The previous post about PCOS was about the criteria involved in diagnosing someone with PCOS. Many clinicians follow the Rotterdam criteria, which require 2 out of 3 criteria to be met in order to be diagnosed with PCOS.  They are: 

1. Delayed ovulation or menstrual cycles (anovulation)
2. High androgenic hormones like testosterone
3. Polycystic ovaries on ultrasound

Because you need to meet 2 criteria, your PCOS presentation may be slightly different than someone else’s. This brings us to the four types of PCOS.

The 4 PCOS types

Type A

Classified by:

• Hyperandrogenic
• Anovulation
• Polycystic ovaries

Known as the classic type of PCOS. Signs and symptoms include: high BMI, increased weight circumference, highest androgens values, increased LH/FSH, AMH, low progesterone, and menstrual irregularity. Insulin resistance is also a factor – leading to an increased risk of diabetes and heart disease. 

Type B

Classified by:

• Hyperandrogenic
• Anovulation

Another classic form of PCOS. Signs and symptoms include: increased BMI, weight around the waistline, menstrual irregularity, signs of high androgens (ie. hirsutism, acne, and hair loss). Insulin resistance is also a factor in this type. In addition, this type may include older women. 

Type C

Classified by:

• Hyperandrogenic
• Polycystic ovaries

Signs and symptoms include: Medium BMI score, weight around the waistline, high androgens (ie. testosterone), polycystic ovaries, and while periods may be regular – ovulation may not be occurring (therefore, be sure to get your progesterone checked around day 21)! 

Type D

Classified by:

• Anovulation
• Polycystic ovaries

Considered the ‘lean’ PCOS. Signs and symptoms include: menstrual irregularities, polycystic ovaries, androgen levels are optimal – no physical signs of androgen excess, normal BMI, normal waist circumference, may be signs of insulin resistance. 

Rule these conditions out

Before you jump aboard the PCOS train, you want to rule out certain conditions first, as they may be the cause of some of your symptoms:

• High prolactin (found on blood work)
• Hypothalamic amenorrhea
• Hypothyroidism – this can occur with PCOS
• Non-classical congenital adrenal hyperplasia

A note about insulin resistance

As you might have noticed, insulin resistance is predominant in many of the types of PCOS. So how do you measure for it?

• Fasting insulin
• Fasting glucose
• Oral glucose tolerance test

You can use these first two values (which you can get assessed through blood work) to calculate your HOMA-IR score. Ideally your score should be less than 1.5.  Too much insulin can lead to excess androgens being formed (in various ways) and it may also impair ovulation. 

Final Thoughts

If you’re thinking that you have some of these signs and/or symptoms, and have yet to get any of your blood work done – do it! Because there are different types of PCOS, you want to get solid evidence of which type you may be. This will ultimately help determine the best type of treatment for you!

Find out your PCOS type with this blood work:

• Total testosterone
• Free testosterone
• DHEA
• Androstenedione
• DHT
• Fasting insulin
• Fasting glucose
• TSH
• Free T4
• Free T3

Don’t forget that Naturopathic Doctors can also requisition blood work! Speak to your ND to determine if that’s the best option for you. 

Now that you have a solid plan, please sign up for my monthly newsletter called The Flow for more informative and useful content like this! I want to make sure that you have a good flow!