4 Types of PCOS (a Flowchart)

Types of PCOS.

Polycystic ovary syndrome (PCOS) is not one disease. Instead, it’s “a heterogeneous disorder with different underlying biological mechanisms.” In other words, it’s a set of symptoms (androgen excess and anovulatory cycles) caused or driven by several different underlying factors. To successfully treat PCOS, you need to identify which factor (or factors) is driving the symptoms. In other words, you need to know your functional type of PCOS.

The four functional types of PCOS include insulin-resistant PCOS, post-pill PCOS (which is temporary), inflammatory PCOS, and the far less common adrenal PCOS.

First things first, what is PCOS?

PCOS is best defined as androgen excess (high male hormones) when all other causes of androgen excess have been ruled out. And despite the name, polycystic ovary syndrome has nothing to do with cysts on the ovaries. For one thing, the so-called “cysts” that are visible on ultrasound are not ovarian cysts but are instead actually follicles or eggs, which are normal for the ovary.

👉🏽Tip: Large, abnormal ovarian cysts can cause pain and other symtpoms. They are separate issue and not the same thing as polycystic ovaries. 

For another thing, “there is no evidence that the presence of polycystic ovaries has any implications with regard to the endocrine or metabolic features of PCOS.” In other words, you can have polycystic ovaries and have perfectly normal hormones. Conversely, you can have normal-looking ovaries but still have the hormonal condition of androgen excess (aka PCOS).

So, the first step in determining your type of PCOS is to ask the question: Is it really PCOS?

Is it really PCOS?

Diagnosing PCOS.

It’s really PCOS if you have androgen excess as demonstrated by 1) high androgens (male hormones) measurable on a blood test, and/or 2) significant facial hair or jawline acne. PLUS other reasons for androgen excess have been ruled out.

👉🏽 Tip: Other reasons for androgen excess include congenital adrenal hyperplasia (which accounts for up to 9 percent of cases of androgen excess), high prolactin, and hormonal birth control with a high androgen index (testosterone-like progestin)

If you don’t have androgen excess, then you don’t have PCOS. That’s true even if you have polycystic ovaries and that’s true even if you have irregular periods or no periods. There are lots of reasons for no periods including the very common hypothalamic amenorrhea, which is a lack of periods due to undereating or undereating carbs. (And yes, you could have been mistakenly told you have “lean PCOS” when you actually have hypothalamic amenorrhea.)

For more information read:

If you’re certain you have PCOS, let’s move on. Do you have insulin resistance?

Insulin-resistant PCOS

Insulin-resistant PCOS.

Insulin resistance means having high insulin. It’s also called metabolic syndrome or pre-diabetes. The best way to test for insulin resistance is to measure the hormone insulin, not glucose.

👉🏽Tip: For more information about insulin testing, see my insulin blog post and Chapter 7 in Period Repair Manual.

If your insulin is high, then high insulin is driving your high androgens and you have insulin-resistant PCOS.

The treatment of insulin-resistant PCOS is to reverse insulin resistance with diet, exercise, and supplements like magnesium and inositol.

👉🏽 Tip: There’s a 70 percent chance your PCOS is insulin-resistant PCOS. 

If you’re certain you do not have insulin resistance, let’s move on. Did your symptoms start when coming off the pill?

Post-pill PCOS

Post-pill PCOS.

It’s pretty common to experience a temporary surge in androgens when coming off a drospirenone or cyproterone pill like Yasmin, Yaz, Diane, or Brenda. Under current diagnostic guidelines, that temporary surge in androgens is enough to qualify for the diagnosis of PCOS or post-pill PCOS.

With my post-pill PCOS patients, I recommend the following:

You have post-pill PCOS if you meet the criteria for PCOS (excess androgen and other conditions ruled out), plus you do not have insulin resistance, plus symptoms started when trying to come off the pill.

If you did not just come off the pill (or spironolactone) or had problems before birth control, let’s move on. Do you have signs of chronic inflammation?

Inflammatory PCOS

Inflammatory PCOS.

Chronic inflammation can stimulate the ovaries to make too much testosterone and is a contributing factor for every type of PCOS.

When chronic inflammation is the primary factor or driver, it’s inflammatory PCOS.

The treatment for inflammatory PCOS is to identify and correct the underlying source of inflammation. That could mean avoiding a food sensitivity such as dairy, fixing an underlying gut problem, or addressing chronic mast cell activation or histamine intolerance. The supplements zinc and N-acetyl cysteine work particularly well for inflammatory PCOS.

You have inflammatory PCOS if you meet the criteria for PCOS, plus you do not have insulin resistance, plus you’re not in a temporary post-pill phase, plus you have signs and symptoms of inflammation, as follows:

  • unexplained fatigue
  • bowel problems like IBS or SIBO
  • autoimmune disease like Hashimoto’s thyroid disease
  • headaches
  • joint pain
  • a chronic skin condition like psoriasis, eczema, or hives.

If you do not have chronic inflammation, let’s move on. Do you have adrenal PCOS?

Adrenal PCOS

Adrenal PCOS.

Most women with PCOS have an elevation of all androgens including testosterone and androstenedione from the ovaries and DHEAS from the adrenal glands.

If you have only elevated DHEAS (but normal testosterone and androstenedione), then you may have adrenal PCOS, which accounts for about 10 percent of PCOS. Adrenal PCOS is similar to the genetic condition late-onset congenital adrenal hyperplasia (CAH).

Adrenal PCOS is not driven by insulin resistance or inflammation. Instead, it’s an epigenetic upregulation of adrenal androgens. Treatments include magnesium, zinc, licorice, adaptogen herbs, and pantothenic acid (vitamin B5), which modulates adrenocorticotropic hormone (ACTH).

👉 Tip: What if you have more than one type? The types are listed in order of priority. So, if you have insulin resistance, then you have insulin-resistant PCOSeven if you also have inflammation and a post-pill worsening of your symptoms. 

Anti-androgen treatment for all types

In addition to treating the underlying driver of your PCOS, you may also require a natural anti-androgen supplement such as cyclic progesterone therapy.

Still confused?

What if you’ve been told you have PCOS but don’t meet any of the above criteria?

Go back to the drawing board. Do you truly have PCOS? As in, do you have high androgens? If not, you don’t have PCOS and could instead have hypothalamic amenorrhea.

See the full flowchart below and ask me in the comments. For information about the 4 types of PCOS and their treatments, see Chapter 7 of Period Repair Manual.

Dr Lara Briden
4 Types of PCOS including insulin-resistant PCOS and post-pill PCOS.
4 Types of PCOS

218 thoughts on “4 Types of PCOS (a Flowchart)”

  1. I am so hoping for an answer as I fit NONE of these categories but I have PCOS. I am 30 years old, diagnosed 10 years ago. I currently have hirsutism, elevated AMH, polycystic ovaries and I have periods twice a month. It has been like that for years now. I don’t ovulate but I bleed. I’ve been on cyclical progesterone for almost 6 months but I still get spotting even at day 13 and I’ve had to increase my dosage instead of decrease it. And I bleed only 3 days on progesterone as opposed to my normal 5 days. Thyroid normal (everything has been checked), blood sugar and insulin great, iron, zinc great… My whole bloodwork is great except we couldn’t check for my hormones as I don’t have a day 21 in my cycle! The only thing we found was an iodine deficiency but I’ve been supplementing for 6 months (lugol’s %2, one or two drops a day). I have absolutely no idea why nothing seems to be working.

    • Have you tried Rasberry Leaf Tea? My friend did after her periods changed post COVID and she experienced a 30-day period. She took intensive tea extracts for a couple days and then just the tea. Worked like magic. I’ve now been taking it to improve my cycle

  2. Please help!!!
    I went on the pill about 2 years after stating my period. I did start quite late (aged 17) which I believe was due to me being underweight. I had regular periods for the first 2 years which no other PCOS symptoms.
    Fast forward 8 years. I am now 27 and decided to come off the pill last Dec (2021) as I didn’t want the synthetic hormones any more. I am still waiting for my period and have been diagnosed with PCOS.
    My ultrasound showed the follicles on my ovaries and I have high testosterone levels.
    I know everyone is different but I am sure my periods will return to normal and the PCOS is only temporary (as I didn’t have it before the pill) but my dr has told me the pill was masking my PCOS and to take a ‘bleed inducing’ pill once every 4 months to shed my uterus lining. I am very apprehensive about putting MORE synthetic hormones in my body.
    I’m wondering if it ‘normal’ to still be experiencing this 9 months after stopping the pill. My hormones are definitely fluctuating (I can feel the mood swings, changes in libido, skin changes etc)

    Any advice is welcome, I’m at a loss and feeling worried. I am doing everything else I can to naturally induce ovulation.

  3. We have been on a long and difficult journey with our 17 year old daughter who suffers from cyclical insomnia & anxiety combined with elevated histamine discomfort (extremely ITCHY eyes that keep her awake, this also comes and goes each month), and ultimately she is on anti-psychotic medication because of the mental decline she experienced at the onset of symptoms a couple of years ago. While she is now stable, the insomnia (taking over 3-4 hours to fall asleep) and anxiety are resurfacing (she recently came off the pill after being on it for nearly 2 years) and we desperately want to get to the bottom of it. Prior to the pill she had irregular periods (41+ days between cycles but then they would last 18+ days sometimes). We don’t know how to move forward for the right treatment. Could you please please help us.

  4. Hello, what happens if I do have pcos (other issues exluded), no insulin resistance and only gut problems (but none of the other symptoms) and all my androgen levels are normal?

  5. I have adrenal and inflammatory pcos, mcas, Achalasia, diabetes, AVM of the brain. Metformin is the only drug that treats me. It blocks dheas. I am 49 and will never conceive, even though my dheas has decreased by age, the acne and symptoms only get better with metformin. I don’t have any hormonal tumors. My mcas is treated with montelukast and Zyrtec. I take magnesium for cerebrovascular disease-AVM and Lipitor/coq10. Pcos left untreated causes diabetes and cerebrovascular disease. I just hope our society changes their views on this terrible disease. It ruined my chances for a family and career. Having a stroke because of the medical communities ignoring me for metformin for 9 years. A sad commentary about pcos. Pcos is a disease not a dietary or vitamin deficiency.

  6. Excellent Blog. PCOS was something I also had. I take many supplements, such as PCOS seeds and Healthveda. PCOS was not cured by taking these supplements. Solvve Supplement was finally discovered. The Solvve vitamin has been quite beneficial in my PCOS recovery. I’ve lost 8 kgs and enjoy the taste. I’m a lot happier and healthier now. God blessed! I hope PCOS is a condition that affects women. The link provided below will be quite beneficial.

  7. Hi! I was recently diagnosed with PCOS, but I’m not sure whether that’s really what I have. Here is my relevant history:
    – I lost my periods when I was 18 due to a restrictive eating disorder. At my lowest weight I was about 110 lbs and I am 5’7”. I was told this was due to hypothalamic amenorrhea, which seems plausible.
    – When I was 21 I began birth control to “regulate” my hormones and was on this for 2 years. While on it I had 2 bleeds per month.
    – My doctors switched me over to hormone therapy with an estradiol patch, and synthetic progesterone pill which I took for 10 days every 6 weeks. I was on this for another 3 years
    – At this point I got a new gynecologist who encouraged me to get my periods back naturally, so I stopped the hormone therapy (May 2020). I also began real therapy for my eating disorder.
    – As of October last year I consider myself recovered from my ED and am at a normal weight of 140lbs
    – Since stopping the hormone therapy I have only had one period (April 2022)
    – I got an ultrasound done this week and I do have follicles on my ovaries
    – A recent LH/FSH test (April 2022) showed a ratio of 3:1, but this was around the time I would have ovulated when I did get a period
    – In October my free testosterone was measured at 3.9 pg/mL and total testosterone was 27 ng/dL
    – In October my DHEA was measured at 646 ng/dL
    – I have never had my insulin measured so I do not know if I have insulin resistance

    Can you let me know your thoughts? I am feeling pretty lost and multiple doctors have told me to just take birth control, which I really don’t want to do again! I’d really appreciate your input.

