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Irregular cycles and weight gain? Could it be PCOS?

Updated: Oct 30, 2023

Affecting 5-10% of women, PCOS (polycystic ovarian syndrome) is the most common reproductive disorder. This disorder is much more common than previously thought, and the exact cause is unknown.

PCOS can be triggered by inflammation, genetics, stress or insulin resistance.


  • menstrual irregularities (long cycles)

  • painful cycles

  • androgen symptoms: hirsutism (dark/coarse hair on chin, upper lip, nipples/chest/stomach)

    • acne (especially on jawline)

    • hair loss

  • weight gain

  • depression/anxiety/fatigue

  • infertility due to a lack of ovulation

  • symptoms typically improve with age - cysts and androgens (male hormones) can decrease BUT metabolic risks INCREASE with age

As with anything in the human body, PCOS can present differently in different people. However, there are 4 main presentations used to categorize the disorder, and knowing which one you are helps dictate treatment:

  • A: Classic PCOS - most severe, 60% of cases

    • Delayed ovulation + high androgens + cysts on the ovaries

    • Tend to have the most weight gain in mid-section

    • Tend to have high LH/FSH ratio

    • More risk for metabolic disease

    • More menstrual irregularities

    • Low progesterone is very common in this type of PCOS

  • B: Also classic but less severe

    • Delayed ovulation + high androgens - no cysts on ovaries

  • C: Non-Classic/Ovulatory

    • High androgens (male hormones) + cysts on the ovaries but regular cycles

    • More mild symptoms

    • Less weight gain typically

    • Moderate increase in LH/FSH + androgens

    • Types A+B can move to this more mild type once someone changes lifestyle/age/etc

  • D: Non-classic non-hyperandrogenic

    • Irregular cycles + cysts on ovaries but normal androgens/ no hair growth etc

    • Less weight gain and insulin resistance

    • If this is suspected you typically need to rule out other causes since it may not be PCOS

If you experience these symptoms, there are a variety of tests on your hormones that can help your doctor deduce whether you have PCOS.

At modrn med we typically run a DUTCH test to look at hormone levels as well as blood work.

Important blood work to ask your doctor for include:

  • LH, FSH, estradiol on day 3 of the cycle (day1= first day of your period).

  • progesterone day 19-21of the cycle

  • DUTCH Complete on day 19-21

  • Androgens: Free and total testosterone, androstenedione, DHT, DHEA-S

  • Fasting insulin, HbA1c

  • Inflammatory markers: hs-CRP, ESR

  • Full thyroid panel: TSH, FT3, FT4, anti-TPO, anti-TG

  • Vitamin D

Once the type of presentation you have is discovered, there are conventional and natural treatment options your doctor can recommend.

Get started by becoming a patient with Dr. Williams here.

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