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August 30,2025

Lecture modified: PCO new types according to provocative factor added

Provocative factor (Trigger) classifies PCO TO 5 TYPES:

    1. Insulin-resistant PCO (main trigger in most cases of PCO) è hyperinsulinism (Fasting insulin >10mlu/ml), which may be:
      1. Congenitally programmed insulin-resistance hyperinsulinism
      2. Acquired postnatally due to obesity leading to insulin-resistance.

These patients benefit from metformin, inositol and sugar lowering agents.

    1. Post-Pill PCO: Temporary surge in androgens when coming off drospirenone or cyproterone type of birth control pill, like Yasmin, Yaz, Diane, or Brenda. That surge in androgens is enough to qualify for the diagnosis of PCOS, even though it’s temporary. Patients have regular cycles before starting OCP, do not have insulin resistance, symptoms of irregular mensus / hirsutism started three to six months after stopping a drospirenone or cyproterone birth control pill.

These patients benefit from supporting hormone balance with diet, and reassurance.

    1. Inflammatory PCO: Chronic inflammation can stimulate the ovaries to produce excess testosterone. Patients often have signs and symptoms of inflammation, such as unexplained fatigue, bowel problems like IBS or SIBO, an autoimmune disease like Hashimoto’s thyroid disease, headaches, joint pain, or a chronic skin condition like psoriasis, eczema, or hives. There will be elevated CRP leucocytes WBCs TNF.

These patients benefit from anti-inflammatory diet (omega-3s, turmeric), reduced stress, improved gut health

    1. Adrenal PCO when the source of hyperandrogenism is the adrenal, the main androgen will be DHEA-S. accounts for 10% of PCOS diagnoses, menstrual cycles are often regular.

These patients benefit from reduced stress diet (adaptogens) and reassurance

    1. Hidden Cause PCO

https://obgynegy.com/lectures/detail/study-day-54-55-polcystic-ovarian-disease