Which Type of PCOS Do You Have?

Polycystic Ovary Syndrome (PCOS) is a common hormonal condition, but it doesn’t look the same for everyone. The symptoms, causes, and best treatment approaches can vary widely, which is why it often feels overwhelming or confusing to manage.

While the Rotterdam Criteria remains the preferred method of diagnosing PCOS, you may have heard of there being “4 types” or phenotypes of PCOS. Researchers and clinicians now recognize that PCOS can show up in four different subtypes, depending on the dominant root cause. Understanding your type of PCOS could help you take more targeted steps toward feeling better, improving your cycle, managing symptoms, and supporting your long-term health.

Let’s break down each type and what makes them different.

The Four Types of PCOS

1. Insulin-Resistant PCOS (The Classic PCOS)

This is the most common type with majority of women with PCOS falling into this category, and it is strongly linked to insulin resistance and metabolic issues.

Characteristics:

• Weight gain, especially around your abdomen
• Strong sugar or carb cravings
• Low energy or fatigue
• Higher risk of type 2 diabetes, cardiovascular disease, and metabolic syndrome

What’s happening:

In this type, your body struggles to use insulin properly, a condition known as insulin resistance. When insulin levels stay high, it stimulates the ovaries to make more androgens, which can worsen and causes many classic PCOS symptoms such as irregular cycles, acne, and hair growth. Insulin resistance also interferes with ovulation, which contributes to fertility challenges.

Management Strategies:

• Focus on improving insulin sensitivity through lifestyle change
• Eat a low-glycemic, anti-inflammatory diet
• Include strength training and work toward sustainable weight management
• Consider supplements or medications like inositol or metformin (talk to your healthcare provider first)

These changes can help rebalance hormones and reduce symptoms over time.

2. Post-Pill PCOS

This type often appears in women after stopping hormonal birth control, especially pills containing progestins.

Characteristics:

• Temporary rebound that causes irregular periods after coming off the Pill
• Increased acne or hair loss

Important to know:

This isn’t considered true PCOS, and the birth control pill doesn’t “cause” PCOS. These symptoms are usually temporary and resolve on their own within 6-12 months.

What’s happening:

While you are on the pill, ovulation is suppressed and androgen levels are reduced. When you stop, your body may temporarily produce extra androgens as it adjusts, which can look and feel like PCOS.

Management Strategies:

• Give your body time to rebalance
• Support ovulation with balanced meals, enough protein, and stress management
• Work with a registered dietitian for individualized nutrition support and supplements that can help support your cycle

3. Inflammatory PCOS

This type is mainly driven by chronic inflammation in the body.

Characteristics:

• Fatigue
• Digestive issues like bloating or IBS
• Skin conditions such as eczema or psoriasis
• Joint pain
• Bloodwork indicating markers of inflammation such as high CRP (C-reactive protein), elevated white blood cell count, or food sensitivities

What’s happening:

Chronic inflammation can disrupt how your hormones signal each other, interfering with ovulation and causing the ovaries to make more androgens. Research also links inflammation to factors like chronic stress, gut imbalances, and environmental toxins (e.g., microplastics or hormone disruptors).

Management strategies:

• Follow an anti-inflammatory diet including omega-3s (fatty fish, flaxseeds), polyphenol-rich foods (like berries, green tea), and plenty of fibre
• Improve gut health by cutting back on processed foods and addressing any food sensitivities
• Work with a registered dietitian for personalized health and dietary support
• Reduce inflammation with stress management, regular movement, and good sleep hygiene

4. Adrenal PCOS

This type is often linked to chronic stress rather than insulin issues.

Characteristics:

• Elevated DHEA-S (dehydroepiandrosterone sulfate), rather than high testosterone
• Linked to chronic stress and excess cortisol production (HPA axis dysfunction)
• Might experience symptoms like anxiety, insomnia, fatigue, and irregular cycles
• Often occurs in women who don’t have metabolic symptoms, also known as the “lean PCOS”

What’s happening:

Instead of your ovaries producing too many androgens, your adrenal glands are producing too much DHEA-S in response to long-term stress. This is part of your body’s stress-response system (HPA axis), which can get overactivated.

