4 Types of PCOS (a Flowchart)

Types of PCOS

To treat PCOS, you need to know what’s driving it. In other words, you need to know your functional type of PCOS.

You could have insulin-resistant PCOS, post-pill PCOS (which is temporary), inflammatory PCOS, or the far less common adrenal PCOS. These are functional types of PCOS based on the underlying physiological driver.

First things first, what is PCOS?

Despite the name, polycystic ovary syndrome has absolutely nothing to do with cysts on the ovaries. The things your doctor saw on ultrasound are follicles or eggs, which are normal for the ovary. You can have many eggs and still have normal hormones, and that’s why ultrasound cannot diagnose (or rule out) the hormonal condition PCOS.

PCOS is best defined as androgen excess (high male hormones) when all other causes of androgen excess have been ruled out.

So, step 1 in determining your PCOS type is to ask “Is it really PCOS?”.

Is it really PCOS?

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.

PLUS other reasons for androgen excess have been ruled out.

Other reasons for androgen excess include certain types of birth control, congenital adrenal hyperplasia (which accounts for up to 9 percent of cases of androgen excess), and high prolactin.

Having irregular periods (or no periods) could mean you have PCOS, or it could mean you have hypothalamic amenorrhea, which is lack of periods due to undereating or undereating carbs.

The thing to understand is that you can have polycystic ovaries with hypothalamic amenorrhea or undereating. That means you could have been mistakenly told that you have “lean PCOS” when you actually have hypothalamic amenorrhea.

For more information read:

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

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).

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

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

Do you have insulin resistance? If you want to say “no,” then my next question is “are you sure?”

70 percent of PCOS diagnoses are insulin-resistant PCOS.

Did your doctor test for the hormone insulin or only glucose? A test for blood glucose or HbA1c is not a test for insulin resistance.

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

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:

  • Stay calm and know the symptoms are part of a temporary drug-withdrawal process.
  • Consider using a natural anti-androgen supplement like zinc, DIM, or peony & licorice combination for a few months. Read the 7 best natural anti-androgen supplements.

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 if you had a problem before birth control, then let’s move on. Do you have signs of chronic inflammation?

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, or 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 this type of 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
  • headaches
  • joint pain
  • a chronic skin condition like psoriasis, eczema, or hives.

If you do not have signs of chronic inflammation, then let’s move on. Do you have 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 diagnoses.

Adrenal PCOS is not driven by insulin resistance or inflammation. Instead, it’s an abnormal response to stress. Treatments include stress reduction, magnesium, adaptogen herbs (including licorice), and vitamin B5, the “anti-stress factor.”

For information about the 4 types of PCOS and their treatments, see Chapter 7 of Period Repair Manual.

👉 Tip: Thinking 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 PCOS — even if you also have inflammation and a post-pill situation.

Still confused?

What if you’ve been told you have PCOS, but you do not seem to meet any of the criteria discussed here?

Go back to the drawing board. Do you truly have PCOS? As in, do you have high androgens? Either measurable on a blood test or the clear physical sign of facial hair.

👉 Tip: Your androgen symptoms could be from birth control. Some progestins such as levonorgestrel are very “testosterone-like” and cause acne and hair loss. Read 4 causes of androgen excess in women

Because if you don’t have high androgens, and lack of periods (and maybe mild acne) is your only symptom, then you could actually have hypothalamic amenorrhea. (And look at your luteinizing hormone — it’s high with PCOS and low with hypothalamic amenorrhea.)

See the full flowchart below and ask me in the comments.

Dr Lara Briden
4 Types of PCOS
4 Types of PCOS

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

  1. 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!

  2. 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 !

  3. 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.

  4. 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

  5. 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?

  6. 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!

  7. 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.

  8. 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?

  9. 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!

  10. 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.

  11. 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.

  12. 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!!

    Katie

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. 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!

  18. 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?

  19. 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?

  20. 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.

  21. 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?

  22. 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 🙂

  23. 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

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

  25. 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.

    Hugs!

    Katie

  26. 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?

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

  28. 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

  29. 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! 🙂

  30. 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.

    Katie

    • 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.

  31. 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.

  32. 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 ?

  33. 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?

  34. 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!

  35. 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?

  36. 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!

  37. 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).

  38. 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.

  39. 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.

  40. 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….

  41. 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.

  42. 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?

  43. 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!

  44. 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

  45. 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?

  46. 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.
    Thanks
    Allison Smith

  47. 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.

  48. 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.
    Ita

    • 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.

  49. 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!

  50. 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

  51. 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.

  52. 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…

  53. 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!

  54. 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?

  55. 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

  56. 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?

  57. 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!

  58. 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?

  59. 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.

  60. 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….

  61. 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.

  62. 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.

  63. 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)

  64. 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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