Curious about your PCOS type?
Let me guess… you just saw something online about PCOS Types and now you’re searching aimlessly to figure out what type you are. Maybe the idea of PCOS types is new to you, and it has sparked your interest. Regardless, in this article, we will explore the validity of PCOS types and how they can help you manage your PCOS.
The Complex Nature of PCOS
Polycystic Ovary Syndrome (PCOS) significantly affects hormones and the reproductive system, marked by ovulatory dysfunction and elevated androgen hormones. Diagnosing PCOS involves excluding other conditions and evaluating clinical symptoms and biochemical signs of the disorder. PCOS exhibits heterogeneity, with a diverse range of symptoms, signs, and underlying factors that vary among individuals. The following highlights various ways in which the diversity of PCOS is observed:
- Symptoms and manifestations: People with PCOS may experience different symptoms and clinical manifestations. Some common symptoms include irregular or absent menstrual periods, hirsutism (excessive hair growth), acne, and weight management issues. However, the severity and combination of these symptoms can vary widely among individuals.
- Underlying causes and contributing factors: PCOS can have multiple underlying factors that contribute to its development. These factors can include hormonal imbalances, insulin resistance, genetic predisposition, and environmental influences. The relative importance and contribution of these factors may differ from person to person, further adding to the heterogeneity of the condition.
- Metabolic and hormonal profiles: The metabolic and hormonal profiles of people with PCOS can also differ. Some individuals may have higher levels of androgens (male trait hormones), while others may have more pronounced insulin resistance or metabolic disturbances. These variations can impact the clinical presentation and potential health risks associated with PCOS.
Recognizing the complexity of PCOS is important in clinical practice as it highlights the need for personalized and individualized approaches to diagnosis, treatment, and management. It is also helpful for you as you will be less likely to fall for the false promises of overly simplified solutions. Something that the research and clinicians all agree on is that PCOS is not a one-size-fits-all kind of condition.
Need a deeper understanding of PCOS? Check out this comprehensive post.
Clinical PCOS Phenotypes
The concept of PCOS types or phenotypes is still a hot topic of debate within the medical community. Researchers are currently concentrating on comprehending the distinct subtypes or phenotypes within PCOS, aiming to enhance the level of personalized care. The goal is to improve diagnostic accuracy, treatment outcomes, and the overall comprehension of the condition. These classifications, referred to as PCOS Phenotypes, are supported in research and implemented in clinical practice. They include three main characterizations: ovulatory dysfunction (irregular or absent periods), elevated androgens, and polycystic ovaries 2. “Classic PCOS” is commonly defined by the first two phenotypes, meanwhile the following two phenotypes are commonly described as “Nonclassic PCOS.”
Type A (“Frank PCOS”) is characterized by ovulatory dysfunction, elevated androgens, and polycystic ovaries (PCO).
Type B (“Non-PCO PCOS”) is characterized by ovulatory dysfunction, elevated androgens, but ovaries are normal.
Type C (“Ovulatory PCOS”) is characterized by elevated androgens, PCO, but normal ovulation.
Type D (“Mild” or “Nonhyperandrogenic PCOS”) is characterized by ovulation dysfunction and PCO, but normal androgen levels.
How Clinical Phenotypes Help you
Understanding these PCOS phenotypes can be vital for effective client management. Knowing your phenotype can help you with personalized and targeted treatment approaches. Here’s how this knowledge can benefit you.
- Fertility Considerations: We understand that fertility concerns vary among PCOS phenotypes. By identifying your specific challenges related to fertility, you can implement targeted treatments that align with your goals. Another consideration is if your phenotype doesn’t include ovulatory dysfunction, this will cue further investigation if you are experiencing infertility.
- Symptom Management: Symptoms like hirsutism, acne, or irregular menstrual cycles differ across phenotypes. If you experience these common PCOS symptoms and fall within a phenotype that is characterized by elevated androgens you can use that to your advantage. Lowering androgens is what you will want to focus on to help improve your PCOS symptoms. Pinpointing the specific symptoms associated with your subtype allows you to develop strategies to overcome your PCOS.
