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


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!

Female Friday

July 13, 2018
female friday

Female Friday is BACK this week, with a couple of hot links! Lately I’ve been trying new things – like golf! I can hit a ball past the 50 – and as someone who is not particularly skilled in sports, seems like a huge achievement for me!

Here’s what you should be reading

The future effects of stress during pregnancy (link)

“Children of mothers who experienced a death in the family during their pregnancy are more likely to be diagnosed with anxiety, depression, and attention deficit hyperactivity disorder. It is one of the first studies to show the impact of in-utero stress on mental health later in life.”

While family deaths may not be able to be avoided, this study makes the case for taking care of mental health during pregnancy – especially if you hope to avoid mood disorders in children. A mother’s mental health is important during and after pregnancy, and seeking support should not be avoided. 

Reducing menstrual cramps (link)

There is value knowing what is available to you for those painful periods, but I can’t say I agree with this entire article. Here’s my take:

  • To calm inflammation, avoid inflammatory foods. If you’re eating a pint of ice cream before and during your period, know that it can lead to more inflammation (and more pain!). Investigate your food choices and your stress levels around the time your cycle begins. 

  • Birth control will not ‘fix’ your period. Birth control acts as a temporary bandage for your period problems, and once you go off it, those symptoms are likely to come back. Investigate it further. Plus, if you have debilitating cramps, it might be endometriosis

  • Stay active. Certain yoga poses have been shown to be helpful for period pain. On a personal note, I save high intensity workouts after my period is over because I do believe in rest and relaxation during bleed days. It also fits in with the yin/yang perspective as the beginning of the cycle is more yin-based. 

  • External heat on the abdominal area. Agree!

  • Talk to your gyno. Or your ND to figure out how to relieve the pain from a holistic perspective.  

Best Menstrual Cups (link)

Are any of your favourite menstrual cups on this list? I’ve only tried the DivaCup. PS. If you do use a menstrual cup, be sure to use it safely!

Experiencing a period as a trans man (link)

An illuminating read with an accompanying video, about a menstruating man. 

“In one scene, Bliss changes their pad in a men’s restroom and then has to roll it up and put it in their pocket because there aren’t trash cans inside the stalls. And in another, they walk down an aisle full of pink and purple period products, lamenting how everyone who makes and markets pads and tampons assume that only women use them.”

Endometriosis and birth control (link)

“In a 2017 study “Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills” Dr. Robert Casper also praised progestin-only birth control pills as a viable option for endo women.”

I would add a caution about progestin-only birth control methods, because there have been studies linking them to depression and lowered feelings on quality of life.