When you're first diagnosed with PCOS, doctors usually explain it as one condition. You get the diagnosis, maybe a prescription for birth control, and that's that. But here's what they often leave out: PCOS isn't one-size-fits-all.
I know it sounds overwhelming, but understanding which type of PCOS you have is actually good news. It means you can stop trying treatments that weren't meant for you in the first place. It means you can focus on what will actually make a difference for your body.
Let's Start with How PCOS Gets Diagnosed
To understand the different types, we first need to talk about how PCOS is diagnosed. Most doctors use something called the Rotterdam criteria, which says you have PCOS if you have at least 2 out of these 3 features:
- Irregular or absent ovulation (your periods are unpredictable or missing)
- High androgen levels (either on blood tests or visible symptoms like acne and excess hair)
- Polycystic ovaries on ultrasound (12+ follicles or enlarged ovaries)
This creates four possible combinations, what doctors call phenotypes:
The Four Phenotypes
Phenotype A (Full PCOS): Irregular periods + high androgens + polycystic ovaries
Phenotype B (Classic): Irregular periods + high androgens
Phenotype C (Ovulatory): High androgens + polycystic ovaries
Phenotype D (Non-hyperandrogenic): Irregular periods + polycystic ovaries
Here's what research shows: phenotypes A, B, and C tend to have similar underlying drivers, especially insulin resistance. They're all connected to the same metabolic and hormonal imbalances. Phenotype D is a bit different. It has less metabolic impact and may have a purely ovarian origin.
Now, the phenotypes tell you what you have. But what really matters for treatment is understanding why you developed PCOS in the first place. That's where things get interesting.
The Four Root Causes of PCOS
Think of these as the “why” behind your symptoms. Your PCOS likely has one (or more) of these underlying drivers:
1. Insulin-Resistant PCOS (The Most Common)
How common: About 70% of people with PCOS have this type
This is where your body's cells stop responding properly to insulin. So your pancreas compensates by pumping out more and more insulin, which then signals your ovaries to produce excess testosterone. It's a self-perpetuating cycle.
You might have this type if you're dealing with:
- Weight gain, especially around your belly
- Difficulty losing weight even when you're doing everything “right”
- Sugar cravings and afternoon energy crashes
- Brain fog (like you can't think clearly)
- Dark patches of skin, usually on your neck or in your armpits
What actually helps:
- Eating protein, fat, and fiber together at every meal to stabilize blood sugar
- Regular movement (resistance training is especially good for insulin sensitivity)
- Prioritizing sleep and managing stress (both affect insulin)
- Working with a practitioner on supplements like inositol, magnesium, or berberine
2. Inflammatory PCOS
How common: It's significant, though we don't have exact numbers
Chronic inflammation throughout your body triggers your ovaries to produce excess androgens. The inflammation can come from gut issues, food sensitivities, environmental toxins, or chronic stress. Sometimes it's a combination.
You might have this type if you experience:
- Frequent headaches or migraines
- Joint pain (that you can't really explain)
- Persistent fatigue, even when you're getting enough sleep
- Skin conditions like eczema
- Digestive issues like IBS or constant bloating
- Elevated inflammatory markers (your CRP is above 2.0 on blood tests)
What actually helps:
- An anti-inflammatory diet (Mediterranean-style eating works really well)
- Identifying and removing foods that trigger you
- Healing your gut (this is huge for inflammatory PCOS)
- Omega-3 fatty acids and antioxidants like NAC
- Actually addressing stress, not just pushing through it
3. Adrenal PCOS
How common: About 10 to 30% of people with PCOS
This type is driven by an abnormal stress response. Your adrenal glands overproduce DHEA-S (a type of androgen) in response to chronic stress. The interesting thing? Your testosterone and androstenedione levels might be completely normal.
You might have this type if you're experiencing:
- Elevated DHEA-S but normal other androgens on blood tests
- That “wired but tired” feeling
- High anxiety or you're constantly on edge
- Sometimes more regular periods than typical PCOS (which can be confusing)
- Hair thinning on your scalp
- Acne
What actually helps:
- Stress management becomes absolutely crucial (meditation, yoga, breathwork, whatever works for you)
- Making sleep a non-negotiable priority
- Adaptogenic herbs like ashwagandha, rhodiola, or licorice (work with someone knowledgeable here)
- Magnesium, vitamin B5, and vitamin C to support your adrenals
- Avoiding excessive high-intensity exercise (I know it sounds counterintuitive, but it can spike stress hormones even more)
4. Post-Pill PCOS
How common: For some it's temporary, for others it reveals PCOS that was already there
This happens when you stop hormonal birth control, especially pills with drospirenone or cyproterone (like Yasmin, Yaz, or Diane). Your body experiences a temporary surge in androgens as it adjusts to regulating hormones on its own again.
Here's the tricky part: Sometimes the pill was masking PCOS symptoms you already had. Other times, it's truly temporary and resolves within 3 to 6 months. It can be hard to tell which one you're dealing with.
You might have this type if:
- Your symptoms started 3 to 6 months after stopping the pill
- You didn't have these symptoms before starting birth control
- You suddenly developed irregular periods, acne, or hair changes after coming off the pill
What actually helps:
- Patience (I know that's frustrating to hear, but this often resolves on its own)
- Supporting your body with nutrients like magnesium, zinc, vitamin B6, and vitamin E
- Herbs like chasteberry (vitex) to help your hormones rebalance
- Quality sleep and stress management while your body adjusts
Why Your Type Actually Matters
Understanding your PCOS type isn't just interesting information. It directly impacts what will actually work for you.
If you have insulin-resistant PCOS, managing blood sugar becomes your foundation. But if you have adrenal PCOS, intense workouts and restrictive diets might make things worse because they're just adding more stress to your already-taxed adrenals.
If you have inflammatory PCOS, you need to find and address the source of inflammation. Is it your gut? Food sensitivities? Environmental triggers? That becomes your focus.
It's like trying to fix a car without knowing what's broken. You could try everything, but you'll save so much time and frustration by understanding what's actually going on.
How to Figure Out Your Type
Start with blood work. When you talk to your doctor, ask them to test:
- Fasting insulin and fasting glucose (to check for insulin resistance)
- Testosterone and androstenedione (androgens from your ovaries)
- DHEA-S (androgen from your adrenals)
- High-sensitivity CRP (to measure inflammation)
Then look at your symptoms and timeline. Did they start after you stopped birth control? Do you have signs of chronic inflammation like joint pain or IBS? Are you doing all the “right things” but still struggling with weight?
Here's the Thing: You Can Have More Than One Type
In reality, you might have more than one underlying driver. Insulin resistance often goes hand-in-hand with inflammation. Stress makes insulin resistance worse. These systems all talk to each other.
The goal isn't to fit yourself perfectly into one box. It's to understand your primary drivers so you can address them strategically instead of just treating symptoms as they pop up.
Track Your Way to Understanding
One of the most powerful things you can do? Start tracking your symptoms consistently. When do you feel worst? What actually helps? Are there patterns with your cycle, stress levels, or certain foods?
This data becomes incredibly valuable for understanding your specific type of PCOS. And it's exactly what you need to have productive conversations with your healthcare provider instead of just listing symptoms and hoping they connect the dots.
Because at the end of the day, your PCOS is uniquely yours. What works for someone else might not work for you, and that's okay. Understanding your type helps you stop wasting time on treatments that weren't designed for your body in the first place.
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