- Risk Assessment: Different PCOS phenotypes carry varying risks, such as cardiovascular disease or diabetes. The “Classic PCOS” types are often associated with higher rates of insulin resistance and metabolic syndrome. Understanding these associations enables us to assess and manage potential long-term health risks more effectively, ensuring a comprehensive approach to your well-being.
Metabolic Phenotypes
In October 2022, I participated in the 20th Annual Meeting of the Androgen Excess & PCOS Society in Anaheim, CA, where I had the honor of contributing to a patient advocacy and support panel. During my presentation, I shared the day-to-day challenges faced by individuals with PCOS, emphasizing the crucial role of advocacy and support in their lives. While acknowledging the significance of scientific research, I reminded all investigators in the audience that real people experience these symptoms every day.
At the meeting, a notable debate occurred regarding whether metabolic status should be incorporated into the PCOS phenotypes. After a thorough discussion with compelling arguments on both sides, the consensus ultimately leaned towards not adding metabolic status to the phenotypes. Nevertheless, it’s worth noting that many clinicians highlight distinct patterns of metabolic abnormalities observed in individuals living with PCOS. Although various classification systems exist globally, the commonly recognized metabolic phenotypes of PCOS include:
Insulin-resistant phenotype
This phenotype is characterized by insulin resistance, which means that the body’s cells don’t respond like they should to insulin. Insulin resistance leads to elevated insulin levels and can contribute to metabolic issues such as impaired glucose tolerance and increase the risk of developing type 2 diabetes. Those with the insulin-resistant phenotype of PCOS often have increased belly fat, high levels of androgens, and a higher risk of cardiovascular issues.
Obese/overweight phenotype
This phenotype refers to those who carry excess weight. Obesity tends to exacerbate insulin resistance and hormonal imbalances in PCOS, leading to increased androgen production, menstrual irregularities, and a higher risk of metabolic complications. Weight management and lifestyle modifications can be helpful considerations for this phenotype.
Lean/non-obese phenotype
PCOS is commonly connected to excess weight but it is important to know that there is a group of those with PCOS who are lean. This phenotype may still exhibit insulin resistance, hormonal imbalances, and other metabolic disturbances, despite the absence of excess weight. People with this phenotype may have a higher risk of developing metabolic complications due to being overlooked as many believe PCOS always leads to weight gain.
Non-insulin-resistant/non-obese phenotype
This phenotype is characterized by the absence of insulin resistance and obesity. PCOS warriors with this phenotype typically have fewer metabolic disturbances and a lower risk of developing type 2 diabetes. However, they may still experience symptoms related to androgen excess, such as hirsutism, acne, and menstrual irregularities.
It’s important to note that these metabolic phenotypes are not mutually exclusive, and an individual with PCOS may exhibit a combination of metabolic abnormalities. The identification of metabolic phenotypes in PCOS can help guide personalized management approaches, including lifestyle modifications, targeted therapies, and monitoring for specific metabolic risks.
Recent studies suggest alternative PCOS categorizations based on genetic markers with each displaying unique hormonal and metabolic traits. While this is promising for personalized treatments, further research is required to validate and refine these classifications 3.
the popular types of PCOS
You are likely here because of four popular PCOS types: Post-pill PCOS, Insulin-resistant PCOS, Inflammatory PCOS, and Adrenal PCOS. These types are commonly used in functional medicine to better understand and personalize PCOS management. However, these PCOS types haven’t been formally recognized in research and are not used in a clinical setting. Since you are likely to come across them online, here are these suggested types of PCOS.
Post-Pill PCOS
Post-pill PCOS describes the onset of PCOS-like symptoms after discontinuing birth control. It is not an official type of PCOS. The use of hormonal contraceptives can temporarily mask underlying hormonal imbalances, and discontinuation may reveal pre-existing irregularities. Managing Post-Pill PCOS involves giving the body time to readjust, adopting a healthy lifestyle, and consulting with a healthcare professional if irregularities persist. Unlike true PCOS, this condition typically represents a temporary disruption in hormonal patterns rather than a persistent hormonal imbalance.
