Graphic describing that this post is about the 4 types of PCOS and identifying the main driver of your PCOS symptoms

4 Types of PCOS: Which One Do You Have?

Do you have PCOS, but have no idea which of the four types of PCOS is driving your symptoms? You know it means you will “likely struggle with weight and fertility” but what else? Have you been researching PCOS to figure out what you can do instead of just taking Metformin, birth control and losing weight?

You’re not alone. Actually, only 11.9% of women diagnosed with PCOS felt satisfied with the lifestyle recommendations given to them upon diagnosis.

There’s so much to know about PCOS. What even is PCOS? What is the root cause of your symptoms? How do you know where to start when making diet and lifestyle modifications? 

In this article, I’m going to break down what PCOS is, what causes PCOS and introduce you to the 4 types of PCOS so that you know exactly where to start. 

What is PCOS? 

PCOS is the most common endocrine disorder in premenopausal women affecting 6-13% of women and is considered a condition of androgen excess. This means that your body is producing too much testosterone (a hormone produced in the ovaries).

All women produce some testosterone, however when there is too much, it can cause hormone imbalances within your body that can affect fertility. But, these hormone imbalances affect more than just fertility. They can affect appetite, metabolism, skin and mood, just to name a few! 

The condition is very individual with different phenotype criteria and 4 different types of PCOS producing different symptoms and therefore needing different lifestyle modifications. This is why band aid treatments like metformin and birth control just aren’t cutting it. 

What causes PCOS? 

Research still has not concluded for sure what causes PCOS, however there are some things that are possible. 

Inflammation

Some inflammation in the body is normal because it’s our body’s ability to protect itself and fight against infections. However, they are finding that too much or chronic inflammation can cause problems like insulin resistance, gut issues and hormone imbalances.

Oxidative Stress

Oxidative stress levels (stress on our body and it’s cells) are higher in women with PCOS, which can cause damage to the cells.

Fetal Programming

Some research has shown that if fetus is exposed to high androgen levels or endocrine disrupting chemicals such as plastic water bottles or air pollution, it could promote androgen production

Dysbiosis

They have also found that women with PCOS have an imbalance in gut microbiota, called dysbiosis. This means you have more “bad” bacteria that can lead to inflammation in the gut. This can cause hormone imbalances within the body that leads to androgen production 

How do you get diagnosed with PCOS? 

In order to get diagnosed with PCOS, you must meet 2 out of these 3 criteria… 

1. Irregular periods or anovulation 

This would mean that you experience 8 or fewer menstrual cycles per year or your menstrual cycles are longer than 35 days 

2. Signs of hyperandrogenism 

You would meet this criteria if you have had elevated testosterone, DHEA-sulfate or androsterone levels through blood work. However, you could have physical signs of high androgen levels such as, hair growth on upper lip, chin or other areas, hair thinning or loss around hairline or acne around jawline. 

3. Polycystic ovaries 

A common misconception is that you have to have ovarian cysts in order to have PCOS. However, this is untrue and they actually aren’t even cysts on your ovaries. They are follicles! 

If your doctor sees 12 or more follicles on your ovaries or your ovarian volume is greater than 10 centimeters via a pelvic ultrasound, you would meet this criteria.

Graphic summarizing the 3 diagnostic criteria for PCOS including irregular periods or anovulation, clinical or physical signs of high androgen levels and polycystic ovaries

How to Treat PCOS

The typical treatment for PCOS upon diagnosis is Metformin for weight, appetite and insulin levels. Birth control for acne and irregular periods as well as a diet of some sort to help you lose weight. But, this doesn’t reflect that not every person with PCOS is going to experience the same symptoms. This is because their root causes are going to be different. 

The best way to address your PCOS symptoms is to…

  • Identify which of the 4 types of PCOS is driving your symptoms
  • Create sustainable diet and lifestyle modifications to address the root cause 
  • Use supplements and medications, whenever necessary

The 4 Phenotypes

So now you likely know which of the three criteria you meet, but what do you do with that information? The first step to understanding your PCOS is to know your phenotype. There are four different phenotypes depending on which PCOS diagnostic criteria you meet. See the infographic below to see which phenotype you fit into. 

Graphic summarizing the 4 phenotypes of PCOS: type A "classic", type B "classic", type c "non-classic" and type D "non-classic"

The specific phenotype helps you to better understand what symptoms and labs are related to your PCOS diagnosis. However, we can take it a step further with this information and see specifically what is driving your PCOS symptoms. We do this by identifying which of the 4 types of PCOS you have.  

Main Drivers of PCOS 

The 4 Types of PCOS that you may fall under will give you a better understanding of where to start with your diet and lifestyle modifications. The four types are as follows: 

1. Insulin Resistant PCOS

This type affects about 80% of women with PCOS. What this means is that your body is unable to use insulin adequately. Therefore, the excess insulin is causing other hormone imbalances that can affect appetite, cravings, mood, metabolism and skin. To see if you have insulin resistant PCOS check out this blog! 

2. Inflammatory PCOS

Most women with PCOS also have a bit of inflammation, which can affect insulin resistance and gut health. For that reason, you will often see symptoms affecting skin, digestion and mood with this type of PCOS. Click here to see more about Inflammatory PCOS! 

3. Adrenal PCOS

Less common, adrenal PCOS means that you have hormonal imbalances with your hormones, cortisol and DHEA-sulfate. You will often see symptoms similar to the others, however you will usually experience worse mood symptoms. Check out this post to see what adrenal PCOS entails!

4. Pill-Induced PCOS 

This type of PCOS is temporary and is a symptom of coming off the pill. A great indicator is to ask yourself, “did I have these symptoms prior to taking the pill?”. If you didn’t, it’s likely these symptoms are driven by coming off the pill. However, if you experienced symptoms prior to going on the pill, it is likely you had PCOS back then and just missed a diagnosis. 

You will likely only see elevated LH:FSH ratio, which means you have higher levels of luteinizing hormone than follicle-stimulating hormone. This imbalance can cause androgen production and cause PCOS symptoms.

Be patient and know that it is nothing you did wrong. Pill-induced PCOS is just a temporary androgen surge caused by the suppression of hormones while on hormonal birth control. 

Make sure that you are eating adequately, managing stress, getting adequate sleep and gentle movement. With time, you will see these symptoms improve. 

Here’s the tea!

PCOS is a complex condition that requires an in-depth look at your symptoms and labs in order to fully understand the root cause. As you can see, there are 4 types of PCOS, which are impacted by different hormones and systems in the body. Once you know your root cause, recommendations can then be made to address the root cause and relieve symptoms through diet and lifestyle modifications.

Are you ready to gain clarity and confidence in your PCOS management? If so, you can click this link to apply to work with me 1:1. In my 1:1 nutrition program, I teach you to identify your root cause and make recommendations for diet and lifestyle changes to alleviate symptoms without dieting!

  1. […] While there is no cure for PCOS, diet and lifestyle changes have been proven quite effective in reducing and managing symptoms. To determine the right diet and lifestyle changes for you, it’s vital to understand what specific type of PCOS you’re dealing with. To learn more about the different phenotype criteria and the 4 different types of PCOS, check out this blog post! […]

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