Understanding PCOS - The 4 Types No One Tells You About

In this episode, Coach Cate breaks down the nuance of PCOS - why it's so hard to manage symptoms, why just losing weight never works, and how to actually see results when managing PCOS symptoms. She also walks through the 4 different types of PCOS and the common misconceptions that women believe about PCOS. 

Transcript

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Hey, hey, welcome back to Healthy Period. I'm Coach Kate, the Period Girl. This episode is one that has been highly requested. My DMs are flooded with questions about this one. So today I'm going to dive deep into something that affects so many women, but is still wildly misunderstood, and there's so much nuance. PCOS. And if you've been diagnosed with PCOS or polysystic ovarian syndrome, or if you suspect you might have it, this episode is definitely for you. And here's the thing: PCOS isn't just one condition. There is so much nuance with PCOS, how to treat it, how to reverse it, and what actually works. There are actually four different types of PCOS, which I'll go through, and understanding which type you have changes everything about how you approach treatment. So I had a client who was doing HIIT workouts five to six days a week. She was eating 1200 calories a day, and she couldn't understand why her PCOS symptoms were getting worse. She was exhausted, her periods disappeared, and she kept gaining weight despite doing everything right. And when I switched her over to strength training, increased her calories, and focused on walking instead of high-intensity cardio, her period returned within three months, and she finally started losing the weight that she'd been fighting for years. And you know that feeling at 3 p.m. when you're so tired you could cry or fall asleep right at your desk. I have a client who would reach for another coffee, maybe something sweet, and she'd get a temporary boost, but an hour later she was even more exhausted. That's the blood sugar roller coaster that's driving your PCOS symptoms. And so many women with PCOS feel like their bodies are working against them. Women constantly tell me that they thought they were just lazy or undisciplined. They just needed to be more consistent. When actually their insulin resistance and hormonal imbalances were making weight loss nearly impossible. So what actually is PCOS? PCOS is a systemic, I've recorded this about three times and I have butchered that word every single time. So it's going to stay here. We're going to just move through this one. It's a systemic hormonal and metabolic condition. So let me say that again. It's not just about your ovaries, it affects your entire body. PCOS is a syndrome, which means it presents as a collection of symptoms. Not every person will experience the same ones, and that's why it's so confusing and there's so much nuance. You might have irregular periods and acne while your friend with PCOS has hair loss and weight gain. You're both dealing with PCOS, but your bodies are expressing it differently. Common symptoms include irregular menstrual cycles, acne, hair loss on your head, but unwanted hair growth on your face or body, weight challenges, especially around your midsection, mood swings, fatigue, and you might even struggle getting pregnant. The diagnosis typically follows what's called the Rotterdam criteria: irregular ovulation, clinical or biochemical signs of high antigens like testosterone, andor polycystic ovaries visible on an ultrasound. But here's what's important PCOS is a diagnosis of exclusion, meaning your doctor should be ruling out other conditions like thyroid disorders first. And I need to be real with you for a second. If PCOS is left unmanaged, it increases your risk for some serious long-term health issues, metabolic syndrome, type 2 diabetes, cardiovascular disease, and infertility. But it's not just physical, the emotional toll is real. Anxiety, depression, body image issues. So many women with PCOS feel like their bodies are working against them. And when doctors just throw birth control at you without addressing the root cause, it makes things even more frustrating. So this is where things get interesting. Most doctors don't talk about this, but there are actually four distinct types of PCOS. And understanding which type you have is the key to your healing. So let's start with type one, which is the most common type, insulin-resistant PCOS. It happens when your body struggles to regulate blood sugar, which causes your ovaries to produce excess testosterone. So here's how it works in a simple way. When you eat refined sugars and processed carbs, your blood sugar spikes. Your body releases insulin to bring it back down. But over time, your cells become resistant to insulin. So your body has to produce more and more of it. So think of it this way, right? I'm an older sibling, so I have younger siblings. When we were younger, if one of them would knock on my door, I might open it the first time, maybe even the second time. But as they continue to knock and knock and knock on my door, I'm gonna become desensitized to that knocking. I'm not even gonna care what's going on on the other side of the door. I just ignore it. That's what happens, right? So if you are constantly having blood sugar spikes and insulin is constantly being released to bring blood sugar into your cells, the insulin is knocking on the cell's door and the cells aren't responding. So your blood sugar is staying high, which means the pancreas is signaled to continue making insulin. So your blood sugar is high and now your insulin is high. High insulin levels do three things that wreak havoc on your hormones. First, excess insulin stimulates your ovaries to produce more androgens like testosterone, leading to symptoms like irregular