What Are the Four Types of PCOS?

October 12, 2024

What Are the Four Types of PCOS?

Polycystic ovary syndrome (PCOS) is a widespread hormonal condition that affects women in their reproductive years. Characterized by hormonal imbalances, irregular menstrual cycles, and cysts in the ovaries, PCOS can significantly impact a woman’s fertility and overall health. While many people believe PCOS is a singular condition, research suggests that there are actually four distinct types of PCOS, each with its own causes, symptoms, and treatment approaches.

The Four Types of PCOS:

  • Insulin-Resistant PCOS (Classic PCOS)
  • Post-Pill PCOS
  • Inflammatory PCOS
  • Adrenal PCOS

Insulin-Resistant PCOS (Classic PCOS)

The most common type of PCOS, insulin-resistant PCOS, is driven by insulin resistance and is typically linked to metabolic issues like obesity, prediabetes, or diabetes. Women with this form of PCOS often have elevated insulin levels, which can lead to excessive androgen (male hormone) production. The high levels of androgens cause the classic symptoms of PCOS, including irregular periods, acne, weight gain, and excessive hair growth (hirsutism).

Insulin resistance is a major factor which causes PCOS symptoms. A study published in the Journal of Clinical Endocrinology & Metabolism showed that 70-80% of women with PCOS exhibit insulin resistance, even if they are not overweight . Insulin resistance causes the ovaries to produce more androgens, leading to a hormonal imbalance that disrupts ovulation.

Symptoms:

  • Weight gain, particularly around the abdomen
  • Difficulty losing weight
  • Irregular menstrual cycles
  • Acne and oily skin
  • Excessive facial and body hair

Treatment:

Treatment for insulin-resistant PCOS primarily aims to enhance insulin sensitivity. Doctors suggest lifestyle modifications such as:

  • Diet: A low-carbohydrate and low-glycemic diet can help to regulate the blood sugar levels.
  • Exercise: Regular physical activity improves insulin sensitivity.
  • Medications: Metformin, an insulin-sensitizing drug, is often prescribed to manage blood sugar levels and restore ovulation.
  • Supplements: Inositol and magnesium are commonly used to improve insulin resistance
  1. Post-Pill PCOS

Post-pill PCOS is a temporary form of PCOS that occurs after a woman stops taking hormonal birth control, particularly those containing progestin. Birth control pills suppress ovulation and regulate menstrual cycles, but once discontinued, the body may take some time to rebalance its hormones. This can lead to a temporary surge in androgens, causing PCOS-like symptoms.

A study in Human Reproduction found that some women who stop taking oral contraceptives may experience temporary symptoms of PCOS, such as irregular periods and acne . However, these symptoms usually resolve within a few months as hormone levels stabilize.

Symptoms:

  • Irregular or absent menstrual cycles after stopping birth control
  • Mild acne or skin breakouts
  • Temporary weight gain
  • Increased body or facial hair

Treatment:

Post-pill PCOS typically clears up on its own within a few months.However, treatments that can help regulate hormones during this transition include:

  • Supplements: Zinc and vitamin B6 may support hormone regulation.
  • Diet: A nutrient-dense diet can help balance hormones naturally.
  • Herbal Remedies: Chasteberry (Vitex) is often used to restore hormonal balance after stopping the pill.
  1. Inflammatory PCOS

Inflammatory PCOS is caused by ongoing inflammation in the body, which can disrupt ovulation and elevate androgen levels. Women with this type of PCOS may not have insulin resistance but show elevated markers of inflammation, such as high levels of C-reactive protein (CRP). Inflammation can be caused by various factors, including autoimmune disorders, environmental toxins, or poor diet.

A study published in the Journal of Reproductive Immunology linked chronic inflammation to disrupted ovulation and increased androgen levels in women with PCOS . Inflammatory markers like CRP are commonly elevated in women with this form of the condition.

Symptoms:

  • Fatigue
  • Skin conditions, such as eczema or psoriasis
  • Digestive issues (e.g., bloating, IBS)
  • Joint pain
  • Acne, especially inflammatory acne

Treatment:
The treatment for inflammatory PCOS focuses on reducing inflammation. Key strategies include:

  • Anti-Inflammatory Diet: Incorporate more omega-3-rich foods (e.g., fish, flaxseeds), leafy greens, and antioxidant-rich fruits.
  • Supplements: Omega-3 fatty acids, turmeric, and probiotics can help reduce inflammation.
  • Lifestyle Changes: Stress reduction through yoga or meditation can also be beneficial.
  1. Adrenal PCOS

Adrenal PCOS is characterized by an overproduction of androgens (such as DHEA-S) by the adrenal glands rather than the ovaries. This type of PCOS is often triggered by chronic stress, as stress stimulates the adrenal glands to release excess androgens. Women with adrenal PCOS may not have the classic symptoms of insulin resistance or inflammation but may experience irregular cycles and high levels of adrenal androgens.

A study published in the Journal of Clinical Endocrinology and Metabolism found that about 10% of women with PCOS have elevated adrenal androgens rather than ovarian androgens . This form of PCOS is more commonly seen in women who have an elevated stress response.

Symptoms:

  • High levels of DHEA-S (an adrenal androgen)
  • Anxiety or chronic stress
  • Normal insulin levels
  • Irregular menstrual cycles
  • Acne, but less likely to have excessive body hair or weight gain

Treatment:
Managing adrenal PCOS focuses on lowering stress levels and promoting healthy adrenal function. Key treatments include:

  • Stress Reduction: Mindfulness practices, yoga, and regular physical activity can lower cortisol levels.
  • Adaptogens: Herbs like ashwagandha and rhodiola can support adrenal health and balance hormone production.
  • Lifestyle Changes: Prioritizing sleep and limiting caffeine intake can help reduce adrenal overload.

Conclusion

Understanding the different types of PCOS is essential for effective management. Each type—insulin-resistant, post-pill, inflammatory, and adrenal PCOS—has unique underlying causes, symptoms, and treatment approaches. By identifying the specific type of PCOS a woman has, healthcare providers can create personalized treatment plans that target the root cause, improving symptoms and overall health.

FAQs

  1. Can you have more than one type of PCOS?

Yes, it is possible to have overlapping symptoms from different types of PCOS. For example, a woman may have insulin resistance along with chronic inflammation. In such cases, treatment strategies will need to address both insulin sensitivity and inflammation.

  1. How is PCOS diagnosed?

PCOS is typically diagnosed through a combination of symptoms, blood tests (to measure hormone levels), and imaging tests such as an ultrasound to check for ovarian cysts. Your doctor will also rule out other potential causes of irregular periods and hormonal imbalances.

  1. Can PCOS be cured?

There is no cure for PCOS, but the condition can be managed through lifestyle changes, medications, and supplements. With the right treatment plan, many women with PCOS can achieve symptom relief and improve their chances of conception.