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- From Chaos to Clarity: Finding Your PCOS Type
From Chaos to Clarity: Finding Your PCOS Type
***Disclaimer: I’m not a licensed medical professional and do not treat or diagnose illness. This content is for educational purposes only.
Why weren’t we told what type we have?
That’s such a powerful and important question — and honestly, you're not alone in wondering this. So many people with PCOS have this same experience: they leave the gynecologist’s office with a diagnosis and maybe a prescription, but not much understanding of what’s actually going on in their body — let alone that there are different types of PCOS.
Most gynecologists are trained to diagnose PCOS based on the Rotterdam criteria, which looks for 2 out of 3 signs:
Irregular or absent ovulation
Elevated androgens (testosterone)
Polycystic ovaries on ultrasound
This approach doesn’t differentiate between the root causes — it just checks the boxes. So if you fit the criteria, you get the label “PCOS,” but not necessarily a deeper explanation.
Once you have your history, labs, and imaging, you can classify which phenotype fits best. That in turn helps inform personalized approaches.
1. Insulin‑Resistant PCOS
Root cause: Blood sugar imbalance, insulin resistance
Common signs & symptoms:
Sugar cravings, especially after meals or around your period
Feeling tired after eating, or needing a nap after carbs
Weight gain (especially around the belly), difficulty losing weight
Skin tags, dark patches of skin (especially neck/armpits)
Acne, especially along jawline/chin
Irregular cycles, long cycles, or missed periods
Mood swings or “hangry” crashes when you go too long without food
✨ This is the most common type — and it’s often improved with blood sugar-stabilizing foods, mindful movement, and herbal/metabolic support.
Mechanism: Excess insulin drives ovarian androgen production and disrupts follicle development.
Clues:
Acanthosis nigricans (darkened skin folds)
Family history of type 2 diabetes
Central (“apple‑shaped”) adiposity
How to test:
Fasting insulin and glucose → calculate HOMA‑IR
Oral Glucose Tolerance Test (OGTT) with insulin measurements at 0, 30, 60, 90, 120 minutes
Hemoglobin A1c (for longer‑term glycemic control)
2. Adrenal PCOS
Root cause: Elevated DHEA-S from adrenal (stress-related) hormone imbalance
Common signs & symptoms:
You have high androgens (acne, hair loss, hirsutism) but normal insulin + ovarian markers
Sensitive to stress, overstimulation, or burnout
“Tired but wired” feeling, sleep issues, cortisol spikes
Lean body type or normal weight
You feel emotionally drained or edgy often
Cycles might be irregular, but not absent
✨ This type is less about food and more about nervous system healing — breathwork, rest, sleep, somatic work, and adrenal-nourishing herbs like ashwagandha or holy basil.
Mechanism: Overproduction of DHEA‑S and other adrenal androgens, often linked to chronic stress or HPA‑axis dysregulation.
Clues:
Predominant elevations in DHEA‑S (vs. testosterone)
History of chronic stress, insomnia, or adrenal fatigue symptoms
How to test:
Serum DHEA‑S (often > 600 μg/dL)
24‑hour urinary adrenal androgen profile (e.g., DHEA, androsterone, etiocholanolone)
Salivary cortisol rhythm (morning, midday, evening) to assess HPA‑axis balance
3. Inflammatory (Post‑Inflammatory) PCOS
Root cause: Chronic low-grade inflammation
Common signs & symptoms:
Fatigue that doesn’t improve with rest
Joint pain or muscle soreness
Skin issues like eczema, psoriasis, or acne that flares with stress or certain foods
Digestive issues (bloating, constipation, IBS-like symptoms)
You feel puffy or swollen often
Irregular cycles, PMS, and ovulation pain
Heightened sensitivity to stress or certain foods (dairy, gluten, sugar)
✨ Often linked with a gut-immune connection. A great place to start is anti-inflammatory foods, digestive support, and nervous system regulation.
Mechanism: Chronic low‑grade inflammation (e.g., from gut dysbiosis, food sensitivities) contributes to insulin resistance and androgen excess.
Clues:
Elevated markers of inflammation (CRP, IL‑6)
Digestive symptoms, history of antibiotic use, food reactions
How to test:
High‑sensitivity CRP (hs‑CRP)
Cytokine panel (IL‑6, TNF‑α) if available
Comprehensive stool analysis (gut microbiome, markers of dysbiosis)
4. Post‑Pill PCOS
Root cause: Hormonal rebound after coming off the pill
Common signs & symptoms:
You had regular cycles before the pill, but after stopping, your periods vanished or became irregular
Breakouts flared months after stopping birth control
Hair loss, especially around the temples
PMS and mood swings since coming off the pill
Often thinner body types, not always insulin resistant
Can be mistaken for other PCOS types — but timing is key
✨ Usually resolves with time, but the transition can be rocky. Supporting liver detox, hormone metabolism, and nutrient replenishment (zinc, B6, magnesium) is key.
Mechanism: Dysregulation of the HPO‑axis after coming off hormonal birth control, leading to transient anovulation or androgen imbalance.
Clues:
History of ≥ 6 months on combined oral contraceptives
Irregular cycles or breakthrough androgenic symptoms after stopping
How to test:
Wait 3 months off hormones (to allow HPO‑axis reset) before testing
Baseline labs on cycle day 3 (if periods have resumed) or any day (if amenorrheic):
FSH, LH, estradiol
Total and free testosterone, DHEA‑S
Ultrasound for PCOM features (if cycles remain irregular)
Using the Rotterdam Criteria Alongside Subtyping
Regardless of subtype, you confirm PCOS diagnosis by demonstrating two of three Rotterdam features and ruling out mimickers (thyroid disease, hyperprolactinemia, nonclassic CAH, androgen‑secreting tumors, Cushing’s).
Clinical/lab evaluation for hyperandrogenism
Menstrual history or ovulation tracking
Transvaginal ultrasound for ovarian structure
Together, your Rotterdam diagnosis anchors the PCOS label, while subtype testing (insulin, adrenal, inflammatory, post‑pill) steers a personalized treatment plan.
***Bonus Tip: You can have more than one type — like inflammation and insulin resistance, or post-pill that reveals underlying stress patterns.
Want 1:1 holistic health coaching to bring balance to hormonal imbalances? Click the link below.
