Types of PCOS: Identifying Symptoms and Causes

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder common among women of reproductive age. It affects the ovaries, the reproductive organs that produce eggs. PCOS is characterized by a range of symptoms, including irregular menstrual cycles, excessive hair growth, acne, and weight gain.

Despite the name, not all women with PCOS have cysts on their ovaries. In fact, many do not. PCOS is also one of the leading causes of infertility among women, according to the WHO.

This condition is quite prevalent, affecting approximately 7-10%, as per the Endocrine Society. Despite its common occurrence, PCOS remains underdiagnosed in many cases. Some women may not experience noticeable symptoms, while others may have a range of issues that lead to a diagnosis. Understanding the various types of PCOS is essential for managing symptoms and improving quality of life.

A common misconception about PCOS is that it is always associated with the presence of ovarian cysts. While cysts can be a symptom, their presence is not necessary for a diagnosis. Instead, PCOS is primarily identified through a combination of symptoms, hormone levels, and sometimes, the appearance of the ovaries on an ultrasound.

Types of PCOS

Understanding the different types of PCOS is crucial for effective diagnosis and treatment. There are several ways to categorize PCOS, including conventional medicine and functional medicine approaches, as well as emerging research-based subgroups.

Conventional Medicine PCOS Types

• Symptoms: Women with Type A PCOS experience high levels of androgens (male hormones), irregular or absent menstrual periods, and polycystic ovaries. This type is often associated with more severe symptoms, including significant hirsutism (excess hair growth), acne, and sometimes, male-pattern baldness.
• Causes: The exact causes are multifactorial, often involving genetic and environmental factors. Insulin resistance is a common underlying issue.
• Treatment: Managing insulin resistance through diet and exercise, hormone regulation through medications, and sometimes, fertility treatments for those seeking to conceive.

• Symptoms: Similar to Type A, women with Type B PCOS have high androgen levels and irregular or absent menstrual periods, but they do not have polycystic ovaries.
• Causes: Elevated androgen levels and insulin resistance are common, along with potential genetic predispositions.
• Treatment: Hormonal treatments to manage androgen levels, lifestyle changes to improve insulin sensitivity, and medications to regulate menstrual cycles.

• Symptoms: This type involves high androgen levels and the presence of polycystic ovaries, but menstrual cycles may be regular.
• Causes: Hormonal imbalances and genetic factors play a significant role. Insulin resistance may also be present but is less prominent than in other types.
• Treatment: Hormonal treatments to control androgen levels and lifestyle modifications to manage symptoms.

• Symptoms: Women with Type D PCOS have irregular or absent periods and polycystic ovaries but normal androgen levels.
• Causes: Often linked to insulin resistance and hormonal imbalances that do not significantly elevate androgen levels.
• Treatment: Lifestyle changes to manage insulin resistance, medications to regulate menstrual cycles, and fertility treatments if needed.

4 Functional Medicine PCOS Types

• Symptoms: High blood sugar, darkened skin around the neck and armpits, sugar cravings, weight gain.
• Causes: The primary cause of insulin-resistant PCOS is the body's resistance to insulin, a hormone that regulates blood sugar levels. When cells become less responsive to insulin, the pancreas produces more of it to compensate. This excess insulin can increase the production of androgens, leading to symptoms like excess hair growth and acne.
• Treatment: Focus on a low-sugar diet, regular exercise, and supplements that improve insulin sensitivity.

• Symptoms: Acne, skin rashes, fatigue, joint pain, gut issues, weight gain.
• Causes: The inflammation in this type of PCOS can be triggered by various factors, including poor diet, high stress levels, and exposure to environmental toxins. These factors contribute to the body's chronic inflammatory response, which can exacerbate PCOS symptoms and lead to further hormonal imbalances.
• Treatment: Anti-inflammatory diet, stress reduction techniques, and supplements to reduce inflammation.

• Symptoms of Adrenal PCOS: High DHEA levels, primarily produced by the adrenal glands, leading to stress-related symptoms.
• Causes: This type of PCOS is primarily driven by an overproduction of DHEA-S from the adrenal glands, often in response to chronic stress. The adrenal glands are responsible for producing stress hormones, and when they are overstimulated, they can disrupt the hormonal balance, leading to the symptoms associated with PCOS.
• Treatment: Stress management practices, adrenal support supplements, and lifestyle changes to reduce stress.

• Symptoms: PCOS symptoms appear after stopping hormonal birth control, such as irregular periods.
• Causes: Hormonal birth control works by suppressing ovulation and altering hormone levels. After stopping the pill, the body may take time to readjust, leading to a temporary imbalance in hormones. This imbalance can mimic or exacerbate PCOS symptoms.
• Treatment: Hormonal balancing treatments, lifestyle changes, and patience as the body readjusts.

