4 PCOS Types and Finding the Type of PCOS You Have

PCOS Part 1: Diagnosing & Understanding Your Type

What is PCOS?

Polycystic Ovarian Syndrome (PCOS) is a common hormonal disorder affecting millions of women worldwide. Often compared to the “IBS of hormones,” PCOS is frequently overdiagnosed and treated with a one-size-fits-all approach—typically birth control pills or metformin for PCOS. However, not all PCOS cases are the same, and understanding the different types of PCOS is essential for effective management.

How is PCOS Diagnosed?

Diagnosis of PCOS symptoms is based on the Rotterdam Criteria, which requires the presence of at least two out of the following three conditions:

1. Irregular or Absent Menstrual Cycles – Missing periods for at least three months or irregular periods exceeding 35 days with significant variation.
2. Polycystic Ovaries – This differs from ovarian cysts. Polycystic ovaries contain numerous small follicles (fluid-filled sacs that house eggs) that fail to mature and ovulate.
3. Elevated Androgens – Increased levels of testosterone, DHEA, or DHT confirmed through bloodwork, often accompanied by acne, excessive facial/body hair growth, or hair thinning due to PCOS.

Understanding your PCOS type is crucial for determining the most effective PCOS treatment options.

The Four Main Types of PCOS

1. Insulin-Resistant PCOS (Most Common)

What it is: High insulin levels cause the ovaries to produce excess androgens, disrupting ovulation and leading to PCOS weight gain.

Symptoms:

• Frequent hunger, headaches, or fatigue between meals
• Fatigue or excessive thirst after eating
• Sugar cravings and lack of fullness cues
• Unexplained weight gain with PCOS
• Darkened, velvety skin patches or skin tags

Testing:

• Fasting insulin (Optimal: 2-8)
• Hemoglobin A1C (Optimal: 4.8-5.3)
• Fasting glucose (Optimal: 70-90)
• Continuous Glucose Monitoring (CGM) for deeper insights if standard bloodwork appears normal

2. Post-Pill PCOS (Common After Stopping Birth Control)

What it is: Discontinuing hormonal birth control (pills or IUDs) can trigger a temporary rebound surge in androgens, leading to PCOS-related symptoms.

Symptoms:

• Hormonal acne breakouts
• Excess facial/body hair growth
• Hair thinning or shedding
• Irregular or missing periods
• Low progesterone levels and anovulation

Testing:

• Track ovulation with BBT or LH test strips
• Mid-luteal progesterone testing (DUTCH test preferred)
• Evaluate symptom timeline in relation to birth control discontinuation

3. Adrenal PCOS (“Lean PCOS”)

What it is: Dysfunction in the Hypothalamic-Pituitary-Adrenal (HPA) Axis due to an abnormal stress response, leading to excess adrenal androgen production.

Symptoms:

• Trouble sleeping or feeling wired but exhausted
• Energy crashes and caffeine dependence
• Anxiety, stress intolerance

Testing:

• Cortisol levels (saliva or urine – tested at four points throughout the day)
• DHEA levels (both too high and too low can indicate dysfunction)

4. Inflammatory PCOS

What it is: Chronic inflammation in PCOS causes the ovaries to overproduce androgens, leading to disrupted ovulation and hormonal imbalances.

Symptoms:

• Frequent headaches
• Joint pain or muscle aches
• Persistent fatigue
• Digestive issues (bloating, IBS-like symptoms)
• Skin problems (eczema, acne, or rashes)

Testing:

• hs-CRP (Optimal: <1)
• Homocysteine (Optimal: 5-7)

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Understanding Your PCOS Type is Key

PCOS is not a one-size-fits-all condition, and effective PCOS management depends on correctly identifying your type. Whether it’s insulin resistance PCOS, post-pill PCOS, adrenal dysfunction, or chronic inflammation, targeted PCOS diet and lifestyle changes can make a significant difference in PCOS symptom management.

Stay tuned for PCOS Part 2, where we’ll explore natural PCOS treatments, hormone balancing tips, and medical strategies tailored to each PCOS type!

For a more detailed breakdown- you can listen or watch my podcast- Root Cause Radio!