Are There Different Types of PCOS?

I often get the question “what type of PCOS do I have, and can you give me tips for eating for my PCOS type?”

I understand where this question comes from because there’s so much information floating around on social media about the ‘“types” of PCOS. Let’s chat about this further so that you can have a better understanding of this.

Different “Types” of PCOS from the Naturopathic and Functional Medicine Space

If you’ve googled around or follow PCOS influencers on social media then you may have heard that there are four different “types” of PCOS. I’m honestly not quite sure where these originated but they’re very popular in the naturopathic and functional medicine spaces. They say that the 4 “types” are insulin resistant, inflammatory, adrenal PCOS and post-pill PCOS.

I want to stress that these types are not currently reflected in PCOS research and are not recognized by traditional western medicine. They are not part of the International Guidelines for Treating PCOS and your doctor may not have even heard of them!

Below I’m going through each “type” and why they aren’t currently used in your treatment:

1. Insulin Resistant Type: Insulin Resistance and PCOS

Most people with PCOS, around 80%, have insulin resistance. High insulin levels can cause the ovaries to produce extra testosterone, resulting in PCOS symptoms like a missing period, acne, hair loss, and hirsutism. 

Here’s why I don’t love that this is a separate category for PCOS. Research has really pointed to insulin resistance being at the center of PCOS for most people. Even those who currently don’t have insulin resistance are more predisposed to developing it. And people with insulin resistance can also have excess inflammation or elevated DHEA-S as we’ll discuss below. 

Sometimes I work with clients who think they don’t have insulin resistance and they’ve diagnosed themselves with “another type”. But by looking into their labs further, we find that they do actually have insulin resistance. 

I find that the topic of insulin resistance and PCOS can feel especially confusing because the appropriate labs are not being checked to rule out insulin resistance. A fasting glucose and A1c alone cannot rule out insulin resistance with PCOS, and it’s common that these can be “normal” but underlying insulin resistance is still occurring.

If you want more information about this then check out my PCOS lab guide for the appropriate labs to request to see if you have insulin resistance. It’s not just your fasting glucose!

If you have insulin resistance, you can work with a trusted dietitian to help improve your symptoms. This is what I help my clients with, and I also have a few blog posts on nutrition and supplements to get you started.

2. Inflammation and PCOS

In my opinion, it’s a bit misleading to categorize an entire “type” of PCOS around inflammation because generally, PCOS is an inflammatory condition. Insulin resistance is also inflammatory. I recommend that *everyone* with PCOS work on anti-inflammatory nutrition and lifestyle habits. 

Decreasing inflammation IS an important part of managing PCOS. Having other inflammatory issues like gut issues or an autoimmune condition likely makes PCOS worse. But I do not agree that it is a separate category.

3. Adrenal PCOS

The functional space describes adrenal PCOS as when more DHEA is produced from your adrenal glands due to stress. Stress management is the recommended treatment. 

This was specifically brought up at the latest PCOS symposium, and PCOS researchers (many of whom are endocrinologists) disagreed with this theory. They stated that newer research suggests DHEA can be produced in other parts of the body and that we don’t really know enough about elevated DHEA to categorize PCOS in this way.

It’s important to note that stress management is important for anyone with PCOS! It’s not just a separate category. Stress can make insulin resistance worse and is inflammatory.

4. Post-Pill PCOS

The last “type” of PCOS from these categories is described as post-pill PCOS. This refers to a period of time after you stop taking birth control pills, and androgens (male sex hormones) increase. You may experience physical symptoms like irregular periods and acne. This “type” is thought to resolve after a few months as your body adjusts to not taking birth control. 

There is no research to suggest that the birth control pill causes PCOS, or that PCOS occurs when coming off of the pill.

Sometimes people think they have “post-pill” PCOS when they come off of the pill and then get diagnosed with PCOS. It’s important to remember that birth control pills can mask your PCOS symptoms (such as acne and irregular periods or ovulation). If you came off the pill and were diagnosed with PCOS, ask yourself if you had ANY PCOS symptoms before you started the pill.

PCOS Phenotypes

As of now, the only official categories for PCOS are the PCOS phenotypes listed in the The Rotterdam criteria for diagnosing PCOS.

They’ve created categories based on which diagnostic criteria someone meets. 

• Phenotype A: Elevated androgens (male sex hormones such as testosterone), irregular periods, and polycystic ovaries (ultrasound evidence of excess follicles on the ovaries from not ovulating)
• Phenotype B: Elevated androgens & irregular periods
• Phenotype C: Elevated androgens & polycystic ovaries
• Phenotype D: Irregular periods & polycystic ovaries

Even though these phenotypes exist, they are not typically not used in treatment of PCOS. So far the only time these are really discussed is understanding that someone in Phenotype A is probably going to experience more severe physical symptoms of PCOS. There aren’t separate treatments or nutrition recommendations for the specific phenotypes.

Conclusion and Future Research

To sum things up, please don’t stress about your ‘PCOS type’ or how this affects your treatment. PCOS treatment should be based on your own individual labs and symptoms. 

There IS a lot of chatter in the PCOS research space delving into how PCOS develops and why people experience different symptoms. I do strongly believe in the future that there may actually be separate categories in different types of treatments depending on certain circumstances!

Sources

1. Cooper, J. (2022, February 16). The 4 types of PCOS. Advanced Functional Medicine. Retrieved July 28, 2022, from https://advancedfunctionalmedicine.com.au/4-types-of-pcos/ 
2. Pollie Team. (2022, May 13). The four main types of PCOS [web log]. Retrieved July 28, 2022, from https://www.pollie.co/blog/pcos-types. 
3. Groves, M. (2020, August 2). What Type of PCOS do You Have? [web log]. Retrieved July 28, 2022, from https://thehormonedietitian.com/types-of-pcos/. 
4. National Human Genome Research Institute, www.genome.gov (2022). Retrieved July 28, 2022, from https://www.genome.gov/genetics-glossary/Phenotype. 
5. Sachdeva, G., Gainder, S., Suri, V., Sachdeva, N., & Chopra, S. (2019). 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), 326–331. https://doi.org/10.4103/ijem.IJEM_30_19

Abstract: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683693/

6. Rebar, R. W. (2020, September). Ovulatory Dysfunction . Merck Manuals Professional Edition. Retrieved August 3, 2022, from https://www.merckmanuals.com/professional/gynecology-and-obstetrics/infertility/ovulatory-dysfunction
7. National Library of Medicine, Riaz, Y., & Parekh, U., https://www.ncbi.nlm.nih.gov/ (2021). Retrieved July 28, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK560575/. 
8. Hyperandrogenism: What is it, symptoms and treatment. www.topdoctors.co.uk. (n.d.). Retrieved July 28, 2022, from https://www.topdoctors.co.uk/medical-dictionary/hyperandrogenism#