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.

Frank PCOS (a.k.a “Full-blown” PCOS)

  • Irregular periods
  • Elevated androgens
  • Polycystic ovaries
Ovulatory PCOS

  • Regular periods
  • Elevated androgens
  • Polycystic ovaries

  • Irregular periods
  • Elevated androgens
  • Normal ovaries
Normoandrogenic (a.k.a “Mild”) PCOS

  • Irregular periods
  • Normal androgen levels
  • Polycystic ovaries

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:

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.

Ready to Take Action?

  • Join my next free 30-Day PCOS Diet Challenge here. This is a live program where you’ll receive weekly meal plans and helpful video lessons. You’ll also be part of a motivated and inspiring community of like-minded women.
  • Download my free 3-Day PCOS Diet Meal Plan here. This is perfect for getting started before the next 30-Day Challenge begins.
  • Join my PCOS Monthly Meal Planning Service here. This service includes hundreds of PCOS recipes within a pre-populated, yet customizable meal plan. It’s designed to save you time and help you apply a PCOS diet.
  • Sign up for my next Beat PCOS 10-Week Program. This is a comprehensive live program that runs quarterly. Topics covered include diet, PCOS-centric emotional eating, exercise, stress management, and more. The 10-Week Program includes the same recipes and meal plan as my monthly meal planning service.
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    Quick Disclosure: Some of the links on this page may be affiliate links. This means that when you use them to purchase something, it won't cost you more but I may get paid a commission for referring you. In order to avoid any prejudice, I only recommend products that I personally use or would have recommended anyways.


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