Can we stop calling it 'Lean PCOS' and other insight into PCOS types
Let me filter through the diet recommendations to give you sustainable action steps, plus a fun quiz!
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Hey there Voice Finder,
Years ago I kept hearing about PCOS types like Inflammatory PCOS or Insulin Resistant PCOS. I remember scratching my head and then Google Scholar-ing (new verb alert) the heck out of the terms.
I found these PCOS types were not from research rather gathered from influencers, coaches, and other PCOS helpers. Because PCOS research is poorly funded, I am not against practice based evidence—the information we gather in community and as clinicians working with clients. These types of PCOS descriptions, though, tend to push a diet agenda and promote cures.
I wish we had a cure for PCOS—we don’t. I also wish diets helped most people with PCOS—but they only make insulin and inflammation worse long term. They also further perpetuate weight stigma and cause eating disorders.
This newsletter offers an alternative: PCOS types that we have research on as well as sustainable non-diet alternatives to help you with symptom management.
Finding and Treating Your PCOS Type
If you’ve been diagnosed with PCOS, you might assume you have cysts on your ovaries. After all, it’s called Polycystic Ovarian Syndrome. But, surprisingly, this may not be the case. According to the Rotterdam Criteria used to diagnose PCOS, you need just two out of three symptoms shown below. Based on your symptoms, you’ll fall into one of four main PCOS types.
Why is this important? The same four letters describe everyone with PCOS. But the distinct types mean you and your friend with PCOS may differ in body composition, hormones, symptoms, struggles, and which treatments work best for you.
Treating your Type
If you’ve been told you have PCOS but don’t know which markers were measured, check with your doctor, then head back here. Once you know your type, read on for customized tips for your PCOS.
Classic polycystic ovary PCOS
If this is you, you have the classic PCOS type with all three markers. Since your PCOS “checks all the boxes” you may have to deal with bigger challenges. For example, you probably have higher circulating insulin levels than other types. You may feel like you’re dragging through your days. You may also have intense (like whole-box-of-donuts) carb cravings that are hard to ignore.
One of the best ways you can help is to eat enough. If you don’t, it will actually drive your insulin levels higher over time, making your symptoms and your PCOS worse.
You may also need more protein. Try adding protein to most of your meals and snacks and see if you feel more energized.
Speaking of energy, your type means you’ll need to prioritize your rest. This may mean stepping away from your phone at least an hour before bedtime, setting a consistent bedtime, and respecting your need for quality sleep. If these boundaries don’t help, make sure to rule out a sleep disorder — you can have one and have PCOS at the same time.
As for exercise, you may not feel like moving your body until you are eating enough, sleeping enough, and are settled in with the right medications or supplements. Be patient with yourself and don’t force it until your body has the energy.
Classic non-polycystic ovary PCOS
Because you don’t have cysts on your ovaries, some people may think you don’t have PCOS. Remind them of the Rotterdam criteria and that you have met 2 out of 3.
Most people with your PCOS type have high insulin levels, and uninformed providers may recommend that you diet. Danger! Steer clear. As with classic polycystic ovary PCOS, not eating enough will tend to raise your insulin levels even higher over time. Instead, make sure you eat enough to fuel your activity, and try including plenty of protein to see if it improves your energy.
Also, like those with classic polycystic ovary PCOS, you may feel tired and blah. Give yourself permission to rest during the day. Even just a few minutes of sitting quietly, reading or anything other than go-go-go can make a big difference in your wellbeing. Make sure you also set up a good bedtime routine and stick to it like it’s a prescription medication…which it kind of is. If you still struggle with sleep, make sure to rule out a sleep disorder every few years.
Should you exercise? Once you’ve recovered enough energy, I recommend you find what movement feels enjoyable and do that. You’ll know it’s time when you start craving activity.
Non-classic ovulatory PCOS
Because you have regular periods, some people may think you don’t have PCOS. Remind them of the Rotterdam criteria and that you have met 2 out of 3.
Even though you have regular periods, higher circulating androgen levels may lower your egg quality. If fertility is a concern, ask your health care provider if an inositol supplement would be helpful for you.
Another thing testosterone and other androgens can do is drive up your insulin levels over time. You may feel better eating more protein. But wait…keep reading. I don’t mean that you should eat less fat or fewer carbs. PCOS is hard on your body and you need to make sure you are eating enough food to help your body continually repair. So just add more protein. Try it out and see if it fits for you and provides you with steadier energy levels!
Non-classic mild PCOS
This type of PCOS is often referred to as “lean PCOS.” Grrrrr. This outdated term promotes bias in PCOS care, where weight discrimination already prevails. If you are willing, let your providers know you don’t want it referred to this way.
Your PCOS type overlaps with another condition called Hypothalamic Amenorrhea (HA), which also features inconsistent or missing periods along with smaller ovarian cysts. HA can happen particularly in situations in which a person can’t take in enough energy to fuel intensive activity or sport. Be sure to rule out HA, as your treatment will differ. Many people diagnosed with this type of PCOS actually have HA or PCOS and HA at the same time!
Whether you have HA, PCOS or both, make sure you are eating enough. Doing so, along with getting enough rest, will decrease inflammation and help your body heal and thrive.
Now that you know which type you are, what else can you do?
You may have noticed I advise that all PCOS types get enough to eat. Dieting is always the wrong tool for PCOS — it doesn’t work, and it serves up plates of shame you’re better off without. Diets harm people with PCOS more than people without it. Yes, I appreciate this is a bold statement and I am not afraid to take a stand. Do whatever you can to avoid the diet industry and the culture that promotes dieting. At the same time, help others not have to diet either.
If you want more, I invite you into PCOS Power. It’s my membership teaching you how to lower insulin, balance blood sugar, and better understand PCOS. Expect zero diet recommendations and instead ways to increase energy and decrease cravings sustainably. You will gain insight into which supplements to take, which labs to ask for, and have access to me to ask any questions anytime.
Listening to:
What about the type of PCOS that's estrogen dominant?