Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions affecting women of reproductive age, yet many women go years before being diagnosed and treated. Women with PCOS have imbalances in their hormones, but depending on what’s driving the hormonal imbalance, they can present with different symptoms. The most common signs and symptoms of PCOS include irregular menstrual cycles, excess facial and body hair, acne, weight gain, infertility and polycystic ovaries on ultrasound. Some women may present with all of these symptoms, yet others may only experience one or two. Making a timely and accurate diagnosis of the reason behind a woman’s hormonal symptoms is key towards optimizing a woman’s health and helping her feel like the best version of herself again. Read below to learn how PCOS is diagnosed and the four types of PCOS women typically fall into.
According to the Rotterdam criteria, PCOS can be diagnosis when a woman presents with two or more of the following features:
1. Hyperandrogenism. Hyperandrogenism is when women have elevated levels of androgenic hormones such as testosterone in a blood test, or when women have excess facial and body hair, moderate-severe acne, and/or hair loss.
2. Absent or irregular menstrual cycles. Menstrual cycles that are longer than 35 days are considered “irregular”.
3. Polycystic ovaries on ultrasound. This can be defined as either 12 or more follicles ranging in size from 2-9mm in a single ovary, or an ovarian volume greater than 10mL.
PCOS can further be broken down into 4 subtypes:
Type 1 – Frank PCOS
- This category is typically thought of as the “classic” presentation of PCOS where women have all three Rotterdam criteria (hyperandrogenism, irregular menstrual cycles, and polycystic ovaries). Women with Frank PCOS often have insulin resistance, tend to gain weight the easiest (especially around their abdomen), and report the most irregularities in their menstrual cycle.
Type 2 – Ovulatory PCOS
- Women with Ovulatory PCOS have regular menstrual cycles, but do have signs of hyperandrogenism and polycystic ovaries on ultrasound. They tend have a lower BMI and carry less weight in their abdomen. Women with Frank PCOS who lose weight and correct insulin resistance typically move into this category.
Type 3 – Non-PCO PCOS
- In this category, women experience irregular menstrual cycles and hyperandrogenism, but have normal ovaries on ultrasound. Similar to Frank PCOS, they tend to gain weight easily and in their midsection, and test positive for insulin resistance.
Type 4 – Normoandrogenic
- This is least common and most mild form of PCOS. Women will report irregular menstrual cycles and have polycystic ovaries, but do not have signs or symptoms of hyperandrogenism. They are often more “lean” and do not have insulin resistance.
It is clear from these 4 subtypes that women with PCOS require an individualized approach to best manage their unique hormonal imbalances. It is also important to rule out other conditions that can mimic PCOS, such as hypothyroidism, hyperprolactemia, and premature ovarian insufficiency. Women with PCOS generally respond well to natural treatments such as diet and lifestyle modifications and supplementation within 3 months of treatment.
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