  8. Hello. Dtr experiencing significant hair
    Loss. Has had skyla iud for one and a half years. Blood tests show elevated dhea and free testosterone. Wondering if symptoms and hair loss from iud or she has pcos Any articles you can point me to?

  9. Hi! I have a question. What is considered “significant facial hair or jawline acne”? For instance, I have 15-20 hairs that grow on my chin, and an occasional pimple here or there (maybe one or two a month?) but I don’t know if this is considered hirsutism or not.

  10. (Broccoli Powder + Kale powder + Brussels sprouts + Sauerkraut (cabbage)
    – I’ve never had any of those in my diet before
    What if I started eating daily these combination 3 time per day
    Could have a similar effect to DIM?

  11. Wonderful article and your book is great as well!

    I’m still trying to figure out what kind of PCOS I have…I’m lean, but do not believe I have hypothalamic amenorrhea. My testosterone was high, though still in the “normal” range, my glucose was in the normal range (still think it would be optimal to be a bit lower though), but my fasting insulin was *below* the normal level! What could cause PCOS/high androgens in someone with not just normal insulin, but maybe even low insulin? Would the insulin test results show a dramatic difference if taken after eating as opposed to fasting?

    Also, CAH ruled out and DHEAS was in the “normal” range of 223 or so.

    Would appreciate your insight! Thanks!

  12. Hi! I’m so glad I found your work! After 35, I suddenly developed symptoms of androgen excess. Blood tests have been normal. Saliva tests showed high testosterone and dhea and low normal levels of estrogen and progesterone. My lipid levels are all off, but my a1c was 4.9 and my fasting insulin was 3.5 at that point (we’ve eaten a lc paleo diet for many yrs). One dr said I had PCOS and prescribed metformin. At the end of 3 months, all of my symptoms and my labs were actually worse. So, I found another dr. The new one said she thinks my body is responding to the normal 35+ drop in progesterone by keeping my estrogen/progesterone at good ratios by converting excess estrogen to testosterone, causing my symptoms. She prescribed cyclic progesterone and said to experiment with the dose. After reading your articles, I’ve started doing 300 mg. But my symptoms don’t seem to be dissappearing. How long should I expect it to take? Would you agree with what my current dr is saying? Do I have PCOS or is this just premenopause? And would you recommend anything else? Thanks!

  13. hello! i was diagnosed with pcos due to polycystic ovaries and irregular periods. My LH is higher than my fsh , however my androgens and insulin are completely normal. It seems like I don’t fit any of the types you suggested but I also don’t fit into the undereating condition. Thoughts?

      • very mild. A bit of chin hair but nothing too bad. Occasional jawline breakouts at 33. I started progesterone 300 mg at night for 10 days. How long til the patient usually begins ovulating on their own and how do you test that?

  14. The only androgen that was elevated was my free testosterone and it was 4.6; the lab normal range was 0.5-4.2 so it was barely elevated. I used to have 40 day cycles right after my miscarriage a year ago which is what prompted testing. But now my cycles are 33-34 days long and period lasts 7 days. Could it not be PCOS?

  15. Hi Lara

    I have been diagnosed with PCOS (PCO, irregular cycles, acne, mild hirsutism, PMS, low mood, brain fog), but all my bloods are consistently normal and I don’t seem to fit into any of the categories (the closest is post-pill, but it has been over 2 years now). I’m really confused about what to do.

    I have trialled vitex, inositol, NAC, glutamine, maca root and low calorie diet to no effect. I am a healthy BMI and exercise at least a few times a week.

    I’ve reserved a copy of your book from my local library and am waiting for it to become available, but would really love your thoughts in the meantime!

    Thank you so much.

  16. Hello Lara,

    I was wondering, what are the symptoms of elevated DHEAS besides PCOS? Is it automatically tested with the other androgens or should I specifically ask for this one?

    Many thanks for your hard work,


  17. Hello Dr Lara, having read your Period Repair Manual book, I can only say it is the best I have come across. I refer to it constantly as my 23 yr old daughter was diagnosed with underlying PCOS in 2019 by a gynaecologist. However another gynaecologist and an endocrinologist were not convinced she had it. Although she is not overweight she has noticed that she puts weight on more easily especially around the hips, buttocks, stomach and thighs and is more difficult to shift. Her hair has always been fine but she thinks it is getting thinner. She was advised to do the Dutch Test which showed she was hardly producing any of the oestrogens throughout her whole cycle and was advised to seek help. I know you don’t do the Dutch Test and I was wondering if that was because you thought the results weren’t giving a true enough picture.. She has been on Berberine & Oregano Oil for SIBO since end of January 2021 for SIBO so that might have affected the most recent blood test results. She also takes Magnesium, Multivitamin, Vit D3, Fish Oil and a probiotic. I would value your opinion on her as she is very anxious about her fertility as am I. She came off the pill in 2018 and her periods have been regular since then. The results from her blood tests are as follows, starting with the most recent:

    13 MAY 2021
    170H Progesterone 5.7 nmol/L (0-6.0 range)
    Androstenedione 3.4 nmol/L (0-5.5 range)
    DHAS 6.5 umol/L (0-9.6 range)
    Testosterone(Mas) 0.9 nmol/L (0-1.5)
    FSH 4.3 U/L (3-8 range)
    LH 6.1 U/L (2-13 range)
    Oestrodiol 250 pmol/L (100-2000 range)
    Progesterone 19.6 nmol/L
    Prolactin 171 mU/L (0-630 range)
    SHGB 53 nmol/L (20-155 range)
    Testosterone 1.0 nmol/L (0.5-1.7 range)
    TSH 1.29 mu/L (0.35-5.00 range)
    Ferritin 16 ug/L (15-200 range)

    22 SEPTEMBER 2020
    170H Progesterone 3.6 nmol/L (0-6.0 range)
    Androstenedione 2.6 nmol/L (0-5.5 range)
    DHAS 11 umol/L (0-9.6 range)
    Testosterone (Mas) <0.5 nmol/L (0-1.5 range)
    Free Andro Index 2.3% (0-7 range)
    FSH 2.0 U/L (3-8 range)
    LH 4.1 U/L (2-13 range)
    Oestradiol 581 pmol/L (100-2000 range)
    Progesterone 26.7 nmol/L
    Prolactin 510 mu/L (0-630 range)
    SHBG 48 nmol/L (20-155 range)
    Testosterone 1.1 nmol/L (0.5-1.7 range)
    TSH 2.31 mu/L (0.35-5.00 range)
    Ferritin 21 ug/L (15-200 range)
    Hba 1C 32 mmol/mo

    13 SEPTEMBER 2019
    Anti-Thyroid Peroxidase <1.0 IU/ml (0-6 range)

    5 MARCH 2019
    170H Progesterone 4.5 nmol/L (0-6.0 range)
    Androstenedione 3.0 nmol/L (0-5.5 range)
    FSH 2.3 U/L (3-8 range) LOW
    LH 5.2 U/L (2-14 range)
    Oestradiol 424 pmol/L (100-2000 range)
    Progesterone 31.8 nmol/L
    Testosterone 0.7 nmol/L (0.5-1.7 range)
    TSH 4.2 mu/L (0.35-5.00 range)
    2.96 mu/L (0.35-5.00 range) tested on 10 Sep 2019
    Ferritin 26 ug/l (10-65 range)

    30 OCTOBER 2018 – Came off Loestrin 20 in May 2018)
    170H Progesterone 1.6 nmol/L (0-6.0)
    Androstenedione 5.1 nmol/L (0.5.5)
    DHAS 12 umol/L (2.0-12.5)
    FSH 4.8 U/L (3-8)
    LH 7.0 U/L (2-13)
    Oestradiol 352 pmol/L (100-2000)
    Progesterone <1.0 nmol/L
    Prolactin 239 mU/L (0-630)
    Testosterone 1.1 nmol/L (0.5-1.7)
    TSH 1.19 mu/l (0.35-5.00)

    Many thanks

  18. Dear Lara

    Thank you so much for your content! Even with your book and all the amazing blogposts, I am still struggling to find out my kind of PCOS. I have already been to every doctor here including a naturopath, but she hasn’t got the knowledge that you seem to have! Please help me! I would cry from happiness and gratitude, I just don’t know what to do anymore. I ordered all bloodtests out of my own pocket as a student…and the only thing outside of the reference range or extraordinary is my androstenedione…

    I took the pill (unfortunately) for 5 years. I started when I was fifteen because of my horrible acne. I just didn’t knew better. It has been 2 years since I got off. I still have acne, oily skin and irregular very long cycles (45-60 days), and painful leg cramps and joint pain to the point where I can’t walk anymore.

    I am not vegetarian but don’t eat any kind of milk, gluten and extremely low sugar (0-25g fructose), because if I do not eat this way, I get even more acne. I do mild intermitted fasting as well.

    I already tried and I am still taking Magnesium (400mg), Zink (50 mg), Berberine and Rhadiola + occasional ashwaganda in my smoothie. I drink Matcha tea every day. I am lean (63 kg) with some muscles. I do not train extensively though and I do eat enough.

    Estrogen Day 3: 26,6 pg/ml
    Estrogen 1 day before Ovulation: 486,7 pg/ml
    DHEAS: 273.2 uq/dl. (normal-high)
    Androstendion: 426 ng (high)
    Testosteron: 1,40 mmol/l
    Prolactin Day 3: 8,3 ng/ml
    Prolactin 1 day before Ovulation: 16,3
    FSH Day 3: 4,7
    FSH 1 day before ovulation: 5.5
    LH Day 3: 4.9
    LH before Ovulation: 27.7
    Progesteron in Lutealphase: 19.1 ng/ml
    Fasting Insulin: 8.4 mU/l
    Fasting Glucose: 81 md/dl
    LDL- Cholesterin: 87 mg/dl
    Zink: 11
    TSH supersensitiv: 1.51

    Thank you so much for your help and your time ! It’s just SO hard to treat something that you are not able to diagnose, please help me,


    • I was wondering the same thing. I clearly have insulin resistance despite not being tested 20 years ago when it wasn’t as easy and I was trying to get pregnant. Low-dose Metformin worked after every other fertility treatment didn’t and also continues to help me regulate my period which I think confirms the insulin resistance issue as well as other sugar issues experience. I also have auto immune issues in my 40s And living/eating a low inflammatory lifestyle as much as possible helps significantly. When reading auto immune research they are starting to believe PCOS may be related and both my mother and I with PCOS I have different autoimmune issues. I completely agree you could have both as I believe I’m living it. Is it having both or are insulin resistance and auto immunity related?

  19. Hi! So I think i have the post pill issue where my male hormones were high initally but then subsided. A year after coming off BC my testosterone was 215.3, which on the chart reference was high. I was getting badddd jaw acne and hair loss. I was on antibiotics for 6 months to clear it up but its back now since stopping. How do i treat the real issue here?

