PCOS (Polycystic Ovarian Syndrome) is called a ‘syndrome’, because it is a collection of symptoms, which vary from woman to woman. Depending on the symptoms, women with PCOS can be categorized into certain ‘types’. In this blog post I would like to share with you two ways, in which women with PCOS can be classified – one less known classification according to conventional medicine and a more popular classification, which is often seen on social media and which is based on a holistic approach to PCOS stemming from functional medicine.
The PCOS Types According to Conventional Medicine
Doctors follow the Rotterdam Criteria from 2003 to diagnose PCOS. In order to obtain a diagnosis, at least two out of the three following symptoms have to be apparent:
- Lack of ovulation, usually manifest through irregular cycles or missing periods,
- Elevated levels of androgens (male hormones such as testosterone), and
- Small cysts on the ovaries (presence of 12 or more follicles of 2 to 9 mm in diameter in each ovary).
Depending on the number and kinds of symptoms diagnosed with, women with PCOS fall into one out of four different categories of phenotypes. These phenotypes descent in their severity – from A being the most severe and D being the mildest type.
Type A – Also called classic polycystic ovary PCOS. In this type, all 3 criteria are met and we are dealing with the presence of ovarian cysts, high levels of androgens and lack of ovulation.
Type B – Is also called classic non-polycystic ovary PCOS. In this type, the ovaries appear normal, but androgens are elevated and ovulation is absent.
Type C – Nonclassic ovulatory PCOS. In this type, cycles are regular and ovulation is taking place, but symptoms related to high levels of androgens and cysts on the ovaries are apparent.
Type D – Nonclassic, mild PCOS. In this type we find a lack of ovulation and polycystic ovaries, but no elevated levels of androgens. (1)
Since Type A presents with symptoms meeting all points mentioned in the Rotterdam Criteria, it is the most severe type and associated with higher metabolic and cardiovascular risks. Unfortunately, this phenotype is the most prevalent.
According to a study done in 2019, in which 164 women participated, 67.7% had Phenotype A These women had a significantly higher weight, body mass index (BMI), signs of elevated androgens, menstrual irregularities, as well as higher levels of insulin, and a more abnormal lipid profile. (2)
The PCOS Types According to Functional Medicine
Let’s move on to the second kind of ‘PCOS Types’. Functional medicine, which uses a more holistic approach to healing, follows a slightly different way of classifying women with PCOS, which is based on the underlying root causes of the disease. This classification doesn’t really follow a hierarchy of severity. Nevertheless, it is made up out of four categories as well, which are:
The Insulin Resistant Type – About 70% of women with PCOS fall into this category. In this case, insulin resistance is driving their PCOS. Symptoms include acne, excess hair growth on the face, back and chest, male-pattern baldness and irregular periods. It is also common to easily gain weight and having a hard time losing it.
The Inflammatory PCOS Type – Women with underlying inflammation tend to have symptoms like digestive issues such as IBS (Irritable Bowel Syndrome), unexplained fatigue, headaches, joint pain, skin conditions and even food sensitivities or auto-immune diseases like Hashimoto’s (Hypothyroidism).
The Adrenal PCOS Type – When insulin resistance has been ruled out and tests for elevated androgens show only DHEA-S (produced in the adrenal glands) being elevated while levels of testosterone and androstenedione (produced mainly in the ovaries) are normal, it is most likely adrenal PCOS. Symptoms might include missing periods, acne, or difficulty falling and staying asleep. Stress in an underlying cause for about 20-30% of women with PCOS. (3)
The Post-Pill PCOS Type – This happens, when women get off the birth control pill, which can cause a temporary spike in androgens, which were lowered by the birth control pill. LH levels might be elevated as well and you will experience symptoms like missing periods, acne, or hair loss.
There is an interconnectivity between all of these types. A woman with PCOS usually doesn’t fall into just one category. Insulin resistance, for example, raises blood markers for inflammation (4) and, vice versa, inflammation seems to be an underlying cause for insulin resistance in the first place. There also is a strong connection of elevated stress hormones and excess insulin and testosterone.
Like in functional medicine, as PCOS Health Coach, I use a holistic approach to healing. It means looking deeper into the specific symptoms and root causes and addressing them with the right kind of diet, supplements, exercise and lifestyle hacks.
I hope this information is helpful to you. Please leave a comment on what you think might be the underlying cause of your PCOS symptoms.
You can also take the quiz: https://myhappyovaries.com/pcos-quiz/
Sending you my love,
- Brito Pateguana, N. (2020). The PCOS Plan: Prevent and Reverse Polycystic Ovary Syndrome through Diet and Fasting (1st ed.). Greystone
- Sachdeva, Garima et al. “Comparison of the Different PCOS Phenotypes Based on Clinical Metabolic, and Hormonal Profile, and their Response to Clomiphene.” Indian journal of endocrinology and metabolism 23,3 (2019): 326-331. doi:10.4103/ijem.IJEM_30_19
- Axe, J. (2019). Keto Diet. Your 30-Day Plan to Lose Weight, Balance Hormones, Boost Brain Health, and Reverse Disease (1st). Little, Brown Spark
- Gottfried, S. (2013). The Hormone Cure (1st). Scribner