Four Types of PCOS

As I have been scrolling the Facebook groups that I am in regarding fertility and PCOS, I have been realizing that a lot of women are in the same place I was in for so long!

For years i thought PCOS was a condition that presents the same in everyone. I feel that this is likely due to the lack of knowledge on the part of many PCP and regular Gynecologists. I was diagnosed at 17 with PCOS because of my lack of progesterone, increased testosterone, weight fluctuation, and hirusitism. However, at the time, I did not have cysts on my ovaries so their natural solution was to put me on the birth control pill. I chose to not go that route, and as a result, I was dismissed from the practice. I searched for other doctors that had other options to treat PCOS without birth control, and my search came up with absolutely nothing.

It wasn’t until years later, in my mid-twenties, that I discovered that PCOS is an umbrella term for four different types of hormonal issues that all are closely related to each other and can interchange or mesh together as our bodies grow and change. As a small disclaimer, I am not a doctor so please make an appointment with a doctor you trust if you think that you might be showing these symptoms. Usually a diagnosis requires a combination of blood work, physical symptoms, and an ultrasound to look for poly cystic ovaries.

Type 1: Insulin-Resistant PCOS

This is the classic type of PCOS which includes poly cystic ovaries, irregular menstrual cycles, and hyperandrogenism (increased levels of testosterone and other male hormones that can show up in female bodies). This type of PCOS can be caused by your body not being able to use the insulin it produces, therefore it has to continue to make more insulin to try to regulate your blood sugar. When this happens, it causes inflammation in the ovaries which prevents ovulation and ultimately results in your body producing and releasing male hormones like testosterone. It also causes under-production of estrogen and over production of LH, which can also become a major problem when using OPT or OPK to predict ovulation. Women with this type of PCOS might see small spikes in LH levels on their OPT, but it might not be from actual ovulation.

Symptoms that can come from this type of PCOS include:

• Irregular periods
• Weight gain or fluctuation
• Facial hair or increased hair growth
• Hormonal acne

Type 2: Inflammatory PCOS

This type of PCOS is caused by inflammation throughout the body without signs of insulin resistance being present. This would be characterized by having hyperandrogenism, irregular period, and poly cystic ovaries.

Symptoms that can come from this type of PCOS include:

• Irregular periods
• Weight gain or fluctuation
• Facial hair or increased hair growth
• Hormonal acne
• IBS
• Joint pain and stiffness
• Fatigue
• Headaches

Type 3: Non-PCO PCOS or Ovulatory PCOS

This type is characterized by a female which has hyperandrogenism, irregular menstrual cycles, but does not have poly cystic ovaries.

Ovulatory PCOS is characterized as having all of the symptoms of regular PCOS but with regular menstrual cycles.

Type 4: Mild PCOS

This type is characterized by having poly cystic ovaries and irregular menstrual cycles, but normal androgen levels. This can happen after coming off birth control, and in some cases, will level out on its own.

Helpful Clinical Definitions

(Sourced from Prevalence of Polycystic Ovary Syndrome Phenotypes Using Updated Criteria for Polycystic Ovarian Morphology – link to this research study below.)

Oligo- or Frank amenorrhea was defined as a history of menstrual cycles of >38 days.

Hyperandrogenism was defined as a modified hirsutism score of ≥7 and/or an elevated total testosterone value of ≥3.96 nmol/L as described previously.

PCO on ultrasonography was defined as the presence of ≥26 follicles measuring 2 to 9 mm throughout the entire ovary and/or an ovarian volume (OV) greater than 10 cm³.

All sonographic measurements were made offline by a single observer using Santesoft DICOM Editor software (Emmanouil Kanellopoulus, Athens, Greece). OV was estimated using the equation for a prolate ellipsoid. Follicle counts were performed using a reliable grid system approach for counting follicles throughout the entire ovary as described previously.

Values reported for follicle count and OV represent the mean recorded values of the left and right ovaries rounded to the nearest whole number or 10th decimal place, respectively.

Source:

Clark, N. M., Et. al. (n.d.). Prevalence of Polycystic Ovary Syndrome Phenotypes Using Updated Criteria for Polycystic Ovarian Morphology. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4126218/