periods, acne, and unwanted hair growth. Second, high insulin interferes with normal ovulation, making it harder to conceive. And third, refined sugars and processed carbs contribute to weight gain, which further increase insulin resistance, which creates a vicious cycle. And how does this feel day to day? Those blood sugar spikes followed by crashes leave you exhausted and drained, affecting your energy and quality of life. So the solution, blood sugar balance is key. I would focus on low glycemic index foods, prioritize fiber-rich vegetables, choose healthy fats like avocado and olive oil, eat lean proteins, and include high antioxidant foods like berries and green tea to reduce inflammation. I'd also limit refined sugar and processed carbs so your blood sugar levels can stabilize. This helps manage insulin production, reduces insulin resistance, and minimizes the hormonal chaos that comes with it. So the second type of PCOS is called post-pill PCOS. This one is triggered after stopping birth control pills, especially those that suppressed ovulation. It's often called androgen rebound. Here's what happens: when you're on the pill, it suppresses your natural testosterone production. When you stop taking it, your body can overshoot and produce too much testosterone as it tries to recalibrate. The good news, post-pill PCOS symptoms often resolve within 6 to 12 months unless there are underlying PCOS tendencies that were being masked by the pill. You may develop PCOS-like symptoms without actually having true PCOS. And this can be addressed and often fixed with dietary and lifestyle changes. The third type is inflammatory PCOS. This type is driven by chronic inflammation in your body, often linked to poor diet, stress, or environmental toxins. Symptoms may include not just the typical PCOS signs, but also headaches, joint pain, and skin conditions like eczema. For inflammatory PCOS, your focus needs to be on reducing inflammation. That means emphasizing anti-inflammatory foods, managing stress, and reducing exposure to environmental toxins. And the fourth type is adrenal PCOS. This type relates to your stress response and leads to excessive production of the DHEAS from your adrenal glands. It usually is seen in leaner individuals and may overlap with chronic stress or trauma. If you've been through significant stress, physical, emotional, or both, your adrenals might be the driving force behind your PCOS. For adrenal PCOS, you need low-impact cortisol lowering activities like yoga, walking, or Pilates. High intensity exercise will actually make things worse, but this doesn't mean you should not be strength training. You absolutely should still be in the gym loading your body. The different types of PCOS matter because treatment needs to be tailored to your PCOS type and symptoms. What works for insulin-resistant PCOS won't work for adrenal PCOS. This explains why so many women feel frustrated. They've been given a one-size-fits-all advice. So what do you actually do about your PCOS? Your treatment needs to be tailored to your type and your symptoms. Everyone is different, so you need a personal approach. And here's what's crucial: we need to address root causes rather than just masking your symptoms. Birth control might suppress your symptoms temporarily, but it's not fixing what's actually broken. So on the nutrition side of things, with 70% of PCOS cases being insulin-resistant PCOS, the key is to regulate your blood sugar and get your body to be able to utilize carbs. So start with low glycemic index foods, prioritize fiber-rich vegetables, healthy fats, lean proteins, and high antioxidant foods to reduce inflammation. Limiting refined sugar and processed carbs will help your body stabilize your blood sugar, which helps manage insulin production and reduces insulin resistance. This minimizes hormonal imbalances and supports better reproductive function. Now, some of you might be thinking, should I just do keto? Well, the keto diet is very specific and it could help, but honestly, not every person is ready for that keto diet. So if you have been thinking about doing that, feel free to reach out to me and we can talk about if that makes sense for you. So what about movement that supports your body? This is very case-specific and depends on your PCOS type. So for insulin-resistant PCOS, we need strength training to improve your metabolic health. And even some brief HIIT workouts can help with insulin sensitivity. For adrenal PCOS, we want to stick to the low-impact activities like yoga, walking, or Pilates. Over-exercising will worsen your symptoms. But again, we still want strength training here, but we need to be focused on nervous system regulation. And for inflammatory PCOS, moderate intensity movement that doesn't create unnecessary inflammation in your body. Again, strength training three to four times per week will absolutely help, but there's no need to be going crazy with HIIT workouts, burpees, box jumps, workouts that crush your soul are not necessarily better for you to lose weight. And girl, you cannot out-supplement or out-exercise a stressful lifestyle. Stress management is a non-negotiable non-negotiable. So you can be stressed, your body can be under stress without you feeling stressed. One of my favorite things to do is getting morning light and grounding in each day. Just this is a game changer, especially if adding journaling, meditation, or breath work feels like you don't have time. But taking a few minutes to get in some sunlight in your eyeballs, it's easier to implement into a crazy morning with kids or getting ready for an early work day or whatever other responsibilities you have in the morning. And your sleep is critical. Inadequate sleep worsens insulin resistance and hormonal regulation. It doesn't matter how clean