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What are the four types of PCOS?

Laura Harcourt

Written byLaura Harcourt

Dr Shazia Malik

Reviewed byDr Shazia Malik

girl wearing cotton shirt and nose ring having relaxed facial expression, looking at camera
Polycystic ovary syndrome, or PCOS, is a common hormonal problem that many women may face. Learn more about the condition and its different types.
Polycystic ovary syndrome, often referred to as PCOS, is one of the most common women’s health issues, affecting approximately one in ten women around the world.1,2 However, it’s highly misunderstood and often misdiagnosed.

A hormone problem that affects how your ovaries work, PCOS gets its name from the numerous small, fluid-filled sacs that form in the ovaries in some people with PCOS.2

But, the key word here is ‘some’, as not everyone with the condition will develop these.2 In fact, you could be affected and not even know – more than half of people with PCOS don’t experience any symptoms at all.2

In this guide, we take a closer look at the different types of PCOS and the key symptoms each one can cause.

Understanding the different types of PCOS

Before we get into the different types of PCOS, it’s important to start by looking at the condition as a whole.

There are three main features of PCOS.2 These include:
  • irregular periods
  • excess levels of male hormones in your body, which can cause physical symptoms such as acne or increased hair growth
  • enlarged ovaries (shown in an ultrasound) that contain more egg sacs (follicles) than normal
While many people have heard of PCOS, far fewer are aware that there are different types of the condition. Each of these different types is classified based on their underlying cause.

That’s why if you suspect you may have PCOS, or you’re diagnosed with PCOS, it’s so important to find out which classification you have.

Knowing this information means you can improve your understanding of your condition, helping you learn how to manage it, and any symptoms you have, effectively.

Type one: insulin-resistant PCOS

Many people who have PCOS are insulin resistant, which means that your body can make insulin, but it can’t use it effectively.3,4 Insulin resistance has been found to affect 50–70% of people with PCOS.5

Insulin is a hormone that’s made in your pancreas which manages the amount of sugar (glucose) in your blood. It also moves glucose from your blood into your cells where it’s used to create some of the energy your body uses every day.6

When you’re insulin resistant, this means that your body doesn’t respond to insulin as it should, or isn’t as sensitive to how insulin works, which leads to higher glucose levels.6

Too much glucose causes an imbalance in your normal hormone levels, which can not only lead to many of the symptoms associated with PCOS, such as weight gain, but also make them worse.7

Symptoms of insulin resistance in PCOS

There are certain signs of insulin resistance that are important to be aware of. These include:3,7
  • sleep apnea6,8
  • depression/anxiety
  • dark pigmentation and thickening of the skin in areas such as the neck, back, and armpits8

Getting diagnosed with insulin-resistant PCOS

Being diagnosed with insulin resistance PCOS can usually be done with blood tests to check your insulin and blood glucose levels.7,9

These include the homeostatic model assessment (HOMA) and the oral glucose tolerance test (OGTT). These test for both insulin resistance and glucose intolerance.

While this is typically normal to low in women with PCOS, it could help indicate whether the amount of insulin in your blood is higher than the healthy threshold.10,11

Managing insulin-resistant PCOS

Once diagnosed, one of the most effective ways to manage insulin-resistant PCOS is to make positive changes to your lifestyle. Losing weight can be particularly effective, with a weight loss of just 5% leading to a significant improvement in PCOS symptoms.12 A healthy, balanced diet and regular exercise is the most effective formula for achieving sustainable weight loss.13,14

Following a low glycaemic index (GI) food plan can be particularly helpful – not just in terms of losing weight, but also in keeping it off. Low GI foods provide energy in a slower, steadier way compared to high GI foods which can make your blood sugar levels spike.13,14

What’s more, a low GI food plan may also help reduce levels of insulin resistance, and the short and long-term issues commonly associated with hormonal imbalances.13,14

However, as there’s conflicting data regarding the impact of low GI foods on hormonal balance, and because PCOS carries significant metabolic risks, more research is needed.13-15,

Metformin may also be recommended to help. Only available on prescription, this medication has been proven to be effective in both controlling blood sugars and reducing the negative effects of PCOS in carefully selected patients.16,17

Type two: inflammatory PCOS

Inflammation is part of the way that your body defends itself against bacteria, illnesses, and injury, and is used to start the healing process.

However, if you have inflammation in your body caused by illness or injury that doesn’t show symptoms right away, you may have what’s known as chronic inflammation.18 This type of inflammation can gradually sit in your body over a prolonged period of time, which can then start to damage the cells in your body.19

Long-term, low-grade inflammation is a key contributor to PCOS,20 and some studies have found that people with PCOS have permanently raised levels of inflammation.21-24

Getting diagnosed with inflammatory PCOS

The best way to get a diagnosis of inflammatory PCOS is with a blood test. This can assess both the function of your ovaries and look at your inflammation markers (indicators in your blood) to see if they’re raised.21,22

Managing inflammatory PCOS

To manage inflammatory PCOS effectively, you could start by taking steps to lower the amount of inflammation in your body by making some changes to your diet.

