4 Types of PCOS

September 10, 2018
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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
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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 irregular 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:

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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!

Why Aren’t You Getting Pregnant?

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You might think that you can get pregnant at any time during the month – but that isn’t true. There are about 6 days in your cycle when you’re actually fertile. So it’s important to figure out if your body is ovulating, and aim to have sex around that time (including up to 5 days before). Some people become concerned if they don’t get pregnant on the first shot, but it’s actually not that common to do so. About 84% of couple get pregnant within their first year of trying, while 92% of couples get pregnant after 2 years of trying. Depending on your age, there’s a certain time period where you might want to do some investigating if you haven’t become pregnant.

Types of Infertility

Primary Infertility (also known as Subfertility)

This happens when you’re younger than 36, and haven’t gotten pregnant within 1 year of having regular, unprotected sex, or you may not be able to carry a pregnancy to term. If you’re 35 or older, you might have primary infertility if you haven’t become pregnant within 6 months of having unprotected sex, or you may not be able to carry a pregnancy to term. This might be due to the declining egg quality as you age.

Secondary Infertility

This happens if you haven’t been able to get pregnant after 1 year of having regular, unprotected sex, or you can’t carry a pregnancy to term, DESPITE being able to have done so at least once. Women who are experiencing irregular or absence of periods, endometriosis, PCOS, painful periods, pelvic inflammatory disease, more than one miscarriage, should seek care before the 6 month or 1 year mark. 

What Causes Infertility?

Female Factor

You need to be ovulating and have unobstructed fallopian tubes for conception to occur. Keep in mind that this may not account for unexplained infertility if both those factors are normal. When you aren’t able to ovulate, this is known as anovulation. Some conditions that can affect ovulation are:
  • PCOS: A condition that may cause anovulation in women, or irregular periods
  • Diminished ovarian reserve: Fewer eggs remaining in the ovaries than normal
  • Hypothalamic functional amenorrhea: Symptoms include low body weight, excessive stress and exercise
  • Premature ovarian insufficiency: Decline of ovarian function at a younger age (ie. before your 40s).
  • Menopause: A decline in ovarian function, usually when you are in your 50s
An egg needs to pass through a fallopian tube to be fertilized by semen. But some conditions may cause obstruction. These include:
  • History of pelvic infection
  • History of sexually transmitted infections like chlamydia and gonorrhoea
  • Endometriosis
  • History of abdominal surgery

Male Factor

Men may also contribute to infertility, and it’s commonly based on sperm parameters. These parameters include: sperm count, how the sperm is moving, if the sperm is moving in the right direction, the size and shape of the sperm, total semen volume, and if sperm can transition from a gel-like to liquid state after ejaculation. Causes may also include testicular trauma, chemotherapy, hernia surgery, or infertility with another partner.

Unknown Factor

Sometimes we don’t know why infertility happens. This is known as unexplained infertility.

Risks of Infertility

In women, risks include:
  • Age
  • Smoking
  • Excessive alcohol intake
  • Extreme weight gain or loss
  • Excessive physical or emotional stress

Fertility Tests

A diagnostic workup can include:
  • Hysterosalpingogram: an X-ray investigating the shape of your uterine cavity and fallopian tubes, as well as investigating if there are any obstructions within your fallopian tubes.
  • Sonohysterography: ultrasound exam that will create images of your uterine lining. It uses fluid (administered into the cervix) and sound waves to do so.
  • Laparoscopy: The insertion of a thin telescope-like instrument vis a small incision in your belly button. It allows doctors to visually examine your abdominal and pelvic organs (uterus, fallopian tubes, ovaries), and determine if you have endometriosis, scar tissue, fibroids, or any other ‘defects’.
  • Lutenizing Hormone: This is the hormone that triggers ovulation. If there is no LH surge mid-way through your cycle, it’s suggestive of anovulation. It can also provide information about your ovarian reserve, and if your ovaries are functioning normally.
  • Hysteroscopy: Examining your cervix and the inside of your uterus using a thin, tube called a hysteroscope.
  • Transvaginal Ultrasound: Examining a your uterus, ovaries, tubes, cervix and pelvic area, using a ultrasound probe inserted in your vagina.
  • Ovarian Reserve Time: Estimating the supply of remaining eggs within your ovaries.
  • Other blood tests
In men, a work-up includes: a semen analysis and blood work to evaluate testicular function. These usually include: testosterone, follicle stimulating hormone (supports sperm production), lutenizing hormone (prompts testosterone production), and sex hormone binding globulin.

Final Thoughts

Trying to get pregnant and not being able to do so can be isolating and frustrating. You might be trying to do all the things on this fertility journey, like tracking cervical mucus and temperature, using LH strips. You might even be cutting back on smoking, drinking alcohol, or trying to lose weight. Sometimes treatment can be as easy as reducing toxic exposure (like smoking or alcohol), decreasing stress, or losing weight. It really all depends what you’re ready to do. If you’re looking for support getting pregnant, let’s work together to make the process less stressful, figure out what’s going on if there are any changes can you and/or your partner can make now, to help in the longterm. If you found this information helpful, be sure to sign up for my monthly newsletter called The Flow for more informative articles like this!