Insulin-Resistant PCOS
As mentioned earlier, this type of PCOS stems from the insulin resistance aspect of PCOS. Insulin resistance is common in PCOS with some data suggesting it occurs in 70-80% of the PCOS population. It is closely linked to hormonal imbalances and metabolic disturbances in PCOS, however the severity can vary among people.
Clinicians often assess insulin sensitivity through tests such as fasting insulin levels or glucose tolerance tests. Effective management strategies for PCOS often include addressing insulin resistance through lifestyle modifications, such as diet and exercise, and, in some cases, medications or supplementation.
Inflammatory PCOS
This type refers to those with PCOS who experience symptoms associated with chronic inflammation. Symptoms of inflammatory PCOS may include persistent acne and skin rashes, fatigue, joint pain, gut issues, and weight gain. Managing inflammatory PCOS often involves adopting an anti-inflammatory diet rich in whole foods, engaging in regular exercise, practicing stress management techniques, and considering the inclusion of omega-3 fatty acids.
Adrenal PCOS
Adrenal PCOS is characterized by elevated levels of DHEA, the primary androgen hormone produced by the adrenal glands. Symptoms commonly include irregular menstrual cycles, hirsutism, and acne. Managing Adrenal PCOS involves addressing the underlying hormonal imbalance. Stress management techniques, including mindfulness and relaxation exercises, can help regulate adrenal function. Adopting a balanced lifestyle with consistent sleep patterns, a healthy diet, and moderate exercise is also beneficial.
PCOS types are not clear-cut
Is your head spinning? You may find yourself even more confused now that you have learned about the complexity of PCOS and the controversy surrounding PCOS Types. The controversy stems from the lack of a universally accepted classification system. This lack of consensus can lead to confusion and inconsistency in the diagnosis and treatment of PCOS.
I don’t typically recommend using the popular PCOS Types as a golden standard. They sound helpful in theory, but most people with PCOS don’t fall within these clear-cut categories. Many people will experience an overlap in PCOS features, which can change throughout the lifespan. I like to think of the popular types as drivers. There are also circumstances where these types go hand in hand and, oftentimes, the management options don’t vary much. Let’s use insulin resistance as an example.
Let’s use insulin resistance as an example. If you have insulin resistance, this is what is driving your PCOS symptoms. Insulin also does a delicate dance with the adrenal glands and inflammation. The adrenal glands influence the body’s stress response and produce hormones, such as cortisol, that can affect insulin sensitivity and how well your body regulates blood sugar. To tackle insulin resistance, you will also want to support your adrenal health. Inflammation can impair insulin signaling and put stress on the adrenals, creating a vicious cycle. Lowering inflammation can help you improve your adrenal health and insulin sensitivity. So at the end of the day… you’re likely going to have to address all three areas regardless of what title you give your PCOS.
Final Considerations for PCOS Types
In conclusion, understanding the different types of PCOS can provide valuable insights into the complex nature of this condition. Perhaps stumbling across the popular PCOS Types led you to learn more about PCOS which is a huge WIN! However, it is important to always approach PCOS management holistically, focusing on your individualized needs, and embracing a comprehensive lifestyle approach.
Remember, PCOS is a lifelong condition that requires ongoing attention and care. With the right support and guidance, you can navigate their journey with confidence, resilience, and hope.
Sources:
- Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril. 2016;106(1):6-15. doi:10.1016/j.fertnstert.2016.05.003
- Clark NM, Podolski AJ, Brooks ED, et al. Prevalence of Polycystic Ovary Syndrome Phenotypes Using Updated Criteria for Polycystic Ovarian Morphology: An Assessment of Over 100 Consecutive Women Self-reporting Features of Polycystic Ovary Syndrome. Reprod Sci. 2014;21(8):1034-1043. doi:10.1177/1933719114522525
- Dapas M, Lin FTJ, Nadkarni GN, Sisk R, Legro RS, et al. Distinct subtypes of polycystic ovary syndrome with novel genetic associations: An unsupervised, phenotypic clustering analysis. PLOS Med. 2020;17(6):e1003132. https://doi.org/10.1371/journal.pmed.1003132
