The beginner guide to the different types of PCOS

PCOS symptoms can differ wildly from person and person. One person with PCOS might experience regular cycles. Yet another can go months without getting a period. Others battle to get rid of acne and unwanted hair, while perhaps there are those who only struggle with hair loss and weight gain. Some of us endure all of those horrible symptoms.

The reality is that everyone’s PCOS is different because there are 4 types of PCOS. Even within the same type, the severity of symptoms will vary.

So, why is it worth knowing about these types? One of the main reasons is to find the best intervention for your PCOS. In fact, researchers said understanding the criteria for each of these types of PCOS can help you figure out the most effective way to manage your condition: “The differences observed between the four phenotypes of PCOS underline the need for individualised diagnostic and therapeutic approach.”

Below, we’ll talk about the 4 types of PCOS and their symptoms.

What are the 4 types of PCOS?

The four types of PCOS are based on three main symptoms: anovulation, hyperandrogenism, and PCOS cysts. 

Honestly, when I first heard some of these terms, I had no idea what they meant. Once I delved into the details, many things started to fall into place. Finally, the reasons underlying my personal PCOS challenges become clearer. Much clearer.

Let’s look at how these symptoms might play out in our bodies: 

• Anovulation: delayed ovulation or irregular cycles 
• Hyperandrogenism: excess androgens, leading to acne and increased body hair
• Polycystic ovaries: multiple follicles spotted on an ultrasound  

These categories are rooted in diagnostic criteria from the world’s top health and reproductive medicine experts. In short, it’s how the medical community defines and diagnoses PCOS.  Naturally, depending on your PCOS type, you might recognise one, two, or all of these symptoms all too well. Maybe you're like me and you know all three way too well. According to the National Institutes for Health (NIH), the four types of PCOS are categorized as Type A, Type B, Type C, and Type D: 

“Women with PCOS can have any combination of the following phenotypes: excess androgen levels, ovarian dysfunction, and polycystic ovarian morphology…Type A is the most severe phenotype, and D is the least severe phenotype. Types A and C are the most prevalent phenotypes.”

In 8 Steps to Reverse Your PCOS, Dr. Fiona McCulloch, a naturopathic doctor with PCOS, explores each of these PCOS types. This book is a valuable resource and it’s where I first learned about the different forms of PCOS. McCulloch advocates that everyone should be able to identify their PCOS factors:

“I believe that the (types) are important to know about to help you determine if you have PCOS in the first place and to understand more about the intensity of your PCOS.”

The biggest benefit of learning about these PCOS types is that you can begin to put your personal experience into context. For me, just knowing there were different types of PCOS helped me make sense of what was happening in my body. Once I had the information, I started conducting deeper research and seeking medical advice to better manage my PCOS.

Type A PCOS

Type A is the “classic” and most severe form of PCOS. Typically, people with Type A PCOS meet all three criteria: high androgens, polycystic ovaries, and anovulation.

Unfortunately, according to the Fertility and Sterility journal, Type A PCOS is the most common form of the condition.

If you have Type A PCOS, you have more insulin resistance, writes McCulloch. She said this puts you at a higher risk for developing serious health issues, like diabetes and heart disease. People with Type A PCOS also typically have the highest testosterone levels when compared with people in the other categories. Type As tend to have irregular periods and were more likely to have “breakthrough bleeds”. A breakthrough bleed is when the lining of the uterus sheds, said McCulloch. 

The good news? You can move to a milder type of PCOS. 

To treat Type A PCOS, McCulloch recommends diet and lifestyle changes. She shares the story of a woman with Type A PCOS who started eating better, exercising regularly, and taking supplements to reduce her insulin resistance. Eventually, her cycles became regular. Not only did she move from Type A PCOS, but she also managed to reverse all the symptoms of her PCOS.

Type B PCOS

Type B PCOS is another “classic” type of PCOS, said McCulloch. Similar to Type A, people with Type B have irregular periods and high androgens. That’s not the only thing Type Bs have in common with Type As. People in this category are also at higher risk for diabetes and heart disease. One key difference between Type A and Type B is that the ovaries don’t have cysts.

Other common Type B symptoms include hirsutism, acne, and hair loss.  Again, like people with Type A PCOS, Type Bs typically gain weight around their middle. However, that doesn’t mean lean people can’t have this form of PCOS, adds McCulloch.

Type C PCOS

Type C PCOS is a non-classic PCOS. 

Type Cs have high androgens and cysts on their ovaries. However, unlike many other people with PCOS, people with Type C PCOS have fairly regular periods. Yet while their periods are regular, they might not ovulate during each cycle, said McCulloch. She cites a study that showed Type Cs often experienced incomplete ovulation, and their period was actually a breakthrough bleed.

McCulloch recalls a particular Type C case where the woman had regular, though light, periods. She was experiencing severe hair loss and unwanted facial hair. Then, an ultrasound showed the woman’s ovaries contained several follicles or PCOS cysts.

Together, McCulloch and the patient worked to reduce her androgen levels. Part of the treatment plan set out dietary changes, including eliminating sugar. Over time, the patient’s symptoms eased. Her hair grew back and her cycles shifted from 34 days to 30 days.

Type D PCOS

Type D PCOS is a newer, somewhat controversial, category. It’s controversial because some people don’t even agree that it is a type of PCOS, writes McCulloch.

People with this of type PCOS have normal androgen levels and less insulin resistance. However, they tend to have irregular periods and delayed ovulation. To diagnose this type of PCOS, your doctor would need to rule out other diseases like hyperthyroidism.

Complete the types of PCOS quiz to determine your type

At this stage, you might be wondering, “How do I know what kind of PCOS I have?” Thankfully, there are a number of ways you can evaluate your own symptoms.

McCulloch provides these questions to assess your PCOS factors:

Hyperandrogenism

• Do you have a lot of acne?
• Do you have hair growth on your chin or upper lip?

Anovulation 

• Are your cycles irregular and longer than 35 days?

Polycystic ovaries 

• Did you have cysts “multiple small follicles” on your ovaries?

You can find McCulloch’s complete PCOS quiz here.

Know your PCOS type and regain control of your health

Whether you have a PCOS diagnosis or you’re not even sure if you have the condition, learning the PCOS types can support you to take control of your health. Then, you’ll be able to have informed discussions with your medical health provider about your treatment.