PCOS 101: Which Type Do I Have?

PCOS, as covered in another article, is a condition that can affect your ovaries. But this can be used as an umbrella term; in reality, there are different types of PCOS, and each can slightly differ in the symptoms. In this blog, we’ll be covering the four main phenotypes of PCOS along with the other types that PCOS can be categorized into.

Disclaimer: Although PCOS can be categorized into many different types depending on where you look, these classifications are not definitive due to the fact that we still don’t know much about the exact causes. Although the diagnosis and classification of PCOS has been getting better since the past couple of years due to more research, just keep in mind that the information provided here may be limited.

Phenotypes of PCOS

There are four different phenotypes of PCOS, and these are classified by the following:

• Hyperandrogenism: The amount of androgens (male sex hormones) in the bloodstream; in hyperandrogenism, there are higher levels than usual.

• Ovulatory Dysfunction: This is for ovulation and menstrual irregularities; some women may not ovulate every month or at all.

• Polycystic Ovaries: Doctors can administer ultrasounds and physical examinations to see if you have multiple cysts (fluid-filled sacs) in your ovaries.

There are other classifications for PCOS (whether it’s inflammatory, if the symptoms are not quite obvious, etc.) that can be used to figure out what type you may have.

Phenotype A

Phenotype A, also known as Full/Classic PCOS, is the most common type of PCOS (with an approximate 50-70% prevalence out of all PCOS cases). Women with this type of PCOS have all three factors that classify PCOS, which are hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. 

The symptoms that are typically associated with Phenotype A are:

• Acne 

• Hair loss

• Dark patches of skin, mainly under the breasts, armpits, and neck

• Excessive body hair (hirsutism)

• Infertility

• Irregular/missed periods

• Weight gain

Classic PCOS can increase the risk of endometrial cancer, type 2 diabetes, sleep apnea, and cardiovascular disease.

Phenotype B

Phenotype B, also known as Non-PCO PCOS, is PCOS that consists of hyperandrogenism and ovulatory dysfunction, but does not include polycystic ovaries. This type of PCOS has a 5-19% prevalence out of all cases. Symptoms include:

• Dark patches of skin, mainly under the breasts, armpits, and neck

• Acne

• Hirsutism

• Irregular periods

• Obesity/overweight

• Hair loss

Similar to Classic PCOS, Non-PCO PCOS can increase the risk of type 2 diabetes, endometrial cancer, insulin resistance, and  cardiovascular disease.

Phenotype C

Phenotype C, also known as Ovulatory PCOS, is PCOS without ovulatory dysfunction. This has a prevalence of 18-40% of all cases, making it the second most common out of all cases. 

The symptoms include:

• Acne

• Hirsutism

• Overweight/obesity

• Hair loss

Ovulatory PCOS can increase the risk of HDP (hypertensive disorders of pregnancy, which is basically high blood pressure), type 2 diabetes, cardiovascular disease, and insulin resistance.

Phenotype D

Phenotype D, also known as Non-hyperandrogenic PCOS, is the least common type of PCOS with a prevalence of only 1-11%. This type does not include hyperandrogenism. 

The symptoms are:

• Irregular periods

• Infertility

• Overweight/obesity

This phenotype of PCOS is often seen to be the least severe out of all four, but more research still has to be done. This can still include the risks though, such as endometrial cancer, HDP, and adverse pregnancy outcomes like miscarriage.

Other Classifications of PCOS 

PCOS may be classified into other categories too–such are the following:

• Insulin-Resistant PCOS: Insulin is still being made, but our bodies can’t use it effectively. This leads to higher glucose levels, which in turn can negatively impact your hormone levels. This is a relatively common type of PCOS–it affects around 50-70% of women with PCOS. Sleep apnea, weight gain, dark patches, and depression are signs of insulin resistance.

• Inflammatory PCOS: Inflammation, although used as a method to protect your body against infection, can sometimes be chronic if there’s no illness/injury present. Low-grade inflammation is a contributor to PCOS and its symptoms.

• Adrenal PCOS: Hyperandrogenism, like previously stated, is connected with PCOS, where it’s estimated that 80% of women with hyperandrogenism may also have PCOS. In women, androgen is made in both the ovaries and the adrenal glands (which are located on top of our kidneys). Hyperandrogenism can cause hirsutism, oily skin, irregular periods, and a deep voice.

• Post-Pill PCOS: Although not an official type of PCOS, people can often misconceptualize the fact that after you get off any hormonal contraceptives (like the pill), you can get PCOS. This isn’t the case; instead, women can get symptoms that are similar to those of PCOS because our hormones are going to try to re-regulate after that time period. Some symptoms may include mood swings, acne, bloating, and irregular periods.

• Lean PCOS: People with lean PCOS can experience the same symptoms of PCOS despite having a normal/lower BMI. This type is less common compared to the more commonly associated PCOS with being overweight because it’s harder to diagnose.

Takeaways 

There are many different classifications of PCOS, where each can have their own mix of symptoms. However, keep in mind that these classifications are not all set in stone. There could be many variations of PCOS, where certain individuals may experience different conditions compared to others while still having the disease. In other cases, individuals may have more than one type of PCOS. As you can see, it can be difficult to categorize PCOS and what type an individual may have as it’s all up to the person and their health. Despite that, there are some treatment options available for certain symptoms, and you can talk to your healthcare provider to see what you can do to manage your PCOS. That way, you can relieve your symptoms and live your life to the fullest.