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Polycystic ovary syndrome (PCOS) doesn’t look the same for everyone. Some people experience symptoms of PCOS like irregular menstrual cycles, acne, and excess hair growth. Others may not notice PCOS symptoms until they have difficulty becoming pregnant or find themselves gaining weight. These differences in the signs and symptoms of PCOS lead many people to ask, “How do I know which type of PCOS I have?”
Healthcare providers and researchers use different methods of grouping types of PCOS. One way is to group PCOS types by phenotype (observable physical characteristics). PCOS types can also be described based on the symptoms or triggers. Continue reading to learn more about the different types of PCOS and how they’re grouped.
When healthcare providers talk about phenotypes of PCOS, they’re referring to the observable signs and symptoms of PCOS. There are three criteria used to group PCOS into different phenotypes, including:
When combined with your symptoms, diagnostic tests, such as blood tests and an ultrasound, can help your healthcare team determine which criteria you have. People with PCOS may have all three or just two out of these three characteristics. The specific combination helps to define which PCOS phenotype they have.
People with classic PCOS have all three criteria — hyperandrogenism, anovulation, and polycystic ovaries. In research, classic PCOS may be referred to as phenotype A. It’s estimated that between 44 percent and 65 percent of people with PCOS have this form, making it the most common type of PCOS.
Irregular periods are common in people with classic PCOS. Many will also notice other signs of hyperandrogenism, such as acne and hirsutism (unwanted facial and body hair). Research shows that people with classic PCOS are more likely to develop obesity and dyslipidemia (high cholesterol).
Classic PCOS is also strongly linked to insulin resistance, where the body doesn’t respond to insulin as it should. Insulin is a hormone that helps you manage blood glucose (sugar) levels. When your body doesn’t respond to insulin, blood glucose levels can increase.
To compensate for a low response to insulin, the body may make more insulin, causing hyperinsulinemia. This can cause symptoms like skin tags, weight gain, and acanthosis nigricans (darkening of the skin around the neck and armpits). Insulin resistance and hyperinsulinemia also result in a higher risk of metabolic syndrome. Metabolic syndrome is a group of chronic (long-term) health conditions that increase the risk of heart disease, stroke, and type 2 diabetes.
Classic PCOS without polycystic ovaries — also known as phenotype B — has similar signs and symptoms to phenotype A. Researchers estimate that between 8 percent and 33 percent of people with PCOS have phenotype B PCOS.
People with this type of PCOS experience high androgen levels and irregular ovulation. However, their ovaries don’t appear cystic in ultrasound tests. Although this type of PCOS doesn’t involve ovarian cysts, it’s still linked to irregular periods and insulin resistance.
In ovulatory PCOS (also called phenotype C), people experience symptoms of hyperandrogenism and polycystic ovaries, but have a regular menstrual cycle. Between 3 percent and 29 percent of people with PCOS have phenotype C.
Since people with ovulatory PCOS still ovulate regularly, their periods may appear normal. However, people with this type can still experience signs of hyperandrogenism and can also have higher levels of insulin and abnormal cholesterol levels. Over time, this can increase the risk of metabolic syndrome.
Nonhyperandrogenic PCOS (phenotype D) is the least common type of PCOS, accounting for 0 percent to 23 percent of PCOS cases. Unlike other types, people with nonhyperandrogenic PCOS have normal androgen levels. As a result, symptoms of this type of PCOS are often less severe.
This type of PCOS is defined by irregular ovulation and polycystic ovaries. Although anovulation is one of the criteria for this type, periods may be irregular or occasionally regular with some missed cycles. Insulin resistance is less common in this type, but it can occur. Abnormal levels of hormones — such as luteinizing hormone (LH), follicle-stimulating hormone (FSH), and thyroid hormones — can happen in people with nonhyperandrogenic PCOS.
While the four phenotypes of PCOS are helpful in research, many people and healthcare providers classify PCOS based on the symptoms or causes. This approach can help describe differences in what PCOS looks like from person to person and which PCOS treatments may be the most effective.
Insulin resistance is a common feature of PCOS. Studies estimate that between 65 percent and 95 percent of people with PCOS have insulin resistance or hyperinsulinemia. People with classic PCOS or ovulatory PCOS are more likely to have insulin resistance compared to other types.
Insulin resistance can play a role in the development and severity of PCOS. High insulin levels associated with insulin resistance can increase androgen production and cause problems with ovulation. As a result of insulin resistance, more than half of women with PCOS develop type 2 diabetes by the time they’re 40 years old.
Post-pill PCOS can happen when PCOS symptoms begin when you stop taking hormonal birth control pills. Taking hormonal birth control can help regulate the menstrual cycle and improve unwanted hair growth and acne. That’s why birth control is a common PCOS treatment for those who don’t want to become pregnant.
People with post-pill PCOS likely had undiagnosed PCOS before going on the pill. If you stop taking your birth control pills, common symptoms of PCOS that were once masked by the pills may become more noticeable.
Inflammatory PCOS is linked to chronic inflammation in the body. Normally, inflammation helps the body respond to illness or injury. However, when inflammation lasts too long, it can cause damage to blood vessels.
In PCOS, hyperandrogenism can lead to high levels of inflammatory substances. These inflammatory substances can cause hormone imbalance and problems with ovulation. Chronic inflammation is also linked to insulin resistance, increasing the risk of metabolic syndrome and heart disease over time.
Healthcare providers can use a blood test to look for signs of inflammation. They’ll check levels of white blood cells (immune cells) and inflammatory substances, like C-reactive protein (CRP). High white blood cell levels or CRP levels in people with PCOS may indicate chronic inflammation.
Adrenal PCOS is linked to high stress levels. Emotional stress can stimulate the adrenal glands to make excess cortisol, a hormone that helps the body respond to stress. Over time, elevated cortisol levels can lead to insulin resistance, weight gain, and hormone imbalance.
In rare cases, a genetic change in people with congenital adrenal hyperplasia (CAH) can make it difficult for the adrenal glands to make cortisol. When cortisol levels are too low, the body may respond by making too many androgen hormones. This can cause signs of hyperandrogenism, like irregular periods, excess facial hair, and acne.
Lean PCOS refers to people with PCOS who have a healthy weight based on their height, also known as body mass index (BMI). While overweight and obesity are often associated with PCOS, lean PCOS is still common and can cause similar symptoms to other types.
Research shows that people with lean PCOS often have signs and symptoms associated with overweight and obesity, such as insulin resistance and acanthosis nigricans. Additionally, hyperandrogenism, hirsutism, and ovarian cysts are just as common in people with lean PCOS.
On myPCOSteam, people share their experiences with polycystic ovary syndrome, get advice, and find support from others who understand.
What type of PCOS have you been diagnosed with? What PCOS signs and symptoms did you notice? Let others know in the comments below.
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It literally depends on the person and kind of PCOS you are diagnosed with. I had no issues until I was pregnant with my 2nd child. I got gestational diabetes. I hit the scale at 200lbs for the first… read more
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