Are there really 4 types of PCOS?
If you’ve recently been diagnosed with PCOS, you’ve probably seen something on social media about the different types of PCOS. And now you’re wondering which type of PCOS you have.
The reality is that research doesn’t really support the 4 different types of PCOS that are commonly discussed. However, as a registered dietitian, I believe there is some small merit to discussing these 4 types of PCOS so that you can better understand your PCOS diagnosis.
This article will dive into what people are referring to when they talk about the 4 types of PCOS, what the research actually supports, and how to treat the symptoms of PCOS that you’re experiencing.
Before we dive in, let’s recap what PCOS is and what constitutes a PCOS diagnosis.
Polycystic ovarian syndrome (PCOS) is a common endocrine disorder, affecting up to 20% of women of reproductive age worldwide (1). The Rotterdam Criteria is the universally accepted diagnostic criteria for diagnosing PCOS.
The Rotterdam Criteria indicates you need to have at least 2 of the following 3 criteria to meet a PCOS diagnosis:
PCOS is a diagnosis of exclusion. That means that if you meet at least 2 of the above criteria, your doctor will also need to rule out other medical conditions as the cause of your symptoms prior to being able to give you an accurate diagnosis of PCOS. Depending on your symptoms, these other potential medical conditions may include hypothalamic amenorrhea, thyroid dysfunction, congenital adrenal hyperplasia, or high prolactin levels.
Common symptoms of PCOS may include:
Now that we’ve recapped what PCOS is and how to diagnose this hormonal disorder, let’s dive into the different types of PCOS.
In the world of naturopathic medicine, the 4 types of PCOS are frequently discussed. The idea behind it is that you have a specific type of PCOS, and all of your symptoms are being caused by one specific reason.
The four types of PCOS are:
Now that we know what the types of PCOS are, let’s dive into what each of them means, including symptoms of each PCOS type.
If you have insulin resistance, you are said to have insulin resistant PCOS. This is the most common form of PCOS. Research shows mixed estimations, however, up to 80% of those with PCOS may also have insulin resistance (2).
With insulin resistance, your body’s cells don’t react effectively to the hormone insulin. Insulin is necessary for regulating glucose levels (aka blood sugar levels). This resistance can lead to high levels of insulin in the body.
High insulin levels can disrupt ovulation, leading to irregular periods. High insulin levels also trigger your ovaries to release excess testosterone, leading to high testosterone levels.
Symptoms of insulin resistance PCOS may include:
Diagnosing insulin resistance can be done relatively easily with a blood test. You’ll want to have your fasting insulin level checked.
A common problem I see is that many medical providers will only test a fasting glucose level or a hemoglobin A1c test. These tests are great for diagnosing pre-diabetes or diabetes, however, they don’t pick up on insulin resistance unless it has already progressed to diabetes.
Inflammatory PCOS is said to be caused by chronic inflammation. Chronic low-grade inflammation has emerged as one of key contributors to the development of PCOS (3)
Inflammation can cause anovulatory cycles, leading to irregular periods. It can also cause high levels of androgens (aka male hormones like testosterone).
Symptoms of inflammatory PCOS may include:
Diagnosing inflammatory PCOS can be difficult in some people, especially if the inflammation is very low-grade. There are some blood tests that can check for inflammatory markers; one common blood test is C-reactive protein (CRP).
Adrenal PCOS is said to be caused by an issue with your adrenal function and an abnormal stress response. The adrenal glands are located on top of your kidney and are responsible for the release of several different types of hormones.
Symptoms of adrenal PCOS may include:
If you have adrenal PCOS, you likely have high levels of DHEA-S, which is a type of androgen made by the adrenal glands. DHEA-S levels can be checked with a simple blood test.
To learn more about adrenal PCOS in detail, check out this blog post: Adrenal PCOS: Symptoms, Causes, & How To Manage It.
Sometimes referred to as pill-induced PCOS, post-pill PCOS is not true PCOS.
Post-pill PCOS may occur after stopping hormonal birth control pills. Birth control pills increase sex hormone binding globulin (SHBG) levels, which bind to androgens such as testosterone. So this can lead to lower testosterone levels while you’re on birth control pills.
After the withdrawal of the synthetic hormones, your body can have a “rebound” period of time where you see an increase in symptoms similar to PCOS such as irregular periods, acne, hair loss, or mood changes.
If your symptoms are truly due to stopping oral contraceptives, and it’s not true PCOS, this is temporary and should resolve within 6 months for most people.
If you continue to have symptoms, you may have had underlying PCOS and your oral contraceptive pill was masking the symptoms.
Now that we’ve outlined the symptoms and diagnosis of the 4 types of PCOS, it’s important to note that these different types of PCOS aren’t recognized in the research or in the 2023 International Evidence Based Guidelines for The Assessment & Management of PCOS.
