What Type of PCOS Do I Have and How to Identify It

Polycystic Ovarian Syndrome, or PCOS, is a hormonal disorder that affects nearly one in ten women worldwide. Characterized by irregular menstrual cycles, excessive androgen levels, and cysts on the ovaries, PCOS has a significant impact on women's health and quality of life. The condition can lead to various complications, including infertility, metabolic issues, and emotional distress.

Many cases of PCOS can be classified as one of four different subtypes, following a distinct pattern of symptoms and underlying imbalances. Arguably, one of the reasons women struggle to achieve effective treatment may be due to being grouped under a single diagnosis, because PCOS subtypes respond differently to therapy and have different long-term outcomes.

This post will guide you through the four distinct PCOS subtypes, explain why some cases of PCOS may not fall into one of these types, and how integrative medicine can offer effective, personalized solutions no matter your PCOS subtype.

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The 4 PCOS Subtypes

Insulin-Resistant PCOS

Insulin-Resistant PCOS is the most common subtype, affecting about 70% of women with PCOS (1). This type is characterized by high levels of insulin in the blood, which commonly leads to weight gain, acne, and excessive hair growth. Insulin-resistant PCOS is often thought of as the "classic" presentation of PCOS, leading to misdiagnosis when symptoms don't match this criteria.

Women with this subtype often struggle with obesity and are at increased risk for type 2 diabetes and cardiovascular diseases even after their reproductive years (2).

Inflammatory PCOS

Inflammatory PCOS is identified by chronic inflammation, which can cause the ovaries to produce excess androgens. Symptoms include skin conditions like acne or eczema, unexplained fatigue, and digestive issues such as irritable bowel syndrome (IBS).

Inflammation markers like CRP (C-reactive protein) are usually elevated in women with this subtype (3).

Adrenal PCOS

Adrenal PCOS is less common and is associated with the overproduction of androgens by the adrenal glands rather than the ovaries. This subtype often manifests during adolescence and is triggered by stress.

Symptoms include elevated DHEA-S levels (a hormone produced by the adrenal glands), anxiety, and irregular menstrual cycles (4).

Post-Pill PCOS

Post-Pill PCOS occurs after discontinuing birth control pills, particularly those that suppress testosterone. This subtype is usually temporary, and symptoms might resolve themselves within a few months. Women with Post-Pill PCOS often experience acne, hair loss, and irregular periods shortly after stopping oral contraceptives.

Many providers don't strictly classify PCOS patients by these types, because so many women do not fit neatly into just one of these subtypes. More often than not, many women experience a combination of these PCOS subtypes, having symptoms that overlap one type with another.

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PCOS Subtypes May be Genetic

A recent study proposed a new categorization for type of PCOS based on genetic markers. The researchers then categorized women who had PCOS into 3 different groups based on their hormonal profiles and genetic markers. These groups were (5):

Reproductive group – higher LH & SHBG, but lower BMI, insulin, & glucose levels
Metabolic group – higher BMI, insulin, & glucose levels, with relatively low SHBG and LH levels
Indeterminate – did not neatly fit into either group

About 40% of women did not fit clearly into the reproductive group or the metabolic group because the values measured were between those of the reproductive and metabolic subtypes. Women with the reproductive subtype were significantly more likely to carry a genetic variation affecting androgen production in the ovaries.

Identifying Your PCOS Type

Recognizing your unique PCOS subtype is a helpful first step toward effective management. Here’s how you can identify your type through symptoms and diagnostic tests:

Symptom Analysis

Insulin-Resistant PCOS: Look for signs of weight gain, skin tags, dark patches of skin (acanthosis nigricans), and irregular periods.
Inflammatory PCOS: Be aware of chronic fatigue, skin issues, joint pain, and gut health problems.
Adrenal PCOS: Notice if you have persistent anxiety, high stress levels, and menstrual irregularities.
Post-Pill PCOS: Pay attention to breakouts, hair shedding, and cycle changes after stopping birth control pills.

Diagnostic Tests

Consult a healthcare provider for comprehensive diagnostic tests:

Blood Tests: Measure insulin, fasting blood glucose, and androgen levels.
Ultrasound: Check for the presence of cysts on the ovaries.
Inflammation Markers: Assess CRP levels for inflammatory PCOS.
Hormone Panels: Evaluate DHEA-S levels for adrenal PCOS.

Contact a patient care coordinator now to discuss hormone testing options.

What If Your PCOS Does Not Match a Type?

Unfortunately, misdiagnosis and delayed diagnosis are not uncommon when women experience reproductive & metabolic disorders like PCOS. There are also other health conditions that may mimic PCOS, but are not.

Hypothalamic amenorrhea (HA) causes missing periods due to low levels of GnRH, a hormone made in the hypothalamus that regulates the reproductive system. Severe under-eating, excessive exercise or stress, low body fat, and other factors that affect the hypothalamus are among the root causes for hypothalamic amenorrhea. HA symptoms may overlap with PCOS. It’s possible to have both HA and PCOS, but HA can exclude a PCOS diagnosis.

Similarly, a low or underactive thyroid (hypothyroid) can also cause irregular cycles and lack of ovulation. The bottom line: if your period is irregular or missing completely, it’s crucial to work with an integrative team who will guide you to identify and address the root cause.

Integrative Medicine Approaches for PCOS

Integrative medicine combines conventional treatments with alternative therapies to address the root causes of PCOS. Here are some effective approaches:

Lifestyle Modifications

Exercise: Regular physical activity helps improve insulin sensitivity and reduce inflammation.
Stress Management: Techniques like yoga, meditation, and deep-breathing exercises can lower stress hormones.

Dietary Changes

Low-Glycemic Diet: Focus on whole foods, lean proteins, and healthy fats to manage insulin levels.
Anti-Inflammatory Foods: Incorporate turmeric, ginger, and omega-3 fatty acids to combat inflammation.
Balanced Meals: Ensure your diet includes a variety of nutrients to support overall health & support healthy blood sugar.

Holistic Therapies

Acupuncture: Can help regulate menstrual cycles and reduce stress.
Herbal Supplements: Herbs like inositol, spearmint tea, and chasteberry may improve symptoms.
Nutritional Supplements: Consider vitamins D and B12, magnesium, and omega-3s to replenish nutrients.

Expert Insights

Dr. Taz, our founder and double board certified physician in women’s health and integrative medicine, shares her insights on managing PCOS. According to Dr. Taz, “Many patients often go misdiagnosed for a period of time, because they don’t fit the classical textbook picture that is taught in medical school; grossly overweight, balding and with acne. Most patients I meet, including myself, have a more subtle version of these extremes.”

When treating PCOS, she believes it’s crucial to assess patients as an individual—there is no one-size-fits-all when it comes to PCOS treatment.

For PCOS solutions tailored to your unique chemistry, contact us to get started.

What to Remember

Understanding the subtype of PCOS you have can be incredibly useful in helping you and your integrative healthcare team effectively manage your PCOS symptoms. However, there are some cases of PCOS that may not fit neatly into one of these subtypes. It’s essential to work closely with your healthcare provider to develop a personalized treatment plan that addresses all of your individual needs.

With the right approach, it is possible to live well with PCOS and thrive in all aspects of life.

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