The Real PCOS Types
Inflammatory PCOS, Adrenal PCOS, Insulin Resistant PCOS, Post-Pill PCOS, thyroid PCOS – these are all the ‘types’ of PCOS you’ve likely read about online. The reality is that these are not real types of PCOS. We have no research firmly planting PCOS into these categories, yet these ‘types’ of PCOS are widely discussed online!
While you can certainly have inflammation, adrenal involvement, insulin resistance, hypothyroidism, or have had your PCOS become more prominent after coming off the pill, categorizing PCOS into these types can do a real disservice to those struggling with this condition, and make it even more confusing to find proper and effective PCOS treatment!
Today I’m going to take you through the REAL types of PCOS, the different PCOS phenotypes, the underlying factors of PCOS, and finally comorbid conditions we often see with this condition. That way, you’ll have a way better understanding of what PCOS is and isn’t, as well as how to go about finding care that works for your unique kind of PCOS!
The PCOS Types
Let’s get right to it and dive into the REAL types of PCOS. Your PCOS Type completely depends on our diagnostic criteria for diagnosing PCOS, called the Rotterdam Criteria. According to the Rotterdam Criteria, you need to rule out all other causes that might explain your symptoms. Once that’s done, you simply need to hit two out of the three criteria to receive a diagnosis of PCOS. The three criteria are:
Hyperandrogenism – having clinical signs of high androgens (acne, excess hair growth, hair loss) or biochemical signs on blood work (high testosterone, DHEAS, etc.)
Oligomenorrhea/Amenorrhea – irregular or absent periods
Polycystic Ovaries on ultrasound – these are not cysts but many small follicles creating a polycystic appearance of the ovaries
Your PCOS Type depends on which criteria you hit – check out the chart below to see the real types of PCOS:
As you can see, your PCOS type just depends on which PCOS diagnostic criteria you have! This is an extremely important first step in getting a proper diagnosis of PCOS, as many people get misdiagnosed because they either don’t have polycystic ovaries or they get regular periods. You can clearly see now that you can still have PCOS even if these criteria are not present!
The PCOS Phenotypes
‘classic’ pcos
If you look at the chart above, I’ve listed the two PCOS Phenotypes: ‘Classic’ and ‘Non-Classic’ PCOS. This part is really simple. People who fall into Type A or Type B, or the ‘Classic’ phenotype, present with all the signs and symptoms we classically think of with PCOS. These people often have many signs of high androgens like hair loss or excessive hair growth, and they do not get regular periods. Because of this, people with ‘Classic’ PCOS get diagnosed much more quickly.
‘non-classic’ pcos
The ’Non-Classic’ PCOS types easily get missed. We’re going to focus mostly on Type C here, as there’s a lot of debate as to whether Type D is actually true PCOS. Type C’s get regular periods, and because of that, they face much longer wait times to receive a proper and accurate diagnosis.
how metabolic health & weight factors in
Now here’s where things get a bit confusing – how weight and metabolic health fit into these phenotypes.
For the most part, those with ‘Classic’ PCOS tend to have issues with insulin and tend to struggle with weight loss resistance. Conversely, those with ‘Non-Classic’ PCOS tend to have better metabolic health and tend to be on the leaner side. This is why we often hear about ‘overweight’ and ‘lean’ PCOS phenotypes online and in research.
I don’t love using the terms ‘overweight’ or ‘lean’ PCOS because there are definitely exceptions to this rule. There are many women with ‘Classic’ PCOS who have no issues with weight or insulin resistance, despite showing all the classic PCOS signs and symptoms. There are also women with ‘Non-Classic’ PCOS who do struggle with insulin and weight gain. While this can feel extremely confusing, this is why understanding the underlying factors of PCOS are so important, and this is where the PCOS underlying factors come into play!
The Underlying Factors of PCOS
Based on the best available research we have, here are the underlying factors that drive PCOS forward. Remember, you can have one, some, or ALL these factors with PCOS:
Inflammation & Gut Dysfunction
Insulin Resistance – this factor has been associated with weight gain and difficulty losing weight.
Adrenal Hypersensitivity & Chronic Stress – this factor has been associated with higher stress hormone levels like ACTH, cortisol, and DHEAS. High DHEAS levels can help protect us from metabolic issues like insulin resistance and weight loss resistance.
Environmental Factors (diet, lifestyle, endocrine disrupting chemical exposures)
The important takeaway here is that you can have MULTIPLE factors driving your PCOS forward. This is why these ‘types’ of PCOS we hear about online are so misleading. You can have inflammation, insulin resistance, and adrenal hypersensitivity all at once. They are NOT distinct types of PCOS, and if you have multiple factors present, they all need to be addressed and treated equally!
This is also why you can have ‘Classic’ PCOS but be on the leaner side if you have adrenal hypersensitivity as part of your PCOS picture. Conversely, this is also why you can have ‘Non-Classic’ PCOS, and struggle with weight if insulin resistance is part of your PCOS presentation.
The bottom line is that when we pigeonhole someone with PCOS into these ‘types’ we’re seeing online, they might miss out on treatment they really need because their entire PCOS picture isn’t being addressed properly.
If you want to learn more about each of these factors, you can check out our PCOS course, The PCOS Series & stay tuned for future blog posts on this!
PCOS Comorbid Conditions
Last but not least, there are many conditions that co-occur at high rates with PCOS. This is where some of those other ‘types’ of PCOS come up. This includes conditions like hypothyroidism, and endometriosis.
I also want to briefly mention Post-Pill PCOS here, as this is often discussed as a PCOS ‘type’ online as well. There is no such thing as Post-Pill PCOS. If you are experiencing PCOS-like symptoms after coming off the pill, you may in fact have post-birth control syndrome. If these symptoms persist longer than two years, then you likely had PCOS even prior to going on the pill! Keep in mind that the pill may have just accelerated some of the underlying or driving factors of PCOS, such as insulin resistance or changes to adrenal function, hence why your symptoms may feel more prominent after discontinuing the pill.
Similar to our PCOS Factors, having a comorbid condition is not a ‘type’ of PCOS, but rather another barrier to address in PCOS treatment. Understanding and evaluating whether comorbid conditions are present is just good practice in treating PCOS properly – it’s not a TYPE of PCOS!
Why Does All of This Even Matter?
This matters because after going through the REAL PCOS types, phenotypes, underlying factors, and comorbid conditions, you can clearly see that PCOS is different in every single person that has it, and therefore very individualized treatment is required.
When we diagnose PCOS properly and truly understand all the unique nuances that are contributing to someone’s PCOS symptoms, then we are much more likely to find effective treatment!
A Final Word
Hopefully you have a solid understanding of the real PCOS Types, and all the various factors that play into this diagnosis now!
If you have PCOS and don’t know where to start, consider these steps:
Step 1 – Figure out your PCOS type
Step 2 – Figure out your phenotype
Step 3 – Understand what factors are present for you
Step 4 – Rule out comorbid conditions
Step 5 – Find a practitioner who understands this inside and out so you can receive proper treatment!
If you want more information about how we approach PCOS at our clinic, you can check that out here! PCOS is complicated, but it doesn’t have to be with directed and individualized care!
Ready to make a change?
If you want to learn more about how Naturopathic Medicine can support your PCOS, feel free to reach out to the clinic, or book a complimentary consult with me here.
With loving compassion,
Dr. Alessia Milano, ND