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PCOS is not a specific endocrine disease or disorder, but it is a syndrome complex of many signs and symptoms. A vicious triad of chronic increase in the male sex hormone, androgens, an increase in insulin levels, and altered central release of gonadotropin hormones is the core problem in PCOS. This results in irregular periods, hyperandrogenism, hirsutism, and infertility among many other different concerns. It is a condition that affects 10 – 15% of all women.


Because of the varied symptoms of PCOS, women tend to experience PCOS in different ways. The symptoms of PCOS in a young woman may be different from the symptoms of PCOS in an adolescent girl. This not only makes it hard to diagnose the condition but also makes treating PCOS a challenging task. It is thus, important to determine the type of PCOS, in order to receive the best and most accurate treatment for it.



Types of PCOS:


In order to understand the different types of PCOS, it is vital to understand the phenotypes of PCOS. The term “phenotype” is used in genetics to describe the composition or characteristics of an organism. In 2012, the National Institute of Health proposed the phenotypic approach to classify PCOS. This enables us to categorize patients into different phenotypes of PCOS based on the following combination of 3 diagnostic criteria:


  1. Polycystic Ovarian Morphology on imaging (PCOM)
  2. Hyperandrogenism (HA) which can be either clinical or biochemical
  3. Ovulatory Dysfunction (OD)


Based on the above characteristics, patients are classified into 4 different types of PCOS phenotypes:


  • Phenotype A: HA + OD + PCOM
  • Phenotype B: HA + OD
  • Phenotype C: HA + PCOM
  • Phenotype D: OD + PCOM


Phenotype A:


This PCOS phenotype is a full-blown type of PCOS in which the patient shows pronounced menstrual dysfunction, increased and higher rates of insulin levels, metabolic syndrome, along with obesity and other concerning forms of dyslipidemia. Women with this type of PCOS and insulin resistance have high Anti-mullerian hormone levels (AMH) which results in a high number of ovarian follicles. Despite having increased follicles, women with phenotype A experience infertility since they don’t ovulate naturally.


Phenotype B:


This PCOS phenotype is the non-polycystic ovary type of PCOS with insulin resistance. The symptoms in these patients are clinical hyperandrogenism which results in hirsutism, or biochemical, which can cause ovulatory disturbance without showing polycystic ovaries on the ultrasound. Like phenotype A, these women also experience irregularities in their periods, increased levels of insulin, insulin resistance, obesity, and metabolic syndrome. The AMH levels may be normal to high but patients still suffer from infertility as they might have extreme menstrual irregularities.


Phenotype C:


Phenotype C is the ovulatory type of PCOS. Women with phenotype C have intermediate levels of androgens and therefore don’t suffer from severe hirsutism or metabolic syndrome. The AMH levels are however much lower which results in decreased ovarian follicles causing infertility.


Phenotype D:


PCOS phenotype D is the non-hyperandrogenic type of PCOS. Women with this phenotype have the mildest degree of endocrine and metabolic dysfunction and a much lesser chance of obesity, hyperandrogenism, metabolic syndrome, insulin resistance, and deranged lipid profile. However, they have an increased number of follicles along with ovulatory dysfunction which causes infertility.


It is important to diagnose the 4 types of PCOS to decide the appropriate therapy and give a proper prognosis. Unfortunately, there is no permanent cure for PCOS but the condition can be greatly controlled by being diagnosed and treated at an early stage.


Irrespective of the type of PCOS, a proper healthy diet and daily exercise can help you to quite an extent. Aerobic exercise helps reduce insulin levels and ultimately this helps in reducing the gonadotropin fluctuations and androgen levels. If you are not planning to get pregnant, combined oral contraceptive pills also help in reducing symptoms of irregular periods and even features of increased androgens like hair growth and acne. If you wish to get pregnant, an individualized approach that might include controlled ovarian stimulation with medication along with timed intercourse, IUI, or even IVF is effective ways. Persistent androgenic features like acne or increased hair growth, which do not respond to medication, are ultimately best treated with cosmetic treatment like laser therapy. So, depending on the phenotype of PCOS one has, an individualized approach catering to the need of the woman will help the most.


If you and anyone you know suffer from signs of PCOS, consult a doctor today or book an appointment with Dr. Banker!

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