  20. Hi Lara,

    I have a question. I have high LH levels and low FSH levels. My LH is 19.1 and my FSH is 3.8. I know high LH is linked with insulin resistance, but i just don’t feel like i have that. I am actually underweight and i do not eat a lot of sugar. I do have been drinking spearmint tea for over 6 months for my acne. It did helped at first but my acne is getting worse, so that is why i tested my hormones. Now i wonder, could it be possible that spearmint raised my LH? Since i read that spearmint could raise LH? And what is your advise to lower my LH? I am already planning on taking inositol.

  21. I never had symptoms until after I took progestin only birth control but DHEAS is also only thing that is high……still lost.

  22. Hi, my Lh to Fsh ratio is high but I have no high male hormones. Never had a regular period… what can it be if it’s not pcos and not Ha??

  23. Is it possible to have more that one type?? I fit the whole criteria for both insulin-resistant AND inflammatory..

    • I do as well and when you re-search auto immunity they are starting to believe PCOS is auto immune in nature. I believe at the very least that the insulin resistant type described as well as inflammatory are related. The insulin resistance may be a parent from early on as it was in my teen years and 20s and the auto immune issues bringing to light inflammation or something I became aware of in my 40s which is common for women.

  24. Hi,

    I’m wondering about the symptom of breast atrophy in combination with other symptoms of high androgens. I’m undiagnosed with anything, but experienced hair loss, acne, unwanted hair growth, *and* breast atrophy correlated with periods of missing sleep, eating a lot of sugar, stress, and weight gain. I’ve also heard from a couple of friends that their hormonal symptoms include weird changes in breast size. (I’m not talking about normal changes associated with weight gain/loss, menstrual cycle, or pregnancy.) My current working theory is that I had PCOS, insofar as PCOS means high androgens coming from insulin resistance (despite the fact that I haven’t been diagnosed with insulin resistance so far). However, I don’t see references to breast changes in association with PCOS anywhere, and my understanding is that they’re not directly related. Have you had patients with this symptom? Can you point me to any resources suggesting what else could cause this? I just want to know I don’t have an underlying problem I’m ignoring – and why it’s so hard to find information about this, since I assume I’m not the only one with this symptom.


  25. Hi Lara

    Thank you so much for your wonderful work – it is so, so valuable for all of us females!

    I have always had very irregular periods but apart from mild acne, I have no other physical signs and my blood tests do not show high androgens or insulin sensitivity.

    Having read your brilliant book I’m trying to narrow down the possible causes, and I’m wondering if it could be my thyroid?

    I feel tired most of the time, often can’t get warm and my bloods show high cholesterol and creatinine (despite a healthy diet).

    I don’t think it’s hypothalamic amenorrea (I do not have a low LH to FSH ratio).

    I’m wondering if there is anything else you think it might be please? I’m seeing an endocrinologist but don’t seem to be getting anywhere.

    I’m hoping to try for a family in the next year, and would also just love to be able to ovulate regularly – that’s the dream!

    Thanks so much for any help you can give.


  26. Hello Lara, I really loved your book. I was hoping if you could provide some advice.

    I came off the pill 6 months ago (Mercilon – low dose birth control pill) and have not yet had a period. Blood tests showed high testosterone, high LH and cysts on my ovaries on ultrasound, so my GP diagnosed me with PCOS.

    I was really distraught and found it very hard to come to terms, but reading in your book about Post-Pill PCOS gave me some hope. Before taking the pill (8 years ago), I had regular cycles and no menstrual issues, so I think this might be what I am experiencing.

    I eat generally very healthily, no food restrictions aside avoiding dairy and sugar, and take B6, Zinc and Inositol since 3 months. But still no period and I am starting to worry it may never come back.

    How long can it take for periods to come back? How long can Post-Pill PCOS last? What else can I do?

    Thank you

  27. Hi thanks for your shared information. Could you please supply a reference to evidence based practice for the types of PCOS you have suggested in the flow chart. This would help greatly, Thanks.

  28. Hi, I have struggled with what you call PCOS since I was 13. I have done a lot of research and making myself a ginnuepig to see what works for me and what doesn’t. I recently came across that there is PCOS and PCOD. Poly Cystic Ovarian Syndrome being that a women has actually cysts on her ovaries and Poly Cystic Ovarian Disease being the symptoms of insulin resistance, MS, scoriasis etc. You can have one without the other and challenges how women are thinking about what they actually have. What is your take on this? There is so much information out there on websites that PCOS or PCOD has not been researched enough. Even a doctor i saw who is believed to be well aware of PCOS could not help me.

  29. Hi
    I have been on the pill since I was 14 now 29 and came off in March 2020. I was put on the pill at 14 due to very heavy constant bleeding.

    I had 1 period after coming off the pill and since they have not returned (9 months) but I can tell that I have some sort of cycle (every 34 days, ovulation pain, spotting around the time my period should be). I am not ovulating as I’ve monitored my BBT.

    I had a blood test and everything is normal (including testosterone) but I have a LH to FSH ratio 11.7 / 6.5 in the luteal phase (after when my body tried to ovulate). I do not have excess hair but do have acne.

    I had an ultrasound that showed polycystic ovaries.

    The doctors aren’t sure if it’s pcos and referred me to a gynaecologist but it’s a 9 month waiting list.

    I can’t tell if I have post pill pcos / hidden cause pcos or if I just need to allow my body time to get over being on the pill for 14 years. I can’t tell if I always had pcos and that’s why my cycles were so heavy when I was younger or if that was just hormones at the time.

    I’ve read your book but still felt mixed because of my symptoms when I was 14. I’ve started taking zinc and have considering taking peony and licorice.

    I am trying for a baby so any advice would be appreciated.

  30. Hi Lara,

    I was diagnosed with PCOS around 2 months ago by two separate gynecologists. The evidence of this was multiple cysts on both of my ovaries as-well as an absent period. However, my blood tests showed no abnormalities.

    I will add, I had been on the pill since I was 14 years of age.. and finally came off the pill in February this year (I am soon 20 years old), due to experiencing bad side effects, as well as finally learning about all the implications the pill truly has… Since then, I am still yet to regain my natural cycle. (My sister is diagnosed with PCOS and endometriosis). My doctor tells me I must go back on the pill to deal with my PCOS in order to conserve my eggs if I ever want to conceive in the future. However, as I read again and again, the pill doesn’t solve the issue in the first place. So, I am at crossroads with what to do next… My LH:FSH is 5,6:4,6

    I started the pill due to irregularities in my cycle as well as really bad acne. It was what my gynecologist at the time recommended I did to solve this.

    I am desperate to seek some help and guidance in a more natural way to regain my cycle…however I am now even sure what kind of PCOS I have.. if it’s even PCOS!

    Thanks so much in advance if you manage to reply.

  31. Hi Lara I have a diagnosis of pcos but I don’t have significant signs of androgen excess. I have a small amount of excess hair on my tummy but it really isn’t troublesome And if it were not for my irregular periods I would not think it out of the ordinary. My main symptom is irregular cycle. I had my LH and fsh tested on day 3. My fsh was 5.45 iu/l and LH was 8.1 iu/l. I guess my question is can it be pcos if I have minimal signs of androgen excess and normal testosterone on bloods? However my LH/fsh ratio does seem to support the pcos diagnosis . Thank you!

    • Hi Tamara, I spoke to my doctor and am currently just started going through everything. However it was stated that you can have PCO (polycystic ovaries) and not PCOS (the syndrome and aka the other more dire symptoms) my doctor has told me you can find this out due to blood tests, maybe look into this and give it a try, or ask your doctor as everyone is different! (Also make sure when they do the blood tests they check the right things, as a doctor will specifically check what they think it is which is why I’ve gone for so many blood tests and only after the recent one found out some more info) hope this helps

  32. Hi Dr. Briden,

    I have a long hx of very irregular periods through my teen years and into my mid 20’s. I had a bleed about every 2-3 month in my mid 20’s but in my teen years sometimes only 3x per year. I went on Nuvaring for birth control before getting married about 5 years ago. I went off that about 1.5 years ago and 3 months later started trying to conceive. I am now 30yo. I rarely if ever ovulated and based on my history found a fertility doctor fairly early to help with the journey. I was then diagnosed with PCOS. The issue is after researching and reading and listening to your information I do not really fit into this box. I have a BMI around 20, am long and lean, have only a couple darker hairs on my chin. Lab tests show no elevated androgens but LH (17.29 mIU/mL) is much higher than FSH (7.56 mIU/mL). I had high TSH (7.36 uIU/mL) but have been on a medication and am now <2 uIU/mL. I do have "polycystic ovaries" upon US. I cut out gluten and processed sugary foods just for the health of my gut (I was dx with IBS after having c-dif about 2 years ago). This really has helped my gut health with less bloating and helped with the bumps on my arms. The past 2 weeks I have eaten more gluten and am feeling the effects of that again. My doctor said I do not have HA due to my LH levels. I just requested an insulin level lab (I have only had glucose and A1C) and will get that done this week. I am already taking tons of vitamins (D3, B12, zinc, Coq10, prenatal, probiotic, methylfolate) as well as baby aspirin due to a possible clotting issue resulting in multiple miscarriages. Test that was positive was for Phosphatidylserine Antibody IGA IGG IGM and can impact blood clotting. I may be moving forward with chromosomal testing due to repeat miscarriage (3 in the past year) as well but I think this is a separate issue. I am not sure what the next step is for me since I have some of the signs of PCOS but not the others. I also do not seem to fit the HA category either. I am currently taking letrozole 7.5mg on cycle day 5-9 to assist with ovulation and then progesterone starting 3 days post ovulation to try and sustain early pregnancy. My doctor ordered repeat test for FSH and LH as my other one was about a year ago. I have not been taking magnesium due to being unsure if I really fit into the insulin resistant PCOS category. Any insight you have would be very helpful! I want to treat the underlying condition but also want to have a successful pregnancy.

    Thanks for your time,


  33. Hi Lara, would greatly appreciate if you can clarify something for me.
    Is it good enough to have total testosterone checked through bloodwork to see if the levels are in normal range? Or is free testosterone also necessary?

    Also, you didn’t mention anything about high dheas being caused by adrenal tumors.

  34. I’m not so sure pcos is as simple as you have made your algorithm…if it was so many women would be successfully treated or all, but there are exceptions. So, its not a complete picture. With me, my entire hormone panel passes as normal or borderline levels. Spent 3 years without ovulating once despite the naturopath attempts. I’ve been through so much pain. I had to go back to using the pill to get a life back where I can live more or less, work, wake up daily, and function. My pcos is more steroid enzyme defficiency except I can’t pinpoint what it is but having issues with making vitamin D, making 0 measured both female sex hormones over years, and sometimes having high cortisol and regularly feeling easily stressed suggests my issue is with the enzymes metabolizing cholesterol to all of those…theyre all steroids (including vit D and the sec hotmones not just cortisol). So i know where my issue is, I just dont know what specific steroid enzymes and they dont sell em. Im just in the hands of God who if and when he may heal my body, he can do it. There is so much heartbreak and false hope in medicine and even natural treatments. Only my God shall heal me if he grants it in his will.

