Some women with PCOS experience all of the possible symptoms of PCOS: menstrual irregularities, infertility, insulin resistance, hirsutism (unwanted facial and body hair), weight gain, and acne. However, other women with PCOS experience only one or two of these symptoms. There is some debate in the medical community about whether there are different types of PCOS and, if so, how they should be categorized.

Some doctors diagnose women with a specific type of PCOS, while others do not. Among doctors who refer to types, there are two common approaches to categorizing PCOS.

Insulin Resistance

Some doctors will diagnose women with either “insulin resistant PCOS” or “non-insulin resistant PCOS,” based on the levels of insulin in your body. Insulin is the hormone that enables the cells to take in and use blood sugar (glucose). Women with PCOS are often insulin resistant – their cells are not responsive or sensitive to insulin, and insulin does not work as well. If blood glucose levels become too high, the body will overproduce insulin in response. Too much insulin can then signal the body to make more androgens. High blood glucose (hyperglycemia) can also lead to the development of type 2 diabetes.

If you are insulin resistant, your doctor can prescribe treatments that can combat the resistance, such as Metformin. Regulating insulin levels can promote weight loss and reduce the production of androgens. Reducing androgen levels can help to improve fertility.

If your insulin level is in a normal range, common PCOS management medications and lifestyle changes, such as Metformin and weight loss, are not appropriate or beneficial in reducing symptoms. Dietary supplements such as vitamin D may be prescribed alongside progestin-only birth control pills. Read more about treatments for PCOS.

Symptom-Based Typing

Another way of typing PCOS splits the condition into five subtypes based on the presence or lack of three criteria: menstrual and ovulatory irregularities, insulin resistance, and elevated androgen levels. These five subtypes and their defining criteria include:

• Classic/Insulin-Resistant/Type 1 - menstrual and ovulatory irregularities, insulin resistance, and elevated androgen levels
• Thin/Non-Insulin Resistant/Type 2 - menstrual and ovulatory irregularities, no insulin resistance, and elevated androgen levels
• Non-traditional PCOS 1 - menstrual and ovulatory irregularities, insulin resistance, and normal androgen levels
• Non-traditional PCOS 2 - normal menstrual cycle and ovulation, mild insulin resistance, and elevated androgen levels
• Idiopathic hirsutism - normal menstrual cycle and ovulation, no insulin resistance, and elevated androgen levels

Condition Guide

• PCOS – An Overview
• PCOS – Causes and Risk Factors
• PCOS - The Path to Diagnosis
• Symptoms of PCOS
• Treatments for PCOS

Resources

External resources

• Criteria, prevalence, and phenotypes of polycystic ovary syndrome - American Society for Reproductive Medicine
• The Many Faces of Polycystic Ovarian Syndrome - Natural Fertility Info
• The Five Faces of PCOS - Dr. Nicole Hartman, Naturopathic Physician