you eat or how much you work out, if your sleep is trash, you will not get the healing that you're looking for. And if you're still struggling with symptoms after a few months of consistency with these basics, then you could implement reducing your toxic load in your home by switching to non-toxic cleaning and skincare products and avoiding BPA plastics. And girl, please stop lighting your candles. Throw them all away. Now, here's something that doesn't get talked about enough. Your gut health plays a massive role in PCOS. Your gut is critical for absorbing nutrients like iodine, selenium, zinc, and iron, which are all essential for hormone production. Poor gut health can lead to deficiencies that negatively affect your hormonal balance. The gut is also key to breaking down and eliminating excess hormones like estrogen through the gut liver access. Fiber binds to estrogen in your digestive tract and helps eliminate it. Without enough fiber or a healthy gut microbiome, excess estrogen gets reabsorbed, which contributes to estrogen dominance. So if you do miss your periods, but your period comes back with vengeance when you do get it, this is where estrogen dominance comes in. And chronic gut inflammation contributes to widespread systemic inflammation, which disrupts hormone production and signaling. Elevated inflammation impairs ovulation and progesterone production, leading to more estrogen dominance. So I want to talk about some of the common misconceptions around PCOS. So misconception number one is that PCOS is just about your ovaries. We've talked about this this entire time, but the truth is PCOS is a systemic, hormonal, and metabolic condition that affects your entire body, not just your reproductive system. This misconception leaves women feeling like it's only about fertility or periods, when in reality it impacts metabolism, cardiovascular health, mental health, inflammation, and long-term disease risk. And this matters because women need to understand that managing PCOS is not just about fixing your ovaries. It requires a whole-body approach addressing nutrition, movement, stress, sleep, and inflammation. Misconception number two: everyone with PCOS has the same symptoms. The truth: PCOS is a syndrome, meaning it presents as a collection of symptoms. Not every person will experience the same ones. We talked about this already. You might have irregular periods in acne while your friend with PCOS has hair loss and weight gain. This variability is why so many women feel isolated or doubt their diagnosis. Misconception number three, birth control fixes or treats PCOS. The truth, birth control might suppress symptoms temporarily, but it's not fixing what's actually broken. Many women start birth control to manage PCOS symptoms, but when they stop, those underlying issues resurface, often worse than before, because the root cause was never addressed. And this matters because women deserve to know they're addressing root causes rather than just masking symptoms. The pill is a tool for symptom management. It's not a cure. So if you want to know more on birth control, see episode five, which is a whole episode on birth control. Misconception number four: PCOS diagnosis is straightforward. The PCOS diagnosis is a diagnosis of exclusion, meaning your doctor should rule out other conditions like thyroid disorders first. Many women are not aware that thyroid issues and other conditions can mimic PCOS symptoms. And misconception number five, weight loss is the only solution. So many doctors are telling women with PCOS just lose weight. While insulin resistance and weight can be factors for some women with PCOS, not everyone with PCOS is overweight, right? Adrenal PCOS is typically seen in leaner individuals. Additionally, focusing solely on eat less and move more can actually worsen symptoms by increasing stress and cortisol. And this matters because blood sugar balance, inflammation reduction, stress management, and appropriate exercise for your PCOS type are far more important than simply losing weight. And misconception number six, the gut has nothing to do with PCOS. The truth, and we talked about this today, your gut health plays a massive role in PCOS. The gut is critical for absorbing nutrients, essential for hormone production, breaking down and eliminating excess hormones like estrogen and managing inflammation, all of which directly impact PCOS symptoms. I need you to hear this. Your body is not broken. PCOS does not mean you're destined for a life of symptoms and struggles. Your symptoms are not normal, and you should not be told to just suck it up because you're a woman or just told just to take the pill. You know your body better than anyone else, and you deserve support that addresses the root of what's happening, not just the pill to mask your symptoms. Our bodies are smart. They react exactly how they're supposed to. They don't revolt against us randomly. The symptoms that we have been fighting so hard to suppress just to function are our body's way of telling us that something is wrong and that we need to pay attention. And if today's episode resonated with you, DM me the word PCOS on Instagram and I'll send you two of my free guides, my free PCOS nutrition guide and my four-week workout plan designed specifically for women with PCOS. These resources will give you actionable steps to start balancing your blood sugar, reducing inflammation, and moving your body in ways that support, not stress out, your hormones. And you don't have to do this alone. You don't have to feel dismissed or frustrated anymore. There is a path forward, and I'm here to help you find it. So thanks for listening. Thanks for showing up for yourself. And remember, you are worthy of answers, validation, and a body that feels good. So I'll see you in the next one.