  35. Hi Lara, I’ve just finished your book. I’ve been working on regulating my hormones for just over 3 months. I have highly insulin resistant PCOS, and while I’ve seen some improvement I’m struggling to find info re my chances or achieving something close to normality given my extreme starting point. I had an AMH of 308 pmol, and can’t find my exact testosterone levels from before but they were very high, I do remember a doctor say 3 x normal limits.

    Through diet and supplementation, I have normalised my fasting insulin and glucose, my testosterone has come down but is still elevated (2.3 nmol) and my AMH is now 164 pmol. I am having 28 day cycles, with signs of ovulation and I have started temping this cycle to try and confirm. I’ve had long heavy bleeds but these have been lessening each cycle. I believe my progesterone is low (this was the case when I ovulated previously using gonal F injections). If I am ovulating, with my androgen and AMH levels, I doubt the quality.

    I think my basic question is, given my extreme numbers, is further improvement reasonable for me to expect, or is this as good as it gets for me?

  36. Hello,

    Could you tell me if there is a network of female naturopathic doctors like you that one could find in their area regarding possible PCOS issues?

    Thank you so much for any help.

    Kimberly Beaty

  37. Hi Lara,

    I recently came off birth control and was diagnosed with PCOS (high testosterone, low estrogen and progesterone & period was absent for 4motnjs after coming g off) I have experienced extreme & uncontrollable weight gain. I had irregular periods before going on the pill when I was 16 (I’m 23 now). My confusion lies around NOT being insulin resistant (I’ve had blood work done). I also already have been eating a low inflammatory diet for over two and a half years (no gluten no dairy) I exercise 5 days a week and was in the best shake of my life up to 4 months ago. I’ve now gained so much weight I feel like I stranger in my own body. I am using progesterone cream, saw palmetto, DIM, NAC, magnesium, zinc, an iodine supplement (I was deficient). My thyroid panel was normal and so was all other bloodwork besides the testosterone and iodine.

    I’m having a hard time knowing what to do because most things revolve around insulin resistance PCOS and just say exercise and diet however I already live the life of healthy diet and exercise. I’m worried that My body is going to continue spiraling out of control.

    • You might look into HISTAMINE INTOLERANCE/MAST CELL DISORDER (MCAS) for the weight gain. I’ve LOST 40 LBS, 10 INCHES, 4 PANTS SIZES IN 2020 SITTING AROUND AND EATING AS MUCH AS I WANTED. Yes, this IS what can happen when the HISTAMINE issue is addressed! I continue to drop the weight and inches as I ramp up my food intake and have more energy.

      I gained 55 lbs 6 yrs ago after a car accident, and COULD NOT lose 1 lb no matter what I did! I’m already Gf and DF, and NOTHING changed until summer of 2020 when I started eliminating Histamine foods. The stricter my histamine diet, the more weight I lost! I’ve gone from size 14 pants and XL blouses to size 8 pants and M blouses. WITHOUT TRYING, simply reducing my Histamine load. My primary reaction to food histamine is severe Atrial Fibrillation, so my REAL motivation to reduce histamine was to eliminate the DAILY AFib! The weight loss was a byproduct!

      Laura has an excellent article about the HISTAMINE/ESTROGEN/PROGESTERONE connection. Look up the SWISS HISTAMINE GROUP for comprehensive histamine info and extensive and accurate FOOD LISTS.

      I had to change from a dessicated thyroid Rx to a synthetic T3 and T4, as dessicated thyroid Rx contains milk powder and IODINE = SUPER HISTAMINE! Vitamin B’s are inherently loaded with histamine, so I finally have been able to reduce my histamine load with QUERCETIN to be able to resume small amounts of Vit B. The Quercetin has reduced my lung inflammation (COPD) enough to be able to hike and talk at same time, AND add histamine foods back in so I can again enjoy life!

      Mood Probiotic by Lifted is the ONLY probiotic w/o histamine that really WORKS and cannot be substituted….ALL other probiotics contain HISTAMINE! It also DOES help with anxiety and depression, and was instrumental in helping me isolate alone for months during this pandemic! It also significantly controls the bad gut actors that cause carb cravings, etc–I take 1 with breakfast and 1 with dinner for active control, or 1 at dinner for maintenance. I cannot stress enough the importance of using a Histamine-Free probiotic!!! You will never lose weight w/o it!

      Keep digging and moving forward. Laura Biden’s info on the link between ESTROGEN/PROGESTERONE AND HISTAMINE IS PROFOUND. Her PCOS info also plays into my life since 11 yo, so that’s going to be integrated into my personal protocol as well.

      Good luck! Best wishes for success.

  38. I wonder if you can have two types, because I fit into diagnosis markers of both insulin resistance and inflammatory PCOS but i know early in my diagnosis it was insulin resistance, and now that I am older, it has turned into inflammatory. It’s messing up my thyroid function, kidney function, making me appear pre-diabetic even after months on Intermittent fasting…. it’s making me ill and I hate it.

    • Absolutely the same. In auto immune research they are beginning to talk about PCOS as Autoimmune so it’s no surprise that we see the insulin resistance when we are young and trying to get pregnant and in our 40s or as we get older we see the inflammation and in some cases auto immune presentation.

  39. Dear dr. Briden,

    I suspect I have inflammatory PCOS through mast cell activation (main triggers being pollen and estrogen). Although my fasting insulin test comes back low/normal (4.5 mU/l) and I’ve had a BMI around 19-19.5 since I was a teenager (I’m 31 years old now), according to my doctor PCOS (or: high androgens (not DHEAS), facial hair and polycystic ovaries) is by definition an insuline problem.
    From your book I am not sure what the approach would be for inflammation based on MCAS, as I cannot really get rid of the triggers (estrogen levels are normal). What is your approach in such cases? Do antihistamines also help lowering the androgens indirectly? Do I need a mast cell stabilizer? Histamine in the diet isn’t a trigger for me, so I don’t think the solution lies in this, and I already don’t eat the typical ‘problem foods’ you mention in the book (dairy, gluten). What are the best ‘natural’ mast cell stabilizing supplements? It would be great to get your input on this as it seems to be very hard (if not impossible) to find specialists with knowledge about hormones and mast cells at the same time.

    Thanks so much in advance,

  40. I have irregular periods (gap is of 90 days) , facial hairs, fatigue, hair loss, acne, anxiety issues and also periods are not painful. What is the probability percentage that I have PCOS ?

  41. Hi Lara,
    I have been diagnosed with PCOS and have hypothyroidism (continue to suffer low t3 levels even with levothyroxine) and have not had a period for many years. I do have facial and body hair but I also have low LH to FSH levels and “normal” estrogen. I do not have raised prolactin/ male hormones and had a dexa scan showing osteopenia. I have a history of very low carb dieting and under eating- I now eat at least 2500 calories daily, normal weight. I follow a predominantly plant based diet with some eggs and fish. However I always feel fatigued- i cannot do any exercise other than walking. I am also constantly craving fatty foods- butter, coconut products etc and can have day’s where i suffer with extreme hunger (eating does not make it go away.) Doc has suggested it is IBS.

    I am trying to get pregnant and my doctor has given me metformin- I am also currently completing the progesterone challenge (I previously bled when I did this a few months ago.) and will start letrozole. My question is should I continue with the metformin? I do suffer with blood sugar issues. My gynacologist has also suggested a low carb diet but from reading your blog I am confused with regards to macronutrients and would love it if you could do a sample “fertility” meal plan on your blog?

    i have just purchased your book and cant wait to get reading 🙂

    • Levothyroxine is not an active form of thyroid replacement because it’s T4 only; you would need T3 (cytomel) or a desiccated form of thryroid replacement to get an “active” form. Most people do not do well on T4 only replacement.

      • Very true! T4 requires correct body temp for the various enzymes to convert it to T3, and most women do not convert the T4 into T3 for many reasons. Their TSH tests will give the false illusion of having enough thyroid Rx, when the T3 is deficient.

        Be aware that the dessicated thyroid powder contains MILK powder and IODINE, which is pure HISTAMINE! Going back to synthetic T4 and T3 has reduced my histamine load for me to move forward. And I’m actually titrating down in strength every 6 mos. Would be nice to eliminate it. I’m at the next to lowest strengths for both.

  42. I recently got off BC in Feb 2020 after being on our for 15 years. I immediately became very oily and my back broke out in cystic acne. I took a dutch test and my testosterone levels were normal. My estradiol (E2) was low side 2.19, my Estriol (E3) was above range 18.2, My Estrone (E1) was below range at 6. MY SHBG was also very low. My progesterone levels were below range at 3.5. I’m guessing I have an estrogen metabolism problem? On top of progesterone imbalance? My cycles have varied between 24 days and 30 days since getting off the pill. I’m not sure if I have PCOS or not. I have been taking Indole-3-carbinol, inositol, milk thistle and my acne has cleared 90% along with oil. I’m thinking of taking the licorice and white peony as well for 6 months. Do you have any recommendation based on my test results ?

  43. Hello, so I don’t feel like I fit in any of these either. I have had irregular periods for as long as I can remember ( I’m on nexphon impant, so I don’t get them now because of that). The only other problem I had were some cyst like acne, other then that I never have had issues with cysts on my ovaries, no hair growth issues, no insulin problems. So I’m not really sure if I just have a light case of PCOS( I don’t even know if that’s possible)

  44. Hola Lara,
    Intento averiguar si tengo sop o no. En mi última analítica, tras tomar durante año y medio una píldora baja en androgenos, realizada a los 4 meses de dejar los anticonceptivos me ha salido un exceso de androstenediona ( el max era 3.7 y yo tengo 6.7) el resto de androgenos están bien. Así mismo mi Prolactina esta en 25. En eco no tengo ovarios poliquiisticos y fsh y LH están prácticamente iguales. Con esto que le cuento lo encasillaria en un sop adrenal o lo relacionaria más con el cortisol lo tengo bastante elevado. Gracias

  45. Hello Dear Doctor!
    what if my insulin test is normal but the glucose test (the one that is taken when empty stomach and then second time after you drink some sugar given in the laboratory and then they take it second time) in my case it was so much over the range and this is the only test I had was bad the rest like general sugar or insulin are absolutely normal. I also have super high DHT and jawline acne but normal DHEAS at the same time. I am confused could you tell what can it be? and what supplements should I take. I am taking saw palmetto but I m building up tolerance to it.Thank you in advance!

  46. Hi Doctor,

    Your book states that in order to have a true diagnosis for PCOS, one must have high androgen’s (whether that be proven on a blood test or physically). I do not have physical signs besides a small amount of acne that I am not used to. I have “peach fuzz” on my mustache but no chin hair, or hair on my cheeks or belly. I have a small amount of nipple hair. My doctor tested my total testosterone and SHGB as well as my DHEA-Sulfate. All of which came back normal. Including my thyroid which was normal as well. My 17-Hydroxyprogesterone was also normal. Yet I was still diagnosed with PCOS because of my irregular periods and anovolutary cycles as well as polycystic ovaries on the ultrasound. It is hard for me to accept this diagnosis when I do have regular testosterone levels. Yet I have trouble having regular periods and clearly ovulating. What are some things you think I should look out for in terms of figuring out whether or not I truly have pcos?

    Background info on me: Between my first period age 11 and up until I was 19 years old, I was severely underweight. I gained weight and am now at a healthy weight. Yet I still have irregular cycles. Heart disease and diabetes is prevalent in my family. I exercise everyday (regardless of always being thin and now at a healthy weight), cut out gluten and dairy because I do have some inflammation (or at least I believe I do). Somehow I believe that being such a low weight for years has affected my periods.