A Mediterranean diet, which is rich in antioxidants, omega-3 fatty acids, and fibre, has been shown to be effective at combating PCOS-related inflammation.25 Prioritise foods like salmon, sardines, spinach, kale, olive oil, whole grains, and nuts.

Some other steps you can take to reduce inflammation include:
  • take certain vitamin supplements, including vitamins A, C, D, and zinc26
  • get regular exercise26
  • reach and maintain a healthy weight26
  • find ways to manage your stress levels, such as through yoga or meditation26
  • improve your gut health by actively promoting healthy bacteria in your gut through dietary changes and adding probiotics to your diet26
There’s thought to be a connection between vitamin D deficiency and PCOS symptoms.27 One study reported that after 24 weeks, 50% of people with PCOS who took 24,000 IU vitamin D had improved menstrual disturbances.28 So, to help manage your insulin resistance, your doctor may suggest having your levels measured and taking vitamin D supplements if needed.

Type three: adrenal PCOS

Hyperandrogenism is a condition that occurs when you’ve got an excessive amount of sex hormones called androgens in your body.29

While both men and women have androgens in their bodies, men typically have a lot more which are instrumental in the development of “male” characteristics like body hair and a deeper voice.30

The most well-known androgen is testosterone. In women, androgens are made in the ovaries and in the adrenal glands, which are small glands located on top of each of the kidneys. For this reason, this type of PCOS is sometimes known as adrenal PCOS.30
Hyperandrogenism and PCOS are very closely connected, with one often influencing the other. It’s estimated that around 80% of women with hyperandrogenism also have PCOS.29,31

One study reported that out of 154 participants with PCOS, 3.9% were found to be carriers of congenital adrenal hyperplasia (CAH). CAH carriers are thought to also have an increased risk of developing hyperandrogenism.31

Symptoms of adrenal PCOS

Many of the standard symptoms associated with PCOS also occur in hyperandrogenism.29 These include:
  • oily skin
  • acne
  • thick hair growth, particularly on the face, underarm area, pubic area, and limbs
  • deep voice
  • male pattern balding
  • irregular periods
  • increased muscle mass

Getting diagnosed with adrenal PCOS

The most effective way of confirming adrenal PCOS is by taking blood tests to check your different hormone levels.32

This information, combined with the symptoms you are experiencing, can help your doctor make a potential diagnosis.

Managing adrenal PCOS

The type of treatment you’re recommended will depend on whether PCOS alone is the cause of your condition.

Some of the most common medical treatments that may be given to help manage hyperandrogenism include oral contraceptives, and in some cases, medications such as diuretics or stronger anti-androgen medications, under the guidance of a specialist.33,34

Studies have also shown that weight loss can also be very beneficial in managing hyperandrogenism and PCOS.33,34

Type four: post-pill PCOS

There’s a common misconception that hormonal contraceptives like the pill can cause PCOS to develop – often referred to as ‘post-pill PCOS’. However, there are no studies to prove that this is the case.

Instead, what you’re likely to experience when coming off the pill is a hormone fluctuation that causes symptoms that mimic those of PCOS, including irregular or missed periods.35 This is because it can take time for monthly menstruation to return after being on hormonal contraception.36
You might also find that you start to experience PMS symptoms again, such as mood swings, acne, and bloating, which many people also attribute to PCOS. However, most of the effects of post-pill PCOS should subside as your hormones start to re-regulate.

It's important to be aware that, despite an irregular menstrual cycle, you can also get pregnant as soon as you stop taking the pill.

Could it be something else?

PCOS can be difficult to diagnose because some of its most prominent symptoms can also have a variety of other causes. For example, irregular and missed periods can be caused by gaining or losing a lot of weight, stress and anxiety, excessive exercising, and pregnancy – as well as PCOS.35

Some other conditions that can often be mistaken for PCOS include thyroid disorders like hypothyroidism37 and Cushing’s Syndrome,38 as well as pituitary adenomas (benign tumours on the pituitary gland).39

If you have concerns about your diagnosis and have any reason to believe it’s incorrect, you should always feel free to seek a second opinion from your healthcare provider.

The final say

Like most health conditions, there’s no one-size-fits-all approach to treating PCOS.

However, knowing which PCOS type you have is like having a secret decoder. Once you have this information available, you’ll not only be able to better manage your condition, but you’ll also be able to identify the right treatments to ease your symptoms

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Copyright © Holland & Barrett Retail Limited, 2024. All rights reserved. hollandandbarrett.com is a trading name of Holland & Barrett Retail Limited,. Registered office: Samuel Ryder House, Barling Way, Nuneaton, Warwickshire CV10 7RH. Registered in England: company no. 2758955. Registered VAT no. 211727395.