Four types of PCOS: fact or fiction?

Polycystic Ovaries Syndrome (PCOS) is a hard-to-diagnose endocrine disorder. Some refer to four types of PCOS, but healthcare professionals do not widely accept the use of PCOS types.

What is PCOS?

PCOS commonly affects people with ovaries. For diagnosis, a person must meet at least two of the following criteria:

• Irregular periods – this indicates irregular ovulation.
• Excess androgens – high levels of androgens (the ‘male’ hormone)
• Polycystic ovaries – this is when ovaries increase in size and contain follicles which encircle the eggs

What are the four types of PCOS?

As previously mentioned, there is a school of thought that there are four types of PCOS. These are:

Inflammatory PCOS

This ‘type’ of PCOS is when inflammation occurs causing problems such as headaches, pain, fatigue, IBS, eczema etc. The inflammation also causes ovaries to release more testosterone leading to ovulation issues and hirsutism. 

Adrenal PCOS

Adrenal PCOS is thought to be caused when there are excess amounts of a specific type of androgen, known as DHEA-S, without other types of androgen. This can lead to an abnormal stress response, and given that the adrenal gland is associated with the stress response, this is known as Adrenal PCOS.

Insulin Resistant PCOS

Insulin Resistant PCOS is suggested to be a more common type of PCOS. This is when someone has heightened levels of insulin compared to ‘normal’ because there is a fault with how the body communicates insulin levels, and as a result, more insulin is produced by the pancreas than is required by the body. This is known as insulin resistance. This can lead to weight gain (mainly around the stomach), brain fog, sugar cravings, fatigue, and an increase in androgen levels. 

Post-Pill PCOS

This ‘type’ PCOS is often temporary and resolves itself, but is still hard to experience. It occurs when people with ovaries stop taking the oral contraceptive pill, which causes increased levels of male hormones. This means that PCOS symptoms such as irregular periods or hirsutism can start to occur.

Is there any evidence to support different types of PCOS?

As PCOS is a syndrome, there are a lot of symptoms associated with having it. This means that dissecting PCOS into different types isn’t always feasible, for example, someone may present with two ‘types’. Consequently, PCOS is rarely viewed in types. 

Is there typical PCOS and atypical PCOS?

For many, PCOS can go undiagnosed for a long time. This is especially if someone does not present with ‘typical’ symptoms. So-called typical PCOS describes when people present with weight gain, acne, male-pattern baldness etc. and atypical PCOS is generally when someone presents with irregular periods, low mental health, insulin resistance etc. Although it’s definitely true that some would share the view that there is such a thing as ‘typical’ and ‘atypical’ PCOS, is this the most helpful thing for people with PCOS? Rather than marking people as ‘typical’ or ‘atypical’, we should invest more time in learning all of the symptoms, and investigate for PCOS if someone presents with them.

PCOS diagnosis is difficult enough without the added label of ‘typical’ or ‘atypical’ or a certain type, so let’s just do better to help and diagnose all people with PCOS, by knowing all the PCOS symptoms and how they may present.