    Thank You.

      • Thanks for replying. My doctor has not tested me while on my period. I have noticed when I eat well enough, I do get my period. I have no clue what to look out for anymore. When I was really underweight, my PCP prescribed me with a hormonal medication given to patients with HIV/Cancer who need help gaining weight. Since then, I would miss periods for months on end (although I have always had irregular periods). Since PCOS is a metabolic disorder and this medication seem to have affected my metabolism, I believe this medication has some correlation with what i am suffering with today. Mostly because since then, that is when my symptoms started to appear.

        • It sounds like you may just need to consistently eat more. At least 2500 calories per day including protein, fat, and starch.

          • So sorry to bother you, my doctor states he believe I have PCOS because of “clinical evidence of excess androgens without support from lab tests” also because I have normal levels of estradiol and gonadotropins in addition to having an LH to FSH ratio of more than 2. To answer your previous question I was unable to answer.

  47. Dr. Briden – do you happen to have more information on non-classical adrena hyperplasia (NCAH)? I thought for years I wasn’t ovulating from PCOS but just was confirmed I actually have NCAH. Having problems finding any information on this! Thanks ❤️

  48. If I still don’t fit any of this criteria, is there a doctor out there who might be interested in finding out the cause of my anovulation and poly-cystic ovaries? Or is this a condition without a name and cause? I have ovulated on my own in the past (even with high testosterone) but now with low-normal testosterone levels my body will not ovulate and weight loss makes everything SO much worse. I have seen 4 doctors and a hormone specialist who are dumbfounded as to the root of my issue. They can only tell me it must be a brain problem but can’t seem to pinpoint what is not working. I have contacted Dr. Jerilyn Prior multiple times without response.

  49. Is it PCOS? Not sure, have never been tested for late onset adrenal hyperplasia, my prolactin did seem to be slightly elevated at times, but no consistantly.
    Do I have insulin resistance? Yes, but slightly, my BMI is 17 and fasting insulin is low.
    Post-pill PCOS? Deffinitely worse acne, but my PCOS started after anorexia years ago, when I have been placed on birth control pills because of (THE ONLY ANDROGEN THAT WAS ELEVATED) high DHEAS.
    Inflammatory? I have IBD and a predisposition for celiac, as well as pre-Hashimoto.
    So what type of PCOS do I have? I feel like I have components of all 4.

  50. I have got so many tests done and everything comes out normal yet I have excess facial hair growth.

    The only thing I have been told is that my 5-alpha-reductase is more active since my testosterone is normal but dht is on border.

  51. What does it mean if you have PCOS and ovulate regularly? Is this PCOS or should it be considered a different condition, even if high androgens are present? If it is PCOS, why would you have too many follicles on an ultrasound even if you are ovulating?

  52. Hi Lara, your book is phenomenal and I have learned so much about my condition and remedies to help it.
    However, I am now confused about my type of PCOS. As a teen and in my early to mid twenties I always had very high testosterone levels (even during pregnancy) which correlated with my numerous cysts and anovulation.

    Now, at age 30 I have very normal testosterone levels and the only evidence for PCOS I have is Cysts on the ovaries, Anovulation and high AMH.
    My insulin is very normal, thyroid great, cortisol good and there’s no indication of anything else amiss. I’m not obese and I eat a low-carb, low-glycemic diet with many fresh vegetables, quality proteins and berries.
    I am TTC and started taking many supplements but I only got 1 positive OPK last year and it wasn’t successful.
    I don’t really seem to fit any of the categories perfectly and weight loss/exercise/diet change is not helping me ovulate. Steady, healthy weight loss precipitated all of my current, severe peri-menopausal symptoms and my only relief has been Cyclic Progesterone Therapy on cycle days 14-28 but alas, it is not helping me to conceive. All the medical professionals I have seen tell me fertility drugs are my only option but I have spontaneously ovulated in the past within a couple cycles after coming off of birth control pills. I’m hesitant to take them again because they give me severe heart palpitations. I’m experimenting with the Prometrium to see if it will have a similar effect once stopped but I know it’s not a long-term solution or answer for why I’m not ovulating/producing progesterone on my own. Without progesterone in my body, I am debilitated with intense alternating breast pain, mood swings, zero libido, etc. These things I had not experienced until after the weight loss. When I was overweight I felt normal and even had fertile cervical mucus at times but not anymore. None of the medical professionals I have seen can explain it, so I am desperate for help. This is our 3rd year of TTC.
    Thank you for any feedback,

  53. Hi,
    I was on ortho Evra for 7 years then I started having heavy flows and cramps on the 7th year. I went to the doctor and I was diagnosed with fibriods. My doctor switched me to the pill. After taking it 3 months I started noticing pcos symptoms. I went back to my doctor and I was diagnosed with pcos. I decided to stop all birth control. I’ve been off of it for 1 year but I still cant seem to balance my hormones. I’ve tried everything and gone to 3 different doctors theyve tried to push me to get on birth control. I refuse to do so. I am convinced bc gave me fibriods due to excessive estrogen and the pill gave me pcos.

    • Do you mean low-androgen PCOS? That’s not PCOS.
      I follow the criteria of the Androgen Excess Society who state that androgen excess is a key feature of PCOS.

      • Hi Dr Briden.

        I have recently been diagnosed with PCOS. Had missed and irregular periods for 3 years which seemed to come on randomly after previously having regular cycles and not being on hormonal pills.

        My first blood test showed low testosterone, low free androgen, low DHEA levels.

        After I experienced some rapid weight gain a couple of months later I had more tests, my testosterone was more normal but in no way high. I have been feeling very bad, no energy or motivation, uncontrollable weight gain, chronic constipation etc.
        My ultrasound showed PCOS. Ovaries are enlarged. AMH is upper end of normal. LH is high and LH to FSH ratio is high.

        My BMI was 19.5 before recent weight gain and I have always eaten very well with a plant based diet and plenty of carbs, and , I don’t do any exercise that would be considered a stressor either so I am so confused by my situation.

        Would be so grateful for your opinion

  54. Hi Lara,

    Thanks for this post! I went off of hormonal birth control last summer (after many years on it) and have only had three periods since then, all of which have been very light (three days long). Basically it’s 9-10 weeks between periods. My doctor tested my hormones and says they’re all ideal, and my ultrasound didn’t show any endometriosis or polyps/cysts. No hirsutism either. I tend to eat an abundance of carbs and am a part-time group fitness instructor so I’m in overall good shape. That said, I’d like to have a regular cycle again and also be able to get pregnant – it’s been frustrating not getting any real answers as to what could be causing this and what (besides taking strong meds to force an ovulation) I can do about it.

    Any insight or ideas you could share would be so appreciated!



  55. Hi Lara,

    Thank you so much for the opportunity to ask you questions here.

    So, I have been told that I have PCOS (with the means of ultrasound, irregular periods and AMH). But I’m not too sure how to proceed (we was to start trying to get pregnant and my last cycle was 54 days but sometimes 30 days).

    AMH 10.6 mikron/l. (old test that dates 2013)

    Recent blood test taken a few days after my period:

    S-DHEAS: 3.1
    S-FSH: 2.2 E/L
    B-HbA1c (IFCC): 35 mol/mol
    S-25-OH-Vitamin D: 72 nmol/L
    S-SHGB: 183 nmol/L (and above average as I understand it)
    S-Östradiol: 954 pmol/L (estrogen)
    S-Kobalamin (B12) – 430 pmol/L
    S-Testosteron: 0.7 nmol/L
    S-TSH: 1.8 mE/L
    S-T4: 17 pmol/L

    I’m 165 cm and weighs 53 kg so I’m not overweight or underweight (I eat normally / more than average). I do not have any facial hair but a few ones around my nipples (normal?).

    Looking forward to any guidance.

    Warm (or cold :)) regards from Sweden!

  56. The other interesting thing is with a fasting insulin test there seems like there could be some insulin resistance. The 1 and 2 hour results were flagged as high in the test.

    Fasting at 0 Hour: 5.5
    1 Hour past drink 61.1
    2 Hours past drink 34.0

    But if LH to FSH ratio is not high, does this completely rule out PCOS in the flowchart, and insulin resistant PCOS as the first thing to look at. It’s tough to untangle this mystery.

  57. Not 60 day cycles, they are very irregular. More like spotting every 2-6 months for a half day, not close to a real period. The only time recently with a real period was after being prescribed oral progesterone and vitex but it definitely exacerbated acne so stopped taking it. While taking these had 3 heavy but short periods spaced exactly 20 days apart, with no temp spike for ovulation.

    Prolactin was 7.52 earlier in the year, 4.9 a few months ago.

    Thyroid: was warned about TPO antibodies being high were related to irregular periods and acne by some doctors, other doctors ignored.

    Over last 18 months
    TSH 2.47 .717 .11 2 .0 1.16 1.28
    Antibodies Anti-Thyroid Peroxidase (Anti TPO): 57, 53, 51, 36

    Snapshot recently (these weren’t tested as frequently)
    T4 6.5
    T4 Free 1.08
    T3 111
    T3 Free 2.8
    Rev T3 17.3
    T3 Uptake 26
    Free T4 Index 1.7
    Anti Thyroglobulin Antibodies (Anti TG) <1

  58. I’ve been wondering the same thing… I have inflammatory PCOS and a copper IUD and have been wondering if there is a connection or if they are two separate factors

    • I would not see a direct relationship between the copper IUD and PCOS.
      The inflammatory PCOS I describe here is more linked to gluten sensitivity and that type of inflammation.

  59. Got it, thanks for clarifying and after rereading your blog post I see the answer there too, sorry! For these sample results, would this interpretation be correct?

    LH : FSH
    3.1 : 8.5 Low ratio (probably hypothalmic)
    6.4 : 2.7 High ratio (probably PCOS)
    3.2 : 4.8 Low ratio (hypothalmic)
    5.0 : 6.0 Low ratio (hypothalmic)

    If one were prescribed a candida cleanse diet restricting carbs due to acne, but went off it after a few months, can hypothalmic amenorrhea persist for 18 months or more? For a normal weight individual who eats a balanced diet, doesn’t skip meals, definitely eats carbs.

    Or could there be other reasons for low LH: FSH?

    Thank you!

    • Averaged out, those LH and FSH readings are pretty close to 1:1, so not necessarily hypothalamic amenorrhea.
      Did you say you have 60-day cycles? Is it possible your irregular cycles are due to something else? Has your doctor screened for thyroid and prolactin?

  60. My DHEA-S and Testosterone levels are in normal range but my androsterone and Etiocholanolone are both high. What does that mean? My estrogens are all within the normal range though estrone(E1) is toward the lower end.

  61. OK I think I understand. If you are not having a period even for a months to even a year, you still have to wait until you have a period to do hormone testing, specifically LH and FSH, in order to be useful. The Dutch Test says to test on a random day if no period after 60 days, but this is not worthwhile, I’m thinking.

