You may have heard that there are several types of PCOS. But what you might not know is that there are actually several categorization systems of polycystic ovary syndrome. More importantly, you may also be wondering how to find out what type of PCOS you have.
Conventional Medicine PCOS Types
According to conventional medicine, there are 4 main types of PCOS:
- Type A – High androgens & irregular periods (or no period) & polycystic ovaries
- Type B – High androgens & irregular periods (or no period)
- Type C – High androgens & polycystic ovaries
- Type D – Irregular periods (or no period) & polycystic ovaries
Of these, Type A is considered the most severe and is the most typical presentation. On the other side of the spectrum, Type D is considered the mildest form. It IS possible to move from one category to another with treatment, diet, and lifestyle changes.
Functional Medicine PCOS Types
You’ll tend to see these types talked about on social media and in books about PCOS, so I wanted to make mention of them here:
- Insulin Resistant PCOS – dominated by symptoms like high blood sugar, darkened skin around the neck and armpits, carb & sugar cravings, and weight gain.
- Inflammatory PCOS – dominated by symptoms of chronic inflammation like acne and skin rashes, fatigue, joint pain, gut issues, and weight gain.
- Adrenal PCOS – where the primary androgen that is high is DHEA, which is made primarily by the adrenal glands (in contrast to testosterone, which is made primarily by the ovaries)
- Post-Pill PCOS – seen in women who had normal periods before being on the pill, but experience PCOS symptoms after coming off the pill
In my practice, I don’t strictly classify PCOS by these types, because very few women fit neatly into just one of these subtypes. For instance, I rarely may see a woman with lean PCOS who clearly has only the adrenal type. But, more often than not, I see a combination. In other words, a woman with PCOS can have several of these types of PCOS at once.
New Research into PCOS Subgroups
A recent study proposed a new categorization for type of PCOS based on genetic markers. The researchers were able to categorize women with PCOS into different subtypes based on certain genetic markers. These groups were:
- Reproductive group – higher LH & SHBG, lower BMI & insulin
- Metabolic group – higher BMI, glucose & insulin, lower LH & SHBG
- Indeterminate – did not neatly fit into either group
This research is among the first of its kind showing that there are distinct types of PCOS. In the future, this may lead to a more individualized treatment approach. However, we’re not there yet. You can read my thoughts on this research in this Well + Good article.
How to identify what type of PCOS you have
Again, I don’t focus too much on these “types of PCOS.” Instead, I focus on identifying and treating the root causes of your PCOS symptoms.
- Insulin resistance
- Hormone Imbalances
- Gut Imbalances
Tests can help you determine which root causes are problems for you:
- Fasting glucose, fasting insulin, HOMA-IR for insulin resistance
- Hs-CRP for inflammation
- The DUTCH test for hormone imbalances
- Gut testing (such as the GI-Map) for gut imbalances
Is it possible to not have a type?
Sadly, misdiagnosis is not uncommon. In my practice, I see a lot of women who turn out not to have PCOS at all.
If you’ve recently gone off the pill and all of your hormone levels are low (LH, FSH, estradiol, testosterone, etc.) then you may have hypothalamic amenorrhea, rather than PCOS. Because ovaries can look polycystic after going off of the pill, you may be misdiagnosed with PCOS. However, if you don’t have any of the classic symptoms of PCOS (such as acne, or facial hair), you might want to pursue further testing to get an accurate diagnosis.
Similarly, hypothyroid can cause irregular cycles and absence of ovulation and periods. If your androgens are not high, and you have no cysts on your ovaries, you should not have been diagnosed with PCOS (per the Rotterdam Criteria). Do some deeper digging to find the root cause of your missing periods.
Rarely does someone fit neatly into just one category. Instead, most women have a combination of root causes that need to be addressed in order to manage PCOS in an individualized and balanced manner. In conclusion, the best way to find out what type(s) of PCOS you have and what to do about it, is to work with a credentialed practitioner who specializes in PCOS.
In The PCOS Root Cause Roadmap 6-week program, I help you identify and learn how to treat YOUR root causes of PCOS. Click here to get on the list for next time. Or if you’re interested in working one-on-one with Melissa, you can click here to apply for the waitlist or apply to her PCOS Small Group Coaching Program.
Cowritten by Jeani Hunt-Gibbon.