The Four Types of PCOS, And Why the Right Diagnosis Matters
Polycystic ovary syndrome (PCOS) is a highly heritable, complex hormonal disorder affecting up to 15% of reproductive-age women worldwide, depending on the diagnostic criteria used.
Despite its name, PCOS is not about cysts, and it’s not a single disease. Instead, it’s what researchers call a heterogeneous disorder, i.e. a collection of symptoms like irregular periods, acne, excess hair growth, and ovulation issues.
Polycystic ovary syndrome is characterised by androgen excess which should be confirmed by:
High androgens (male hormones) on a blood test and/or
Symptoms of androgen excess, such as jawline acne, facial hair growth and
Ruling out other causes of androgen excess (e.g. congenital adrenal hyperplasia, high prolactin, or high-androgen birth control.
Since androgen excess in PCOS can arise from different underlying causes, identifying your PCOS subtype is key to effective treatment.
The Four Types of PCOS
In integrative practice, PCOS is often grouped into four broad types, based on the dominant driver. Identifying your type helps guide more effective treatment and avoids wasting time on the wrong approach.
1. Insulin-Resistant PCOS
This is the most common type, and also one of the most commonly mismanaged, often dismissed with the advice to “just go on the pill.”
Chronically elevated insulin levels trigger the ovaries to produce excess androgens like testosterone. This disrupts ovulation and leads to many classic PCOS symptoms.
Insulin resistance can be silent, even in women of normal weight, and is not reliably detected by standard glucose or HbA1c tests. More accurate indicators include:
High fasting insulin
Elevated triglycerides
Elevated ALT
Reversing insulin resistance is a key goal of treatment for this type.
2. Post-Pill PCOS (Temporary)
This type occurs in some women after stopping the combined oral contraceptive pill. It’s caused by a temporary surge in androgens once the suppressive effect of the pill is lifted.
You might have this type if:
You had regular periods before starting the pill
Your symptoms (e.g. acne, irregular cycles) began within a few months after stopping
You show no signs of insulin resistance or inflammation
This type often resolves naturally within 6–12 months, but supportive care can help rebalance your cycle more smoothly.
3. Inflammatory PCOS
Chronic inflammation can trigger androgen production and is a factor in all types of PCOS. But when insulin resistance and post-pill scenarios are ruled out, inflammation becomes the primary driver, and that is when Inflammatory PCOS is diagnosed.
Signs of inflammation include:
Unexplained fatigue, brain fog
Chronic skin conditions (e.g. eczema, psoriasis)
Digestive issues such as IBS or SIBO
Autoimmune conditions
Elevated inflammatory markers (e.g. CRP, IL-6)
Addressing hidden inflammation which is often linked to gut health, food sensitivities, and chronic infections is essential for this type.
4. Adrenal PCOS
This is the least common type and often affects lean women with no signs of insulin resistance. It’s driven by excess DHEAS (dehydroepiandrosterone sulfate), an androgen made by the adrenal glands, not the ovaries.
This type is typically stress-related, often linked to chronic stress, overtraining, or poor nervous system recovery.
Key marker:
Bloodwork shows elevated DHEAS with normal testosterone and androstenedione
Stress regulation is critical to treating this type.
Treatment Strategy
While many PCOS types benefit from general anti-androgen support, this alone is not enough if the underlying cause isn’t addressed:
Insulin-resistant PCOS requires correcting the metabolic imbalance
Inflammatory PCOS needs systemic inflammation to be calmed
Post-pill PCOS responds best to gentle, cycle-supportive care
Adrenal PCOS calls for nervous system support and cortisol regulation
The most effective approach to PCOS is individualised and integrative. Working with an experienced practitioner can make all the difference.
Final Thought
PCOS is a complex condition, and understanding your specific type is the first step toward choosing the right strategy for long-term recovery and hormonal balance.
Whether it's insulin resistance, inflammation, a post-pill transition, or adrenal stress driving your symptoms, the key is targeted, individualised care that works with your body’s unique needs.
By identifying the primary drivers and addressing them systematically, many women can restore regular cycles, reduce androgen symptoms, and improve overall wellbeing, naturally and sustainably.