    We are trying to figure out whether these symptoms point to PCOS or not, and whether we can even know if we can’t use hormone testing to figure it out.
    1) persistent acne since 15 years old, especially around jawline
    2) Basically no period and is currently 20 years old (has had a few very short periods with unpredictable timing and occasional spotting). She tried vitex and progesterone for one month but it inflamed the acne, she had three short but heavy periods spaced 20 days apart exactly, but then period disappeared she stopped progesterone & vitex. She tested basal body temp and did not think she ever ovulated. She has normal anti-mullerian hormone so was told her ovaries are fine.
    3) She has had hormone testing over the years, all on random days because never a regular period, and the results always had “normal” testosterone, “normal” DHEA, “low” estrogen/progesterone (even menopausal levels) per the Dutch test and every other hormone test done by OBGYNs/naturopaths.
    4) no signs of excess hair or baldness, just persistent cystic jawline and cheek acne.
    5) no birth control ever
    6) she does not under eat or over exercise so it is not hypothalmic PCOS.

    Some tell us she has PCOS because her androgens are high as a ratio. Some tell us this doesn’t matter and it is not PCOS. My loved one is so confused and we are both so grateful for your resources and wisdom. We would appreciate your thoughts on whether this is PCOS or not! If we know we can go through the flow chart.

    • no, sorry. If there’s no period at all, then LH and FSH have to be tested on a random day. But the LH value is only valid if she does NOT then get a period two weeks later because LH naturally spikes up with ovulation.

      If she has a low baseline LH/FSH ratio, then it’s probably undereating.
      If she has a high baseline LH/FSH ration, then it looks more like PCOS.

      I don’t use the Dutch test.

  62. specifically if you do not have a regular period and FSH and LH is only meaningfully tested on day 2 or 3 of the cycle, does testing FSH and LH for someone without a regular cycle yield any meaningful information?

    • yes. Even with an irregular cycle, it’s best to test FSH and LH in their baseline state– ie. during the period. LH, in particular, is highly dynamic and rises dramatically later in the cycle with ovulation (if there’s an ovulation).

  63. Ok good to know. Hopefully my next period comes in a timely fashion so I can retest. Any other thoughts with regard to my original message or would it depend on LH/FSH levels? Thanks!

    Also— so sorry for the spam! Didn’t realize I posted so many times. I thought it wasn’t going through!

  64. Hi Lara. After reading your book I’m thinking I might have post pill-induced PCOS. Since I stopped Diane 35 10 months ago, I have acne on my jaw, chest and back plus hair loss and more hairs . Yet my periods are regular (27 to 30 days) and my blood tests seem fine except for the LH/FSH ratio (LH: 6,08 UIL and FSH: 5,47 mUI/mL at day 3). I had ultrasound: 15 cysts on each ovary. My periods were fine before taking the pill and I only had light acne.

    So I’m thinking I could start peony/licorice supplement. Do you think it is appropriate ? If so, when should I start ? 1st day of my next periods ?

    Thank you !

  65. Hi Lara, after reading your book I’m thinking I might have pill-induced PCOS. I have acne on my jaw, chest and back plus hair loss and more hairs since I stopped Diane 35 10 months ago. Yet my periods are quiet regular (27 to 30 days) and my blood tests seem fine except for the LH/FSH ratio (LH: 6,08 ui/ml FSH: 5,47 mUI/L). I also had ultrasound: about 15 cysts on each ovary.
    Before taking the pill, my periods where fine and I just had light acne.
    So I’m thinking of starting Peony/Licorice supplement. Do you think it is appropriate ? If so when should I start ? 1st day of my next period ?
    Thank you !

  66. How long could the post-pill surge last? It’s been 22 months since I stopped taking Ortho-Tri-Cyclen-Lo. I upped my caloric/fat/carb intake and reduce exercise b/c I thought it may be HA and I’ve had three periods in the past 6 months (only had 2 in the year+ prior). My testosterone (free/total) was high normal and DHEAS slightly high before and has since reduced to within normal range, but sadly the excess facial hair persists. I’m now wondering if it’s a post-pill PCOS…also just had my iodine checked and it is low. Normal TSH/ T4 and no thyroid antibodies. Scared to supplement though because I had bad acne when I came off the pill initially, and I don’t want to deal with that again. Feels so complex! Really want my health back. Thanks in advanced for any feedback/thoughts.

  67. Hi Lara, thanks for the great info! I’ve been recently diagnosed with PCOS. I’d say it’s post pill induced as I had very normal cycles before the pill (I was on it for 12 years straight) – been off for 5 months. My blood tests were all normal with no androgen excess. I am in a very healthy weight range and eat very well. The only symptoms I have are lack of ovulation / a period and my ultrasound confirmed poly cystic ovaries. If I am this type does this not relate to insulin resistance? Also would myo inositol be of any help if it doesn’t relate to insulin resistance. I’ve been prescribed Femara as I’m trying to fall pregnant. Thanks for you help 🙂 Lindsay

  68. Hello Dr Lara i have bleeding/spotting at 14th day of cycle for around 7 days followed by ovulation and then menses? What supplement should i take to regulate my cycle n to avoid polycystic ovaries?can breastfeeding cause such irregular cycle pls?

    • Are using temperatures to track ovulation? because it would be very unusual to have ovulation and then menses close together.
      Sounds more like you’re not ovulating (ie. having anovulatory cycles).
      Have you checked with your doctor as to the cause of the spotting?

  69. Hi Lara! I am 24 and was diagnosed a year ago with PCOS about 5 months after coming off of the pill. High LH, high total testosterone (but not free), polycystic ovaries, and missing period for 3 months (I’m thin with no hirsutism besides acne). I was put on the pill but decided to go off it again Feb 2019. Had normal periods (albeit some were light so may have been anovulatory) until August when I started spotting every day which got heavier and eventually turned into heavy bleeding earlier this month (Nov 2019). Dr put me on progestin to stop it and now I am back on the pill. I got tested for insulin resistance last year by an endocrinologist and it was normal. Don’t really have inflammation signs besides fatigue. What kind of PCOS do I have? is Post pill PCOS possible so many months after stopping the pill? Could it be that my insulin resistance fluctuates and was fine then but not fine now? feeling like hormones are my only option if I don’t want to be constantly bleeding, and wondering if taking natural progesterone each month would be an option. Thanks for any answer in advance!

  70. Acne is my main symptom, but my period is also always very clotted (and the past few months has been brown for the first day or two). Thanks for the zinc and DIM recommendation – I’ll try it out.

  71. Do you have any recommendations for women with PCOS and pregnancy?

    I’ve just found out I’m pregnant and I don’t think I have insulin resistance. (Fasting Serum Glucose was 5.1, Fasting Insulin was 6.6). I think I have inflammation PCOS. Should I take a supplement like mayo-inositol anyway?

  72. Hi Dr Briden, At the beginning of this article, you state “It’s really PCOS if you have some sign of androgen excess, such as:
    high androgens (male hormones) measurable on a blood test,
    facial hair or jawline acne.”

    If testosterone and DHEA measure in normal range, estrogens and progesterone consistently measure below normal range, and cystic jawline acne is stubbornly resistant to balanced diet, stress management, can the presence of the jawline acne confirm PCOS in the absence of androgens measuring high? thank you!

  73. Hi Dr Lara – I have been diagnosed with PCOS. I am 34. My labs came back showing Vitamin D deficiency, a 2:1 ratio LH to FSH ratio and low progesterone. An ultrasound showed cysts, but ovaries did not have a large volume. My cycles are irregular with some being almost 55 days other 35. I’m at a loss where to begin, other than dialing in my diet and Vitamin D. What do you suggest? My doctor suggested Metaformin (though insulin was normal) and BC to regulate cycles.

  74. I was diagnosed with PCOS when I was 17 (25 now) I’ve been on the pill since. When I was diagnosed I did not have my period for 6 months and was diagnosed over an ultrasound, I want my new doctor to diagnose me again. I recently got tested for insulin and it came at 5.2 and my ketones came positive at 2+. Should I ask my doctor to run testosterone, androstenedione and DHEAS to verify I have PCOS, what other tests do you recommend. My current doctor hasn’t ran any tests and keeps me on the pill, she has never tried to talk over my PCOS and symptoms.

  75. I was told I have PCOS just by ultrasounds and high AMH levels. After following the No Period Now What book’s advice over the past 4 months I have gained 25+ lbs and now my LH is now higher than my FSH. I am still missing my period and so confused. I am also TTC with my husband now over a year.

    Could I have PCOS still? What do I need to test to make 100% sure it is not PCOS or if it is?

    Thinking about starting fertility treatments again hoping the weight gain will help them work this time….

    Thank you for your advice!!


  76. I would like to have these types of tests done- testosterone, progesterone, etc but my doctor said they do not do those kinds of tests. I am going crazy with all the information out and want to know what kind of PCOS I have or if I even have it at all! Please let me know what to do.

  77. Hi Lara,

    I have been reading your whole blog up and down and recentl went to see a naturopath after my doctors told me taking the pill forever would be the only treatment. However, I want to be self-informed and tried to figure out what type of PCOS I have. I am pretty sure I have the adrenal kind, as DHEAS is the only increased male hormone. My insuline wasn’t increased so no basal hyperinsulinemia but it didn’t decrease as sast as it should have after drinking glucose water so it could be a reactive hyperinsulinemia. Should I still try to do something bout my blood sugar like taking berberine? I hope you find the time to answer!

    Best wishes, Steffi

  78. Hi,
    I have Adrenal PCOS because I’ve had blood tests and my testosterone is fine but my DHEAS is high and I have always had acne. My first blood test was when I was 19 and I’m 42 now. Is there a certain form of magnesium that is more beneficial for this type of PCOS? I do get stressed easily. Every time I go to a naturopath they say my adrenals are stressed and give me an adrenal glandular but it doesn’t help with acne.

  79. Hi Lara,
    I am so glad I’ve been introduced to your research. This article has been far more helpful than the range of medical advices I have been confronted with over the past 7 years. I’m 34. I came off the pill when I was 27. I had no period for 18 months. Every doctor told me I had pcos but never explained why. Their only treatment was to go back on the pill or try hormone replacements to fall pregnant. I did neither and reverted to naturotherapy. Miraculously I fell pregnant with no period! Since then, I’ve had endless tests, painful erractic heavy periods, jawline acne and have been told the pcos is worse. I am not insulin resistant. But suffer serve sinus and occasional hives. Based on this article I feel you’ve given me answers I never had. Do you suggest licorice magnesium and b5? If so – is there something specific? Thank you for this most resourceful article.

  80. I came off the pill, had 7 cycles between 30-40 days and then I contracted parasites while living in the Philippines and my period disappeared. It hasn’t been regular since and I’ve only had a few periods in the past few years. I’ve had high-normal testosterone and slightly elevated DHEAS. I do have an increase in coarse upper lip and chin hair that wasn’t there before. Prolactin is normal. LH was slightly lower than FSH. I thought it may be HA and starting upping my carbs/calories and exercising less and got a period, but then I didn’t get another one. At a loss and would appreciate any insight!

  81. Hi! Could you please tell me how to distinguish between inflammatory PCOS and the others when a patient has an autoimmune disorder with inflammatory symptoms as well?

  82. Hi!
    I am 25
    Have normal bmi, regular periods of 2 -3 days every month, never taken a pill. But having hair loss and new hair growth on body n face.
    I started with testosterone test level is 31 and also vitamin d deficient
    Can i still have pcos?

  83. Hi Dr. Lara, is it possible to have PCOS with very low testosterone, and normal cycles with ovulation? Im confused that I have low testosterone with very oily skin, acne, hairy body. I stopped the pill 2 years ago as well as spiro.

  84. Hello Lara,

    Perhaps this is unrelated, but I’m curious if taking the Plan B pill can cause any lasting effects (similar to post-pill PCOS)? Is it possible for it to cause a lasting disruption to cycles?

