Polycystic Ovaries Syndrome (PCOS) is an endocrine (hormonal) disorder with metabolic and reproductive outcomes. Some naturopathic doctors and alternative nutritionists refer to different types of PCOS, known as root causes, but what does the evidence say?
We look at both functional and conventional medicine views on different types of PCOS in this article. Keep reading to learn more about the different types of PCOS.
What is PCOS?
PCOS commonly affects 1 in 10 people with ovaries in the UK. As there is no cure for PCOS, the management of the condition involves medication, supplementation, gentle nutrition, movement, stress management and other lifestyle tweaks.
>> Read more | PCOS 101: A beginners guide
Are there different types of PCOS?
To be diagnosed with PCOS, a person must meet at least two of the following criteria:
- Irregular periods and/or irregular ovulation
- Excess androgens (hyperandrogenism)
- Polycystic ovarian morphology
PCOS is a syndrome rather than a disease, which means it is a group of symptoms. Therefore, people with PCOS will present with different symptoms and have different diagnostic criteria.
Because PCOS presents so differently in different people, both conventional medicine and functional medicine have aimed to form different types of PCOS.
Conventional medicine
Conventional medicine is “a system in which medical doctors and other healthcare professionals treat symptoms and diseases using drugs, radiation, or surgery.” Conventional medicine may also be called mainstream medicine, orthodox medicine, and Western medicine.
In conventional medicine, people with PCOS are sorted into four different types of PCOS, known as phenotypes of PCOS.
Functional medicine
Functional medicine is an alternative approach to medicine. Functional medicine aims to find a “root cause” of a disease and the treatments, practices and concepts are not supported by medical evidence. Functional medicine is not a protected title and a medical qualification isn’t required to practice as a functional medicine doctor.
Within the realm of functional medicine, people with PCOS are sorted into four different types of PCOS, known as the root causes of PCOS. There is no scientific evidence to support the functional medicine approach to types of PCOS and PCOS management.
What are the four types of PCOS?
There are two approaches to the types of PCOS: conventional medicine and functional medicine.
Conventional medicine
In 2012, the National Institutes of Health (NIH) consensus panel proposed a phenotyping approach to classifying PCOS. A phenotype refers to an individual’s observable traits. In the case of PCOS, the phenotypes are hyperandrogenism (excess “male-type” hormones like testosterone), oligoovulation and/or anovulation (irregular or a lack of ovulation, often characterised as irregular or a lack of periods) and polycystic ovarian morphology.
Type A
Type A PCOS includes clinical or biochemical hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology. It may be known as “full-blown syndrome”.
Type B
Type B PCOS includes clinical or biochemical hyperandrogenism and ovulatory dysfunction. It may be known as “non-PCO PCOS”.
Type C
Type C PCOS includes clinical or biochemical hyperandrogenism and polycystic ovarian morphology. It may be known as “ovulatory PCOS”.
Type D
Type D PCOS includes ovulatory dysfunction and polycystic ovarian morphology. It may be known as “non-hyperandrogenic PCOS”.
| Hyperandrogenism | Irregular periods and/or irregular ovulation | Polycystic ovarian morphology | |
| Type A | Yes | Yes | Yes |
| Type B | Yes | Yes | |
| Type C | Yes | Yes | |
| Type D | Yes | Yes |
Type A is the most severe phenotype, and D is the least severe phenotype in terms of reproductive and metabolic outcomes. Type A and C are the most prevalent types of PCOS.
There is emerging evidence proposing a new method of PCOS classification. The participants were categorised according to certain genetic markers. These three groups were reproductive, metabolic and indeterminate.
The reproductive group were classified as having higher LH and SHBG, lower BMI and insulin levels. The metabolic group was classified as having a higher BMI, glucose and insulin levels and lower LH and SHBG. Indeterminate did not fit into either group. 40% of participants were sorted into this “indeterminate” group, suggesting that this way of classification needs refining further, especially considering that BMI is not a reliable or useful measurement.
Functional medicine
In functional medicine, the four types of PCOS are defined according to “root cause”. Again, it is important to note that there is no evidence for these types of PCOS.
Inflammatory PCOS
Inflammatory PCOS is assigned as a root cause when certain “inflammatory symptoms” like headaches, pains, fatigue, IBS and eczema present alongside PCOS diagnosis.
Adrenal PCOS
Adrenal PCOS is assigned as a root cause when excess amounts of a specific type of androgen, known as DHEA-S, occur without other types of androgen levels being raised.
Insulin resistant PCOS
Insulin-resistant PCOS is assigned as a root cause when excess amounts of insulin occur alongside symptoms of insulin resistance such as brain fog, sugar cravings, fatigue and increased androgen levels.
Post-Pill PCOS
Post-pill PCOS is assigned as a root cause when someone stops taking the oral contraceptive pill and notices symptoms such as irregular periods or hirsutism occurring.
Key takeaways: different types of PCOS
Across both functional and conventional medicine, PCOS has been sorted into four different types. In conventional medicine, the four types of PCOS are type A, type B, type C and type D and refer to the phenotypes of PCOS. In functional medicine, the four types of PCOS are linked to a “root cause” of PCOS and are inflammatory, adrenal, insulin-resistant and post-pill PCOS. Functional medicine has no scientific evidence and should be treated with caution.
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