Understanding the different types of PCOS, including the four types of PCOS and symptoms, can help you and your healthcare provider develop a more effective management plan. 

If you suspect you have PCOS, consider using an online Symptom Checker to identify your symptoms, but always follow up with a healthcare professional for a comprehensive diagnosis and treatment plan.

New Research on PCOS Subgroups

A study by Mount Sinai has identified two distinct subtypes of polycystic ovary syndrome (PCOS) through a novel genetic analysis, revealing significant gene regions associated with each subtype. This discovery could lead to improved diagnosis and personalized treatment strategies for PCOS. 

Emerging research has proposed new subgroups of PCOS based on genetic markers and hormonal profiles. These subgroups can help in creating more personalized treatment plans.

• Characteristics: Higher LH (luteinizing hormone) and SHBG (sex hormone-binding globulin), lower BMI (body mass index), and insulin levels.
• Treatment: Focus on balancing hormones and managing reproductive health.

• Characteristics: Higher BMI, glucose, and insulin levels, lower LH and SHBG.
• Treatment: Emphasis on weight management, insulin sensitivity, and metabolic health.

• Characteristics: Do not fit neatly into either the reproductive or metabolic groups.
• Treatment: Requires a personalized approach based on individual symptoms and health profiles.

Diagnosis and Misdiagnosis

Diagnostic Criteria

The most widely accepted criteria for diagnosing PCOS is the Rotterdam Criteria, noted AJUM in the Wiely publication. According to these criteria, a diagnosis can be made if two out of the following three conditions are met:

1. Irregular Periods: This includes infrequent, irregular, or absent menstrual cycles, which indicate problems with ovulation.
2. High Androgens: Elevated levels of androgens (male hormones) can be confirmed through clinical symptoms like excess facial or body hair and severe acne, or through blood tests showing elevated levels of these hormones.
3. Polycystic Ovaries: The presence of 12 or more follicles in each ovary as seen on an ultrasound, or increased ovarian volume, indicating the presence of polycystic ovaries.

Common Misdiagnoses

Due to the similarity in symptoms, PCOS is sometimes misdiagnosed. Common conditions that are mistaken for PCOS include:

• Hypothalamic Amenorrhea: A condition where menstruation stops for several months due to a problem involving the hypothalamus, often related to low body weight, excessive exercise, or stress.
• Hypothyroidism: An underactive thyroid gland can cause symptoms such as weight gain, irregular menstrual cycles, and fatigue, which can be similar to those of PCOS.

Diagnostic Tests

• Blood Tests: These tests measure hormone levels, including androgens, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and glucose levels to check for insulin resistance.
• Ultrasound: A pelvic ultrasound can help visualize the ovaries and check for the presence of cysts and increased ovarian volume.

General Treatment Options

Dietary Recommendations

• Reduce Sugar Intake: Limit consumption of high-sugar foods and beverages to help manage insulin levels.
• Anti-Inflammatory Foods: Incorporate foods rich in omega-3 fatty acids (like fish, flaxseeds, and walnuts), antioxidants (found in fruits and vegetables), and anti-inflammatory spices (such as turmeric and ginger).

Exercise

• Weight Management: Helps maintain a healthy weight, reducing insulin resistance.
• Improved Insulin Sensitivity: Exercise can improve the body's response to insulin, helping manage blood sugar levels.
• Stress Reduction: Physical activity helps reduce stress, which can exacerbate PCOS symptoms.

Stress Reduction

• Yoga and Meditation: Practices like yoga and meditation can help reduce stress and promote hormonal balance.
• Adequate Sleep: Ensuring sufficient and quality sleep is crucial for overall health and stress management.

Hormonal Treatments

• Birth Control Pills: These can help regulate menstrual cycles and reduce symptoms like acne and excess hair growth.
• Anti-Androgens: Medications that block the effects of androgens, helping to manage symptoms like hirsutism and acne.

Fertility Treatments

• Ovulation Induction: Medications like Clomid and letrozole stimulate ovulation.
• Gonadotropins: Injectable hormones that promote ovulation.

Surgical Options

• Laparoscopic Ovarian Drilling: This minimally invasive surgery involves creating small holes in the ovaries to reduce androgen production and restore normal ovulation.
• Cyst Aspiration: Involves the removal of cysts to relieve symptoms and potentially improve fertility. This procedure is guided by ultrasound to ensure precision and effectiveness.