  85. Hi Lara,

    I am not sure what kind of PCOS I have. I have irregular periods (33-50 days) and on ultrasound had PCOS. My BMI is (and has always been) normal and I am 30. I don’t have hirsutism. I haven’t been on hormonal contraception for 5 years (Depo).
    My bloods on day 2 of my cycle were FSH 3.7 U/L, oestradiol 71 pmol/L, LH 10.1 U/L, testosterone 0.65 nmol/L, Anti Mullerian Hormone 82 pmol/L, thyriod function normal, HbA1c normal.

    Thanks for your advice 🙂

  86. Hi Lara,

    I truly hope I can get a response. Writing from Jamaica and I love your book and advice. It has helped me a lot.

    Is it possible for me to be insulin resistant and still very lean… or is it more likely that I have Adrenal PCOS. Unfortunately doctors in Jamaica do not test insulin levels.

    I have evidence of excess androgens.

    Cysts on ovaries but I am 28 and about 119lbs. I’ve always had irregular periods since I was a teen but after getting married I bought ur book and started taking magnesium taurate, stopped eating junk and my period returned ( i was then able to conceive a beautiful baby girl). During pregnancy and since her birth, I was eating a lot of junk and my hirsutism has worsened rapidly. I am not sure if it was the junk or stress of a newborn that caused it. Not sure if its insulin resistance or adrenal PCOS. Again no matter how much I ate, not much weight gain

    • Yes, it is possible to be lean and also have insulin resistance. Is there no chance that your doctor would test insulin?

  87. Also good to know! Just eating and resting, which is hard! Thank you again! So much respect for you and grateful for your feedback!

  88. Thank you so much for such valuable information! I will focus on those and do you have any suggestions of prepackaged foods I can grab and take on the go? I LOVE protein bars, so any brand you like?

    Thanks again! BTW:This makes me feel like I am not crazy for going about it this way.



  89. Hi Lara,
    Thanks for this helpful article. I have adrenal PCOS (high DHEA-S but normal testosterone). In your book, you recommend B-complex, and in this article you recommend Vitamin B5 specifically. Is one better than the other for adrenal PCOS? I picked up a B complex supplement (Thorne’s Stress B Complex), but I’m hesitant to take it because I’ve read that Vitamin B12 can worsen acne. Would the benefits outweigh that risk in this case, or would it be preferable to take the Vitamin B5 on its own?

  90. Thank you for reply. I am 35. I took the pill for around 8 years but I stopped one year and a half ago.

  91. Thank you for this very didatic explanation! I really like It, but I still did not find my type. I do not have insulin resistance (for sure), always had crazy or no periods. My DHEAS is normal and my testosterone and androstenedione are high. For exclusion, I would have the inflamatory type, but I don’t have these symptoms. Any thoughts on that? I am happy to get to know about your work. Thanks

  92. Thank you so much for your reply to this Lara and Katie for the question. I have been wondering the same thing! I have increased calories, practically doubling food intake but sticking to wholefoods (no dairy for the acne reason, or gluten) over the last 6 months. My LH has increased from around 1 to 4.7. FSH is 6.9. However Oestradiol remains <44 pmol/L – should I be concerned about the esotogen being so low still or just carry on with the eating and no exercise (aside from walking). Any help hugely appreciated! 🙂

  93. Hello my name is Katie and I have been reading your book along with the other book “No Period Now What.”

    Do you agree with the recovery plan in the book “No Period Now What” that basically says to quit all exercise and eat at least 2,500 a day or whenever you feel hungry and to eat all foods (Pizza, Ice cream, Cake) to regain your cycle? (I just get scared in that is wrong to eat those kinds of foods?)

    I was told I have PCOS, but not really sure even after reading about it in your book. I think I have HA and am thinking Vitex could help.

    I just want to figure out if I have PCOS or if it is just HA?

    As far as I know, I have a very low LH at 0.9, a high SHBG at 152, normal testosterone at 30, prolactin of 5.8, and T4, Free is normal at 0.9, but only 0.1 from being on the low side.

    Also, If I am starting Vitex, what about do I need to take each day and is there a certain recommended brand?

    Thank you for ANY advice.


    • Your low LH and high SHBG is pretty typical of hypothalamic amenorrhea. So, yes. It sounds like you need to go in the direction of Nicola’s “all in” approach.

      I take the same approach with my patients and give the advice that “you can’t afford to eat any low-calorie foods. You need to focus almost entirely on higher-calorie foods like meat, potatoes, butter, eggs, coconut cream, etc.”

      Also, I think it’s fine to have sugar in this situation EXCEPT if there is also post-pill ance. Then, I don’t think ice cream is a good choice for skin.

      But, of course, as a naturopathic doctor, I can sometimes recognise that food sensitivities are an issue. And some of my patients do need to choose non-cow’s dairy like goat and sheep dairy.

    • There’s probably no point in starting Vitex until you’ve been eating in the 2500 calorie range for at least three months.

  94. I can’t figure out where I belong. I have high LH:FSH ratio (3:1), polycystic ovaries on ultrasound, no period. BUT I don’t have high androgens, I’m not insulin resistant, no inflammation and it didn’t start when I got off the pill (I was on the pill for a long time, but my situation was exactly the same before). Any thoughts? My doctors (OBGYN & endocrinologist) are literally sending me back and forth from one to the other without giving me a definitive answer.

  95. I’m French girl and I read your book ! It was perfect, complete and easily understandable.
    But I would like to have your opinion because I’m worried about my health.
    I decided to stop the Pill since January, but since January I didn’t have my period. I know it could be normal, but I had eating disorders last year and I’m just getting out of it.
    Last month a doctor detected polykistic ovaries. Before taking the pill my periods were regular, so I think it just because I stoped the pill and because I had eating disorders.

    My hormonal system is stopped and I’m very worried about it !
    I have a vegetarian diet and I eat lot of soy (tofu, tempeh, protein powder). I would like to know if it’s better that I reduce my soy consumption ?

  96. Hello! I found your blog super helpful years ago when I was struggling with PCOS symptoms. I changed my diet and lost some weight I had regained. I’m now 8 months postpartum and heavier than when I got out of the hospital. Should I just keep to the eating that worked before and give it more time? Do you have any articles on post partum issues?

  97. Hi!!!
    I’m 16 and currently recovering from HA. The main causes were under eating and stress for me (exams etc) so I did lose a little bit of weight. However, I’ve stopped exercising for the past 2 months and gained back all the weight I lost plus more. Since I now weigh more than I did when I had my period shouldn’t it be back? This is super frustrating and school starts again soon, I would really like to be able to focus on other things apart from my HA. Any help is appreciated!

  98. I have been diagnosed with PCOS, some facial hair, very dark hair on arms, bad hormonal acne along jawline and over my neck. Rapid weight gain over a short period of time, Fluid retention. I do how ever have regualr periods? Very heavy bleeding with periods. I did have higher DHEA’s,

    I was referred to a specialist whom I found no help at all 🙁

    I feel very tired all the time. What are your suggestions I do to get my health on track?

    What should I ask my doctor to test for in order for me to find which PCOS group I fall under?

    • the first step is to figure out if you have insulin resistance or not. Which means testing for the hormone insulin, not just testing glucose.

  99. I’ve been diagnosed with PCOS a few times but don’t seem to fit in any of the categories. I have significant jawline/cheek acne and I’m 30. My tests show:

    Fasting Glucose: between 5.8 – 6.9 mmol/L in the past year
    HbA1C: 5.0%
    FSH (Day 3): 4.2 IU/L
    LH (Day 3): 4.1 IU/L
    Androstenedione: 4.3 nmol/L
    Testosterone: 0.8 nmol/L (reference range <1.8nmol/L)
    CRP: <0.3mg/L
    Progesterone (Day 22): 29.3 nmol/L
    Fasting insulin: 45 pmol/L (when fasting glucose was 5.8nmol/L)

    I don't think I fit the inflammatory PCOS since I tried a strict AIP elimination diet for 6 weeks with slow reintroductions and did not notice any improvements – I've also tried supplementing with zinc, berberine, b6, NAC, l-glutamine, high quality probiotics and magnesium (According to recommended dosages from Dr. Fiona McCulloch's book).

    Do you have any other suggestions?

    Thank you!

  100. I have asked my doctor and she says I don’t have it because my 17OH progesterone is only slighty elevated.
    My fasting ACTH and cortisol were normal too (without the stimulation test).

  101. Dr. Briden I can’t tell what type of PCOS I have and if I have insulin resistance.
    I’m lean, have low Fsh, high Androstenedion and 17OH progesterone, testosterone is usually high too, but on the last blood test it came normal.
    Glucose is normal, insulin before OGTT is 4.32 (normal ranges 2.6-24.9), after 2 hours is 19.1 (2.6-24.9).
    My periods have always been irregular and my FG score is 27.

  102. Hello dr Briden, thank you very much for all your help and support! I would be really happy if you can answer my question, my testosterone is normal as well as Dheas, only androstenedione is a little bit higher, but my gynaecologist told me I do have PCOS… been taking ‘ the pill’ for more than 4 years with 1 month break between, do you think I have PCOS?

    P.S do your work with clients online? I would be happy If I can work with you.

  103. Thank you so much, Dr. Briden! I eat plenty of healthy carbs and do not eat dairy, and my insulin has always been normal. It may also be helpful to mention that my androgens have been normal and my acne improved a lot once I started the thyroid meds. So, not sure what type of PCOS this would be or if HA is still a possibility. When I’ve gotten periods over the past year they have always been very light, too. Not sure what to try next….

  104. Hello again! Just re-posting my comment thread because for some reason my reply did not link up with my original comment. Feeling a bit stuck so would appreciate any insight into whether I may have HA or if hypothyroidism is more likely the underlying cause of my condition. Thank you, Dr. Lara!

    Angela says
    June 19, 2019 at 8:22 pm

    What is considered “low LH”? I do not fit the criteria for PCOS, but my LH is 2.5 times the level of FSH. Does this mean I’m not experiencing HA either?
    Seems like I’ve had the most progress when taking levothyroxine/liothyronine, so could I primarily have a thyroid issue? Still not having regular cycles, but at least ovulating occasionally since starting the thyroid meds….

    Dr Lara Briden says
    June 20, 2019 at 7:04 am

    are you having any periods at all?
    if so, on which day of your cycle (relative to ovulation) was that LH reading?

    Angela says
    June 20, 2019 at 11:53 am

    Yes, I had my first period in June 2018, which was about one and a half years after going off birth control pills and 3-4 months after starting to take Synthroid. Since then I had a period in August 2018, September 2018, December 2018, February 2019 and March 2019. Now still waiting for another period….the LH reading I cited above was my most recent one, 19 days after my February period and 24 days before my March period. On another reading, taken just a few days before my August 2018 period, my LH was at half the level of my FSH reading. So, not sure if I have HA or if I just need to continue to work on optimizing my thyroid function?…thank you so much for your advice!

    • 24 days before your period is the follicular phase, so if your LH was 2.5 times your FSH then, it does sound more like PCOS than HA. But of course, there are other factors like 1) if you’re eating enough, 2) if you have insulin resistance. (have you been tested for insulin?)

      and in answer to your question, yes, thyroid medication could help to correct and an underlying reason why you haven’t been ovulating. But if you’re not having regular periods within four or five months of starting thyroid medication, then there could be something else going on.