Management Strategies:

• Prioritize stress reduction by meditation, gentle exercise, or journaling
• Support sleep and avoid overstimulation such as caffeine or over-exercising
• Maintain balanced nutrition
• Work with an endocrinologist to monitor hormones and a registered dietitian for support
• See a licensed therapist who specializes in PCOS-related issues

This type requires a focus on lifestyle and nervous system health, rather than metabolic management.

Understanding Your PCOS Diagnosis: Next Steps

If you suspect you have PCOS, or want to know which type you might have, the first step is to get a proper medical work-up.

Talk to your doctor about:

• A full physical exam
• Blood tests (especially for androgens, fasting insulin/fasting glucose, HbA1C, DHEA-S, inflammation markers, and other relevant hormones)
• A pelvic ultrasound
• A referral to an endocrinologist or gynecologist, if needed

A few things to keep in mind:

• PCOS is a diagnosis of exclusion; your doctor should first rule out other conditions that cause similar symptoms, like thyroid disorders, high prolactin, or hypothalamic amenorrhea
• Not everyone with polycystic ovaries has PCOS, and you can have PCOS without visible cysts on an ultrasound
• PCOS shows up differently for everyone, which is why a personalized approach is key

FAQs About PCOS

What is PCOS?

PCOS (Polycystic Ovary Syndrome) is a hormonal disorder that affects 1 in 10 women of reproductive age. It’s characterized by irregular periods, elevated androgen levels, and often insulin resistance.

Can PCOS be cured?

While there’s no cure for PCOS, symptoms can be effectively managed through lifestyle changes, proper nutrition, stress management, and sometimes medication. Many women see significant improvement in their symptoms with the right approach.

How is PCOS diagnosed?

PCOS is diagnosed using the Rotterdam Criteria, which requires at least 2 of 3 symptoms: irregular or absent periods, clinical or biochemical signs of elevated androgens, and polycystic ovaries on ultrasound.

Can you get pregnant with PCOS?

Yes, many women with PCOS can get pregnant naturally or with fertility treatments. Working with healthcare providers to manage insulin resistance and support ovulation can improve fertility outcomes.

What foods should I avoid with PCOS?

Generally, it’s helpful to limit refined sugars, processed foods, and high-glycemic carbohydrates. Focus on whole foods, lean proteins, healthy fats, and complex carbohydrates instead.

Is weight loss necessary for PCOS management?

While weight loss can help improve symptoms for some women, it’s not necessary for everyone. The focus should be on overall health, insulin sensitivity, and hormone balance rather than just weight.

FAQs About July Health

What is July Health?

July Health is Canada’s growing virtual PCOS clinic, specializing in comprehensive care for women with PCOS through evidence-based nutrition therapy and mental health support.

What services does July Health offer?

July Health provides virtual consultations with registered dietitians specializing in PCOS, mental health support from qualified therapists, personalized nutrition planning, and ongoing support for PCOS management.

How does virtual PCOS care work?

Our virtual PCOS care includes one-on-one video sessions eligible for insurance coverage, personalized treatment plans, ongoing support through secure messaging, and access to educational resources – all from the comfort of your home.

Is July Health covered by insurance?

Many extended health insurance plans cover registered dietitian and psychology services. We recommend checking with your insurance provider about coverage for virtual nutrition counselling and therapy services.

How do I get started with July Health?

Getting started is easy! Book a free consultation call to discuss your PCOS concerns and learn how our team of specialists can support your health journey.

Get Expert PCOS Care with July Health

Managing PCOS doesn’t have to feel overwhelming. July Health is a growing virtual clinic dedicated to providing comprehensive PCOS care across Canada. Our team of specialized virtual registered dietitians and therapists understands the complexities of PCOS and works with you to develop personalized treatment plans that address your unique symptoms and goals.

We’re a female-led medical team and our practitioners live with PCOS themselves, so we get it.

Whether you’re dealing with insulin-resistant PCOS, struggling with post-pill symptoms, or managing inflammation, our experts are here to guide you every step of the way. We believe in empowering women with PCOS through evidence-based care, compassionate support, and practical strategies that fit into your daily life.

Ready to take control of your PCOS journey?

Book your free consultation call today to learn how July Health can support your path to better health and wellness.

Want to know what tests to ask for, or how PCOS is diagnosed step-by-step? Check out our next blog post, where we cover the PCOS diagnostic process in more detail and help you feel confident talking with your doctor.