PCOS Unveiled: Understanding the Complexity, Empowering Your Wellness

Often PCOS is considered a condition of insulin resistance and weight gain leading to menstrual irregularity. However, there has been considerable advances in research and we now know that it’s a complex multifaceted condition. While insulin resistance is significant, focusing solely on it overlooks the diversity of mechanisms driving PCOS.

It is a dynamic condition that can change from severe forms to milder forms with corrective strategies that addresses the underlying imbalances.

Over the course of my clinical practice, I have come to believe that not all PCOS require the similar interventions. Not all women with PCOS require drastic weight loss or lowering of insulin resistance . I have often encountered lean women with normal insulin levels in the bloods. Recommending low calorie diets and weight loss can exacerbate hormones making things worse in this population.

In such cases we may need to look at Inflammation, lowering androgens, adrenal health, a balanced diet, lowering toxicity, balancing hormonal health. An individualized approach is essential for managing this multifaceted condition.

Here is the classification of different PCOS phenotypes as per Rotterdam classification:

A: Classic PCOS: This is the most severe form, with a significant risk of metabolic and reproductive complications such as infertility, insulin resistance, and increased cardiovascular risk.

  • Hyperandrogenism (clinical and/or biochemical).
  • Ovulatory dysfunction (e.g., irregular or absent menstrual cycles).
  • Polycystic ovarian morphology on ultrasound.

B: Non-PCOM Classic PCOS: This phenotype resembles Phenotype A in terms of symptoms and risks, except that the ovaries appear normal on imaging.

  • Hyperandrogenism.
    • Ovulatory dysfunction.
    • No polycystic ovarian morphology on ultrasound.

C: Ovulatory PCOS- This phenotype has normal ovulatory cycles and but still has all the other characteristics. They are often less severe metabolically but still carries risk related to androgen excesses such as acne and excessive facial hair.

  • Hyperandrogenism.
  • Polycystic ovarian morphology.
  • No ovulatory dysfunction.

D: Non-Hyperandrogenic PCOS: This is the mildest phenotype, often called “non-hyperandrogenic PCOS. This type is still debated and if it should be included in the category of PCOS.

  • Ovulatory dysfunction.
  • Polycystic ovaries on ultrasound
  • No hyperandrogenism.

Using evidence based targeted nutrient and herbs along with lifestyle strategies has shown to increase clinical outcomes with respect to managing symptoms and increase in live birth rates.
If you are looking for a true holistic approach to PCOS, or you have not seen progress in your journey, please get in touch. I would love to work with you.

For more detailed insights into these phenotypes, see the following references:

  • Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004). Revised Consensus on PCOS Criteria.
  • Teede et al. (2018). International Guideline for PCOS Assessment and Management. Human Reproduction.