By Kym Campbell, BSc. | Updated February 3rd, 2023

Identifying which “type” of PCOS you have often isn’t helpful. It’s more important to know that all PCOS symptoms are caused by three underlying mechanisms. These mechanisms exist on a spectrum creating a unique set of symptoms for each individual. These symptoms can also change over time.

Creating sub-groups of PCOS distracts from the nuances of an individual diagnosis. It also adds confusion to the most salient facts about treatment. That is, the same diet and lifestyle changes are needed regardless of what type you have.

This can be seen among the diverse group of women who take part in my free 30-Day PCOS Diet Challenge. Their goals differ, but the treatment is the same.

The 4 Allopathic Types of PCOS

The mainstream medical community has identified 4 types of PCOS.

These classifications show that women with Frank PCOS have the greatest metabolic health risks. By comparison, PCOS women with normal androgen levels have fewer health risks [1, 2]. They show that PCOS exists on a spectrum. They then chop this spectrum up into discrete categories.

This classification system is based on PCOS diagnostic criteria. They may help improve the quality of research. But they’re not that useful from a patient’s perspective.

Doctors work best when they treat based on personal circumstances. Placing people in different buckets may miss important aspects of an individual diagnosis. For example, a doctor may assume that all women with Frank PCOS are overweight. This can lead to PCOS being missed in normal-weight women. This is what happened to me and many other women I meet through my free 30-Day PCOS Diet Challenge.

The 4 Functional Types of PCOS

Naturopathic and functional medicine takes a more pragmatic approach to categorizing PCOS. They identify the following 4 types of PCOS:

• Post-Pill PCOS
• Adrenal PCOS
• Insulin Resistant PCOS
• Inflammatory PCOS

Post-pill PCOS is where non-PCOS women show PCOS-like symptoms after going off the pill. This is generally a temporary problem that can resolve on its own. It’s not actually a form of PCOS. It’s more of a simple way to explain a common diagnosis. By creating a category for post-pill PCOS healthcare providers can identify “true” cases of PCOS, versus those that just look like it.

Adrenal PCOS is based on the functioning of your adrenal glands. Your adrenals can be normal, or they can overproduce the androgen DHEA-S [3]. Estimates suggest high DHEA-S levels affect around 20 – 30% of PCOS patients [4]. Identifying this problem is helpful from a treatment perspective. Addressing adrenal dysfunction can help resolve PCOS symptoms. But the status of your adrenal glands is independent of your PCOS diagnosis. It’s not really a type of PCOS. It’s more of an add-on to any of the other “types”.

One of the biggest shortcomings of the functional types of PCOS is the separation of insulin resistance and inflammation. These two factors are too intertwined to identify a difference between them.

Inflammation causes insulin resistance [5]. Insulin resistance creates inflammation [6]. The reality is that women with PCOS need to address both of these factors together.

Yes, you can have PCOS and normal insulin sensitivity. But this doesn’t mean you’re off the hook as far as insulin resistance goes. Lean PCOS women with normal insulin sensitivity still benefit from reducing insulin secretion [7]. This is because insulin impacts androgen levels.

Inflammation also isn’t a distinct “type” of PCOS. That’s because it’s a primary problem for everyone with PCOS (more on this shortly). PCOS is inherently an inflammatory disorder. There’s no PCOS diagnosis without chronic inflammation.

The Cause of All Types of PCOS

From a patient’s perspective, there’s a much simpler way to understand PCOS.

There are three key drivers of all PCOS symptoms [8-13]:

• Elevated androgens
• Poor insulin regulation
• Chronic inflammation

Each of these factors exists on a spectrum. If your hair falls out or you have acne or hirsutism, then your androgen dial is turned up. If you have trouble maintaining a healthy body weight then your insulin regulation is likely to be poor. If you don’t get a regular period, then this could be affected by all three mechanisms.

What’s more, none of these factors are static. Major life events can alter your diagnosis. Birth control, pregnancy, and breastfeeding can all alter your symptom presentation. Trauma, surgery, infections, or toxins can also change your immune and endocrine systems.

This simple understanding of PCOS covers all the various ways this diagnosis manifests.

It also points towards the best approach to treatment.

Same Treatment No Matter Your Type

Imbalances in the gut microbiome drive most of the pathology seen in PCOS [14, 15]. An unhealthy diet is also a primary contributor [16]. Poor gut health and a bad diet activate all three mechanisms that drive PCOS.

This is why a PCOS diet is a prerequisite to getting your symptoms under control. If you eat poorly, then any other treatment is likely to have limited benefits. This is why so many women see great results during my free 30-Day PCOS Diet Challenge. I’ve heard from many women who feel better just after trying my free 3-Day PCOS Meal Plan.

There are many other things you can do on your own too.

For example, adding basic nutritional supplements further improves the benefits of diet. Vitamin D and inositol supplements are the most obvious places to start.