If you’re feeling like you fit into several of these PCOS types, you’re not alone. Many people with PCOS don’t fit nicely into one particular “type of PCOS”. There’s a lot of overlap between symptoms and someone may fit into multiple categories.
Let’s discuss which types of PCOS have been identified in the research.
There’s a lot that we still don’t know about PCOS and the cause of PCOS is one of them. While we don’t know the exact cause of PCOS, it’s thought to be due to a combination of genetics and environmental factors (such as environmental toxins, pollution, etc).
Within the scientific literature that we do know, 4 different PCOS phenotypes have been identified.
The 4 PCOS phenotypes according to the research are:
I know, the names aren’t as catchy as the first set of PCOS types we reviewed. But let’s talk about what these different phenotypes are.
Phenotype A is classified as someone having ovulation dysfunction (irregular periods), high androgens, and polycystic ovaries on ultrasound.
This is the most common type of PCOS, accounting for about 60-70% of those with PCOS (4).
Phenotype B includes ovulation dysfunction (irregular periods) and high androgen levels. It does not include ovarian cysts or polycystic ovaries on ultrasound.
Fun Fact: I also have PCOS and I have this phenotype!
Phenotype C includes high androgens and polycystic ovaries. Those with this phenotype have regular ovulation and normal periods.
Phenotype D includes ovulation dysfunction (irregular periods) and polycystic ovaries. Those with this phenotype do not have symptoms of androgen excess or typical PCOS symptoms such as hair loss, hirsutism, or acne.
I know this may all feel really overwhelming, however, your “PCOS type” probably isn’t as important as you may have been led to believe – especially if you’re in the beginning stages of your PCOS journey.
The good news is that the right nutrition and lifestyle changes can dramatically improve your PCOS symptoms and your quality of life.
So what does that actually mean? Let’s talk about it.
Regardless of which “type of PCOS” you may have, the dietary changes you should make are going to be essentially the same.
You’ll want to eat an anti-inflammatory diet and in a way that balances your blood sugar levels.
Anti-inflammatory foods are generally fruits, vegetables, whole grains, legumes, fatty fish, and healthy fats. For a complete list of anti-inflammatory foods to include in your diet (and a list of inflammatory foods to avoid or limit), check out this blog post: Anti-Inflammatory Foods List
To balance your blood sugar levels, here are a few tips to get you started:
For more information on how to get started with a balanced diet for PCOS, you don’t want to miss this blog post: A Dietitian’s 7-Day PCOS Diet Plan (PDF Included).
Movement, or exercise, provides several benefits including improved insulin sensitivity, lower inflammation, and a mood boost.
If you have adrenal PCOS, or high DHEA-S levels, you may benefit from including more restorative exercise that can double as a form of stress management, such as yoga or walking.
Sleep is so underrated when it comes to our health. The truth is that without a good night’s sleep, our hormones can really suffer and hormonal imbalances can be exacerbated.
A poor night’s sleep can actually affect several hormones such as cortisol, insulin, ghrelin, and leptin.
Managing stress levels is essential for improving your hormonal balance. I know, way easier said than done!
When we’re in a state of chronic stress, it can increase cortisol levels, which is commonly known as our stress hormone. High cortisol levels can worsen insulin resistance and disrupt reproductive hormone levels.
Medications and/or supplements may be helpful in managing your PCOS symptoms. Some common medications that are prescribed with PCOS include Metformin, birth control pills, and spironolactone.
There are several popular supplements in the PCOS world, some with impressive research and some without much research.
Always consult with your healthcare provider prior to starting any nutrition supplements.
There are four different types of PCOS that are commonly discussed on social media and the naturopathic medicine world. The 4 types of PCOS are insulin-resistant PCOS, inflammatory PCOS, adrenal PCOS, and post pill PCOS.
These types of PCOS are not recognized by current research, but instead PCOS phenotypes A, B, C, & D are acknowledged in scientific literature.
Regardless of your “PCOS type”, the proper dietary and lifestyle choices can significantly improve your symptoms, overall health, and quality of life.
If you want to take the guesswork out of how to manage your PCOS symptoms with nutrition, the PCOS Playbook is your downloadable guide that walks you through everything you need to know about it. It includes everything you need, from macronutrient basics to label reading to putting balanced and delicious meals together…plus it has over 30 PCOS-friendly recipes! Get your copy today!
Disclaimer: this information is for educational purposes only. It is not intended to replace medical advice or to diagnose or treat any medical condition, including polycystic ovary syndrome (PCOS). Always discuss your unique medical situation with your healthcare provider.
Learn the most common nutrition mistakes I see women with PCOS making and what to do instead!