blood work! Speak to your ND to determine if that’s the best option for you. 

Now that you have a solid plan, please sign up for my monthly newsletter called The Flow for more informative and useful content like this! I want to make sure that you have a good flow!

What is PCOS

September 4, 2018
what is PCOS, toronto naturopath, naturopathic doctor toronto

PCOS is one of the few period-related conditions that I haven’t focused on yet in my blog. Admittedly, there are many resources to refer to when it comes to this condition. But I feel that it’s something for me to talk about and give my perspective on, as it’s a syndrome that I’ve been living with. 

What is PCOS?

PCOS is known as polycystic ovary syndrome. And while you might think that you need polycystic ovaries to have this condition, the criteria has changed since it was first discovered in 1953. 

As of 2003, a new criteria called the Rotterdam Criteria are being used to diagnose PCOS. Moreover, only 2 of the 3 criteria are needed for a diagnosis. They include:

  1. Delayed ovulation or menstrual cycles (anovulation)

  2. High androgenic hormones like testosterone

  3. Polycystic ovaries on ultrasound

Exploring PCOS Criteria

Delayed ovulation or menstrual cycles

We can’t rely on our apps to tell us if ovulation has happened – because as we know, the app will pick a day in the middle of the cycle and declare that as the ovulation day. Therefore, we have to pay attention to our body’s cues – in the form of cervical fluid and basal body temperature. If ovulation does not happen, this refers to anovulation, and may cause a delay of the entire menstrual cycle – where the cycle itself may be longer than 35 days in length. 

If you typically experience long menstrual cycles, despite them being regular, this may indicate PCOS. 

High androgens

All women have male hormones, but higher levels of these hormones can be problematic. Higher levels of male hormones may lead to acne (along jaw or back), growth of facial and body hair (or hair loss!) in specific patterns. 

The Ferrimen Gallway Score is a tool used to assess hair pattern change:


PCOS, toronto naturopath, naturopathic doctor toronto

Source: https://pedclerk.bsd.uchicago.edu/page/hirsutismPC

Yet, someone does not need to display physical signs of high androgens to have them. The following hormones should be evaluated to satisfy the high androgen criteria:

  • Total testosterone

  • Free testosterone

  • DHEA

  • Androstenedione

  • Sex Hormone Binding Globulin

Polycystic Ovaries

An ultrasound needs to be done to figure out if you have polycystic ovaries. Basically, you need 12+ follicles that are between 2-9mm or an ovarian volume bigger than 10cm in a single ovary. If attempt to get an ultrasound done, do so on the third day of your cycle (ie. day 3 of bleeding). 

Next Steps

Now that you’re familiar with the criteria of PCOS, here’s what you can do next:

  • Track your cycle length

  • Determine if you’re ovulating (DO NOT RELY ON YOUR APP)

  • Get your blood work done (PS. NDs can order your blood work too!)

  • Talk to your doctor about an ultrasound if either the first 2 criteria may not be an issue (ie. blood work is optimal)

Now that you have a solid plan, please sign up for my monthly newsletter called The Flow for more informative and useful content like this! I want to make sure that you have a good flow!

What are Fertility Awareness Methods

fertility awareness methods, toronto naturopath

Fertility awareness methods allow the opportunity for people to track their cycle, with the goal of knowing when ovulation occurs. There are a variety of methods (as listed below) and are about 76-88% effective, with a possible increase in effectiveness if you use multiple methods together. 

With most of these methods, it’s wise to track your period and these particular signs for at least 3 months (6 months for calendar methods) to get an idea of your body’s rhythms before you use any of the methods for contraception. 

The Temperature Method

If you’ve been following my blog for a while, you might remember a blog post discussing basal body temperature and fertility.

A quick recap: body temperature changes throughout the menstrual cycle. It’s lower in the follicular phase and slightly higher in the luteal phase. This slight rise in temperature occurs after ovulation, and happens after the formation of the corpus luteum which releases progesterone (the hormone responsible for the temperature change). 

By following this method, you would measure your basal body temperature everyday and chart it (on an app or on paper).  

Days are considered safe once 3 days has passed since the initial rise of temperature, as well as a drop in temperature before the onset of the next menstrual cycle. This is an opportune time to have unprotected vaginal sex (with or without ejaculation). 

During your fertile days, you can avoid sex or use another birth control method. 

The Cervical Fluid Method (The Billings Method)

This method is based on cervical fluid changes, another topic I covered a while back. 

A quick recap: During the follicular phase, increasing estrogen levels will lead to the production of cervical fluid. Cervical fluid will change in colour, texture, and amount during the period, and is considered especially fertile around ovulation. 

Similar to the Temperature Method, cervical fluid needs to be charted everyday, starting from the end of the menstrual cycle. The changes that you may see will give you an idea of when ovulation may occur – which is great if you are hoping for pregnancy (unlike temperature, where it tells you that ovulation has passed).  Record everything daily: your period days, dry days, wet days, sticky days, cloudy days, and slippery days.

There are 3 ways to check your cervical fluid: (1) Before urination, wipe the opening of your vagina with white toilet paper or tissue. Observe the colour and feel of the fluid. (2) Look at your underwear for any discharge – note the colour and texture. (3) Insert your clean fingers into your vagina, and note the colour and texture of cervical fluid on your fingers. The best way to feel the consistency of your fluid is to rub it and stretch it between your thumb and index finger.

This fertility awareness method may not be best for people who don’t generally produce any cervical fluid. 

Source https://pregprep.com/wp-content/uploads/2013/08/131107_pregprep_chart1.jpg

The Symptothermal Method

This method combines cervical fluid, cervix changes, basal body temperature, and calculation to determine the beginning and the end of the fertile period. At the very least, you should be tracking cervical fluid and basal body temperature to determine when to avoid or engage in sex (depending on your goals, obviously). 

The Calendar Method (The Rhythm Method)

This is one of the methods that need at least 6 months of charting your period. 

Mark the first day of your cycle on an app or on a calendar. Remember, the first day is when you notice significant bleeding – not spotting. Mark the first day of your next cycle. Count the number of days in between your period. You’ll find the fertile part of your cycle, once you subtract 18-21 days from the shortest cycle (of the 6 cycles that you have tracked). You would find the end of the fertile part of your cycle by subtracting 9-11 days from your longest menstrual cycle. 

A real life example:

Dec – Jan = 30 days
Jan – Feb = 33 days
Feb – Mar = 28 days
Mar – April = 26 days
April – May = 32 days
May – June = 27 days

My shortest cycle was 26 days 
My longest cycle was 33 days

Start of my fertile phase is (26 days – 21 days) and (26 days – 18 days) = Days 5 to 8
End of my fertile phase is (33 days – 11 days) and (33 days – 9 days) = Days 22 to 24

Therefore, I would be considered fertile between days 5 to 24 of my period. Many couples may find this way a bit constricting, and may need to have another means of contraception if they still want to engage in vaginal sex. 

This method may be unreliable if you experience irregular menstrual cycles. 

The Standard Days Method

This fertility awareness method identifies a standard window in which someone may be fertile. You can only use this method if your cycle is really regular and is never shorter than 26 days and never longer than 32 days. You must also be cool with not having vaginal sex or using another contraceptive method between days 8 and 19 of your cycle – as they are considered the most fertile. 

Final Thoughts

There are at least 5 ways of practicing fertility awareness. Your best bet is paying attention to your basal body temperature and cervical mucus, and doing so for at least 3 cycles if you’re choosing this as your primary method of birth control. Speak to your Naturopathic or Medical Doctor to determine if these methods are right for you.