As I outline in my PCOS natural treatment article, a combination of other interventions can have a significant impact. These include:

• Improving sleep quality
• Exercising regularly
• Actively reducing stress
• Avoiding endocrine-disrupting chemicals
• Minimizing other environmental toxins (especially in drinking water)

When it comes to seeking healthcare, a functional/naturopathic medicine approach is best. A good practitioner can optimize results after you’ve modified your diet and lifestyle. They’re likely to check your thyroid and adrenal function. They can also check your nutrient status and add further supplements. When it comes to herbal medicines, the treatment options are endless.

With the right help and support, a lot of medical interventions can be avoided. This includes fertility treatment and insulin-regulating drugs like metformin.

This is what it means to take back control of your health and fertility.

The Bottom Line

The idea of there being different types of PCOS applies to specific circumstances. Scientists doing research, or clinicians trying to identify pathology. But these categories can be limiting for patients.

The best way to understand PCOS is that there are three drivers of all symptoms. Elevated androgens, poor insulin regulation, and chronic inflammation. These factors exist on a spectrum and can change over time.

By understanding these causes of PCOS, you can take ownership of your treatment. You can understand why diet and lifestyle changes are so effective. You’re also better placed to advocate for the best possible healthcare.

Author

Kym Campbell

Since 2010, Kym Campbell has used evidence-based diet and lifestyle interventions to manage her PCOS. After getting her symptoms under control and falling pregnant naturally, Kym now advocates for dietary change as part of any PCOS treatment plan. Combining rigorous science and clinical advice with a pragmatic approach to habit change, Kym is on a mission to show other women how to take back control of their health and fertility. Read more about Kym and her team here.

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References

¹Clark, N.M., et al., Prevalence of Polycystic Ovary Syndrome Phenotypes Using Updated Criteria for Polycystic Ovarian Morphology: An Assessment of Over 100 Consecutive Women Self-reporting Features of Polycystic Ovary Syndrome. Reproductive Sciences, 2014. 21(8): p. 1034-1043.

²Sachdeva, G., et al., Comparison of the Different PCOS Phenotypes Based on Clinical Metabolic, and Hormonal Profile, and their Response to Clomiphene. Indian J Endocrinol Metab, 2019. 23(3): p. 326-331.

³Gourgari, E., et al., Bilateral Adrenal Hyperplasia as a Possible Mechanism for Hyperandrogenism in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab, 2016. 101(9): p. 3353-60.

⁴Yildiz, B.O. and R. Azziz, The adrenal and polycystic ovary syndrome. Rev Endocr Metab Disord, 2007. 8(4): p. 331-42.

⁵Matulewicz, N. and M. Karczewska-Kupczewska, Insulin resistance and chronic inflammation. Postepy Hig Med Dosw (Online), 2016. 70(0): p. 1245-1258.

⁶Gasmi, A., et al., Obesity and Insulin Resistance: Associations with Chronic Inflammation, Genetic and Epigenetic Factors. Curr Med Chem, 2021. 28(4): p. 800-826.

⁷Baillargeon, J.P. and A. Carpentier, Role of insulin in the hyperandrogenemia of lean women with polycystic ovary syndrome and normal insulin sensitivity. Fertil Steril, 2007. 88(4): p. 886-93.

⁸Carvalho, L.M.L., et al., Polycystic Ovary Syndrome as a systemic disease with multiple molecular pathways: a narrative review. Endocr Regul, 2018. 52(4): p. 208-221.

⁹González, F., Inflammation in Polycystic Ovary Syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids, 2012. 77(4): p. 300-5.

¹⁰González, F., et al., Hyperandrogenism sensitizes mononuclear cells to promote glucose-induced inflammation in lean reproductive-age women. Am J Physiol Endocrinol Metab, 2012. 302(3): p. E297-306.

¹¹Popovic, M., G. Sartorius, and M. Christ-Crain, Chronic low-grade inflammation in polycystic ovary syndrome: is there a (patho)-physiological role for interleukin-1? Seminars in Immunopathology, 2019. 41(4): p. 447-459.

¹²Rudnicka, E., et al., Chronic Low Grade Inflammation in Pathogenesis of PCOS. Int J Mol Sci, 2021. 22(7).

¹³Wang, J., et al., Hyperandrogenemia and insulin resistance: The chief culprit of polycystic ovary syndrome. Life Sciences, 2019. 236.

¹⁴Tremellen, K. and K. Pearce, Dysbiosis of Gut Microbiota (DOGMA)–a novel theory for the development of Polycystic Ovarian Syndrome. Med Hypotheses, 2012. 79(1): p. 104-12.

¹⁵Shan, H., et al., Abnormal Endometrial Receptivity and Oxidative Stress in Polycystic Ovary Syndrome. Front Pharmacol, 2022. 13: p. 904942.

¹⁶Barrea, L., et al., Source and amount of carbohydrate in the diet and inflammation in women with polycystic ovary syndrome. Nutr Res Rev, 2018. 31(2): p. 291-301.