  105. I am totally confused. When I was 15 (now 33) I was diagnosed with PCOS. I started taking birth control. I stopped taking it when I was 25, however, didnt get my period for 15 months after that. And they kept being irregular until now. All doctors say, ‘You have PCOS’. My ovaries on ultra sound are full of cysts, my period is very irregular 36-70 days, however my hormones are fine! No excess androgens ever…. but I do NOT ovulate!! I do not want to conceive, but I suffer from a lot of things due to this (anxiety, mood swings, acne, oily skin, sweating) I tried Inositol, Vitex, Progesterone for 5 days at the end of the cycle, Vitamin D, Vitamin B, Zinc, Magnesium, etc…. the only thing that happened was that I had in between 3 periods of very short cycle length (18, 19 and 25 days.. and those were definitely anovulatory ones) My periods are often light, and I often have PMS all the time from day one to the end of the cycle….. I am normal weight, I eat normal (usually healthy, lots of veggies, only occasionally junk food). Is this really PCOS? You said no androgen excess, no PCOS. But it is definitely no undereating carbs either…. I also do not have a family history of PCOS. Any advice on what to test and how to proceed?

  106. Hello!
    Im 31 and was diagnosed with intramur fibroid about 4 cm. I really want to have a baby now but im not sure if i should remove the fibroid first. Do you have any suggestions about this topic (foods to eat and not to eat, vitamins i should take, should i have it removed). I know you do not have enough information, but still would be thankful for any guidance.

    Thank you!

  107. Good morning ma’am, I was diagnosed pcos,i have irregular menstruation, that’s once in two or 3 months and acne. What type of pcos is it and what’s the remedy

  108. Thank you for your response! This absolutely aligns with my history and I’ve seen an improvement with my hormonal acne supplementing with zinc in just 2 months! My hormone blood test (taken in the luteal phase) shows very high oesterogen, high testosterone and mid-range progesterone – would this align with adrenal PCOS as well? (I will take the blood test to my naturopath too but really value your expertise in treating PCOS)

    • Didn’t you ask earlier about adrenal PCOS?
      Having high testosterone on a blood test suggests that there is some ovarian androgen production as well — so potentially not adrenal PCOS. Do you also have high DHEAS? (adrenal androgen).

      Also, is it high total testosterone or free testosterone? ie. were you also tested for SHBG?

  109. Hi Lara….I’ve been a naturopath – and registered nurse before that- for over 30 years and have seen many medical and naturopath treatments for PCOS – often lots of guesswork involved. It’s such a pleasure to understand the many facets of the disease. Thanks for your incredible work..I love the way you present it…it makes it so user friendly, especially for my clients.
    I’m grateful to you for the work you’re doing for women.
    Allison Smith

  110. My main symptom is long cycles (40-50 days, but always ovulatory). I had no periods for almost a decade when I was under eating and over exercising, but they came back 12 months ago after eating a lot more and gaining a lot of weight (BMI from 18.5 to 22). My doctor thinks I maybe have both HA and PCOS because I’m still having such long cycles (she says 50 per cent of women with HA also have pcos) but we can’t make a definitive diagnosis because I don’t really meet the criteria for PCOS. My blood work and symptoms are still more HA-like despite me being well nourished now.

  111. Hi,
    I did a blood test on the 2nd day of my period and my Dhea s04 is 2.7 umol/l and FSH is 4.64 miu/ml and LH is 9.7 MIU/ml. Androsendione is 8.20 nmol/l. Astradiol is 286.42 pmol/l and progesterone is 0.87 nmol/l. prolactin is 426.11 nmol/l. Altrasound diagnosed that I have multiple follicles on my ovaries .
    Do I have pcos??
    Please advise.

    • The research suggests a link with a history of acute stress around the time of puberty.
      I suspect that endocrine disruptors (environmental toxins) also play a role, especially if exposure before birth.
      Adrenal PCOS is definitely the toughest type to treat and most women need some kind of long-term anti-androgen supplements like zinc.

  112. No, I’m not vegan, I eat meat every day and eggs 2-3 times a week.
    My thyroid hormones + antibodies from my blood test are fine, so is my prolactin. I’ll definitely look into the gluten thing since I eat bread every day!

  113. What if you have no periods on your own 2 years post IUD and had issues with bleeding for over a month before put on pill when younger so never regular cycles but all PCOS labs are normal. Only thing abnormal is TSH 3.67 so dr started on medication. But they still say I have PCOS and can’t twll me why no cycles and infertility

    • no periods at all for 2 years is concerning.
      Are you definitely eating enough to get a period? Did the doctor rule out hypothalamic amenorrhea?

  114. What if you have slightly elevated testosterone and hirsutism but low LH and normal prolactin? Came off pill after 5 years on it and only 1 period in 2 years. Don’t remember totally regular cycles prior to pill but definitely not like this.

  115. I was diagnosed with PCOS before I graduated high school and didn’t realize the problems I’d have with getting and staying pregnant. I wasn’t told which kind of PCOS I had and didn’t know there were options for types. After needing fertility treatments in order to get pregnant and then a preterm birth (32 weeks), a preterm labor resulting in strict bed rest at 26 weeks, and a third pregnancy much the same as the second, I began to think maybe I needed to look further at my health. So, I cut out processed foods, including gluten, and felt amazing. Then, a strange thing happened-my periods began to happen at regular intervals (never had that in my life and I’m 36) and without cramps that were intolerable. And then my joint pains and headaches went away. I never would’ve guessed that inflammation was the number one thing causing so many symptoms. I am left to wonder if I’d have cut out gluten and other inflammatory foods years ago, would my motherhood journey have looked different? Nonetheless, my beautiful three blessings are worth every shot and minute on bed rest, but one has to wonder…

  116. Yes, I had my first period in June 2018, which was about one and a half years after going off birth control pills and 3-4 months after starting to take Synthroid. Since then I had a period in August 2018, September 2018, December 2018, February 2019 and March 2019. Now still waiting for another period….the LH reading I cited above was my most recent one, 19 days after my February period and 24 days before my March period. On another reading, taken just a few days before my August 2018 period, my LH was at half the level of my FSH reading. So, not sure if I have HA or if I just need to continue to work on optimizing my thyroid function?…thank you so much for your advice!

  117. Thank you so much! This gives me a basis upon which to ask for some additional tests when I see my doctor on Friday. Two questions:

    1. What is considered an excess amount of androgens? I have hair on my chin and acne, so I’m still reasonably certain that my doctors were correct when they said I have PCOS.
    2. Once I confirm what type of PCOS I have, where do I go to determine the best type of treatment?

    • Most doctors will test androgens with a blood test but keep in mind that the reference ranges for androgens are age-specific (we have more androgens when we’re younger). The amount of body hair is the other way to assess with something called the “The Ferriman-Gallwey scale.” A little bit of chin hair scores quite low on that scale.

      I discuss treatments in my book Repair Manual.

    • 1:1 LH to FSH is perfectly normal. I can understand your confusion at this point.

      If you were my patient, I’d be looking at all other possibilities like thyroid, prolactin, gluten etc. to find a possible other explanation for such long cycles. You’re not vegan, are you?

  118. Actually, my SHBG is in the center of the referance range. But my testosterone is only a tiny bit too high/upper limit, so I guess that’s why my FAI is quite normal. My thyroid hormones are all fine. I don’t think I’m undereating, I always eat until I’m full. I also eat bread, potatoes and rice every day so I think it’s not the carbs either. Very strange. My doctor was like “You’ve got PCOS so you just have to live with it”… But apparently that’s not what I have, lol

    • If acne is your main symptom, it might be worth just treating that and not worrying too much about the PCOS diagnosis.
      How irregular are your cycles?

  119. Sorry, it seems like my internet browser doesn’t want me to comment at the right place.
    I meant to say that my Testosterone-SHBG ratio (FAI) is 2,3. Does that mean I wouldn’t qualify for a PCOS diagnosis since this is in the normal referance range?

    • If your testosterone is high but your FAI is low, then that suggests that your SHBG is quite high. Is that correct?
      High SHBG can mean undereating or too much thyroid hormone.

  120. I have not never been tested for PCOS and would like to know what type of tests I should request.

    Endocrinologist analyzed my hormonal tested and did not see anything outside the normal range. I have had acne for the last 17 years around my cheeks and chin. My dermatologist prescribed two creams that controls my acne but the last two times I stopped using them for 2 months, my skin was clean and suddenly acne came back ! 🙁 I do have hair on my face and arms (doctor says that’s normal) that’s why I have not been tested for PCOS. My period comes regularly every 25 or 26 days and have not never been on the pill. I have stopped eating dairy products and my acne has improved, eat meat or any other animal products twice a week, no coffee at all. Although my vitamin D is very low.

    What would you consider a lot of hair on the face? would it need to be thick? Your feedback is much appreciated!

  121. I believe I have inflammatory PCOS, with all of your listed signs and symptoms, but have really struggled with how to treat it. A few years ago I was diagnosed with CIRS, and tried cholestyramine and some other supplemental support without much improvement. I wonder, can having been treated with many steroids for asthma and allergies throughout childhood have a permanent effect on hormones? I also have low T3 and chronically low body temp with normal TSH and normal antibodies. Lara, does the second edition of your book have more info on inflammatory PCOS, or do you know of any other resources I could look into for further ideas?

  122. Great article. What do you count as facial hair? I have some small hairs on my upper lip, but I know many women do, and also a few around my nipples. I don’t have any on the chin, don’t have acne or insulin resistance and my androgens have always been normal on blood tests, so it’s hard to conclusively say if I have pcos or not.

    • They’re listed in order of priority. So, if you have insulin resistance, then it’s insulin-resistant PCOS, even if you also have inflammation and a post-pill situation.

  123. What is considered “low LH”? I do not fit the criteria for PCOS, but my LH is 2.5 times the level of FSH. Does this mean I’m not experiencing HA either?

    Seems like I’ve had the most progress when taking levothyroxine/liothyronine, so could I primarily have a thyroid issue? Still not having regular cycles, but at least ovulating occasionally since starting the thyroid meds….

    • are you having any periods at all?
      if so, on which day of your cycle (relative to ovulation) was that LH reading?

  124. What if you’ve had several blood tests and sometimes testosterone was too high and sometimes normal? Can you still work with the PCOS diagnosis? Mild Acne and irregular cycles are present, but no hirsutism.

  125. Can you have more than one of these? What do you think best test for insulin resistance is? Glucose tolerance or fasting insulin? What are the symptoms of each in perio-menopause and menopause?

    • They’re listed in order of priority. So, if there’s insulin resistance, then it is insulin-resistant PCOS, even if there is also inflammation and a post-pill situation.

      The best test for insulin resistance is fasting insulin or glucose tolerance test with insulin (as in, insulin is tested as well as glucose).

      For most types of PCOS, the ovulatory dysfunction tends to improve (and cycles become more regular) into late 30s and early 40s. But then the hirsutism and insulin resistance of classic insulin-resistant PCOS tends to worsen as menopause approaches. It’s because menopause itself is a time of insulin resistance and relative testosterone dominance.

  126. Thanks for the great article Lara. Is mild-moderate chin acne also common with HA? (also have back of neck acne but elsewhere is fine)

  127. Thanks Dr Briden this post is very clear and informative . You mentioned significant chin acne specifically.. Does this mean general chronic acne say all over the cheeks is not one of the signs?


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