The 4 PCOS Types & How to Identify Yours

Are you confused with all the conflicting advice, when it comes to treating Polycystic Ovarian Syndrome (PCOS) naturally?

"Just cut out carbs, exercise more"

"Don't go too low carb though as this will make your symptoms worse!"

"Add in this supplement, but only if you have insulin resistant PCOS"

I doubt you were taught about the different types of PCOS by your doctor. In their eyes, the standard protocol is for you to lose weight, move more, take the birth control pill and maybe Metformin too.

But let me tell you, this advice is damaging for the vast majority of us ladies with this condition. This is because PCOS is a complex, metabolic condition that can present with many different symptoms and driving factors.

In order to be diagnosed with PCOS, you need to have 2 out of the 3 following criteria present (Rotterdam Criteria):

1. Elevated Androgens (present in blood work or symptom wise)

2. Irregular menstrual cycle (ovulation issues, long menstrual cycles 35+ days)

3. Polycystic ovaries on ultrasound

PCOS is commonly misdiagnosed because there are many other conditions that can cause similar symptoms. However it can also be under diagnosed if women aren't displaying the 'classic' appearance or set of symptoms.

Many of my clients have been told that they can't possibly have PCOS because they aren't overweight and don't look like someone with this condition. PCOS is a syndrome, meaning that it's just a collection of symptoms! Yes, a lot of women do struggle with their weight, however there are many women with PCOS who are at a healthy weight. You can even be underweight and still have it!

If your Doctor diagnosed you with PCOS solely based on an ultrasound, then this doesn't actually qualify for a diagnosis and you need to request further investigation.

If doctors were to perform a pelvic ultrasound on a random group of women, a lot of them would have this 'string of pearls' appearance on their ovaries at certain times of the month, however that doesn't automatically indicate PCOS!

There are actually 4 types of Polycystic Ovarian Syndrome (PCOS), that you should know about, so in this post I am going to share what they are, how to identify which you are personally dealing with and how to address the types naturally.

These are insulin resistant, adrenal, post-pill and the hidden cause/inflammatory type.

It's very common for women to have multiple driving factors, and fit into more than one type. At one point in time I was personally dealing with all four at once! Let me tell you.... it was NOT fun!


1. Insulin resistant

This is the most common and recognised type, affecting around 70% of women with PCOS. Insulin resistance occurs when our cells become 'numb' to the hormone insulin, and it is the precursor to the development of type 2 diabetes.

When we consume food (mainly carbohydrates), our blood glucose levels rise. This signals our pancreas to release the storage hormone insulin, which acts like a key, unlocking our cells and letting glucose in, to be used as fuel.

If the key or lock becomes damaged (aka our insulin hormone or cell receptors) then glucose remains elevated in the bloodstream and the cells are 'starving for energy'.

Our pancreas continues to pump out insulin as a way to try and lower blood glucose and fuel the cells, however in women with PCOS, insulin also stimulates the ovaries to produce androgens like testosterone.

Androgens drive the common symptoms such as hirsutism (face/body hair growth), male pattern hair loss, cystic acne and can also halt ovulation, therefore affecting fertility and our menstrual cycles.

Causes of insulin resistance...

Consuming too many carbohydrates and sugars for your personal needs, frequent snacking, sedentary lifestyles, high stress levels, nutrient deficiencies (especially chromium, magnesium, vanadium), inflammation and environmental toxins can all lead to insulin resistance.

Other common signs & symptoms...

Weight gain, difficulty loosing weight, fat storage around the midsection, skin tags, velvety patches of skin (acanthosis nigricans), sugar/carb cravings, blood sugar instability, a family history of type 2 diabetes, fatigue after eating (especially carbohydrate rich meals), elevated liver enzymes or fatty liver disease, acne, frequent urination and excessive thirst.

It is important to note that you can be lean and still have insulin resistance. There are also different degrees of insulin resistance, even lean women can be struggling with this. If you are overweight or obese, then you are likely dealing with this as a driver of your PCOS.

How to test...

The best ways to test for insulin resistance are to request the following blood tests from your GP: HBA1C, fasting blood glucose and fasting insulin levels. (Lab measurements and units differ depending what country you are in, work with a practitioner to analyse your results)

You can also monitor your blood glucose levels at home using a glucometer to see how much your levels increase 1 and 2 hours after eating. Most of us respond differently to different types and amount of carbohydrates, so you may need to experiment to find which work best for you.

It is important to note that all of your labs may come back 'normal', however you could still be dealing with insulin resistance, so don't rule it out. In some cases insulin is so high that blood glucose levels don't elevate much at all, and the glucose is immediately stored as glycogen and fat tissue.

Luteinising hormone (LH) will likely be elevated and greater than a 2:1 ratio to Follicle Stimulating Hormone (FSH).