PCOS is a complex condition and there are many different ways that it can show up for women. This can make it hard to recognise and treat. There are 4 distinct PCOS types depending on the symptoms experienced and each has a different risk profile. Here we discuss each in turn.
What is PCOS?
Polycystic ovary syndrome (PCOS) is a common condition that affects how a woman’s ovaries work and disrupts hormonal balance in the body. Lots of people with PCOS don’t know they have it or have few symptoms. For others PCOS can cause things like irregular periods, easy weight gain, acne and mood changes.
There are 3 main criteria for diagnosing PCOS. You need to have 2 of these to meet the criteria for PCOS.
- Absent or reduced ovulation – this means the ovaries aren’t releasing eggs as frequently as normal. One of the possible symptoms of this is irregular periods
- High levels of androgens (such as testosterone) – this is diagnosed on a blood test or through an examination if you have symptoms such as unwanted hair
- Polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs (these are actually follicles rather than cysts). This can only be diagnosed on an ultrasound scan
It is important to note that only 2 out of 3 of these symptoms are needed to make a diagnosis of PCOS. This means that if you have reduced or absent ovulation and hormone imbalance (specifically high androgens) your GP may diagnose you on these two factors alone.
The 4 PCOS types are labelled from A to D.
PCOS Type A
Women with PCOS Type A have all 3 of anovulation, hyperandrogenism and polycystic ovaries (diagnosed on ultrasound scan). This means they likely have changes to their period, for instance it is short or long in length and unwanted hair growth, acne or they’ve had a blood test that showed high testosterone. They have had an ultrasound scan that showed polycystic ovaries.
Type A tends to have more severe symptoms of PCOS. Women with Type A are most likely to seek medical treatment. It is especially important to monitor health long term in Type A.
People with Type A tend not to have periods as regularly. However it’s important to make sure these are at least every 90 days otherwise there can be risks associated. Read our advice on withdrawal bleeds below.
PCOS Type B
Women with Type B have anovulation and hyperandrogenism. Likely they have changes to their period, for instance it is short or long in length and have unwanted hair growth, acne or they’ve had a blood test that showed high testosterone. Either they haven’t had an ultrasound scan or the ultrasound scan showed normal ovaries.
Type B can also have significant symptoms with PCOS due to the high androgen levels. It is especially important to monitor health long term in Type B.
People with Type B tend not to have periods as regularly. However it’s important to make sure these are at least every 90 days otherwise there can be risks associated. Read our advice on withdrawal bleeds below.
PCOS Type C
Women with Type C have polycystic ovaries and hyperandrogenism. This means they have had an ultrasound scan that showed follicles on the ovaries and likely have unwanted hair growth, acne or they’ve had a blood test that showed high testosterone. Their periods are likely normal. Because women with this PCOS type have normal periods they can sometimes be missed by healthcare professionals, particularly if they aren’t overweight.
Type C is sometimes called the ‘ovulatory PCOS type’ as it is the only PCOS type where ovulation continues as normal. Type C have moderately raised androgen levels so may experience milder symptoms. Because this PCOS type is associated with ovulation, women with Type C may have increased fertility than those with the other PCOS types.
PCOS Type D
Women with Type D have anovulation and polycystic ovaries. Likely they have changes to their period, for instance it is short or long in length and they’ve had an ultrasound scan that shows follicles on the ovaries. They do not have symptoms of high androgens and/or they’ve had a blood test that showed normal androgen levels.
Type D have the mildest degree of endocrine and metabolic dysfunction and the lowest prevalence of metabolic syndrome. Type D are also the least likely to seek medical treatment.
People with Type D tend not to have periods as regularly. However it’s important to make sure these are at least every 90 days otherwise there can be risks associated. Read our advice on withdrawal bleeds below.
Things to discuss with your doctor
Because some people with PCOS have a higher likelihood of developing certain health conditions it’s important to get regular checkups to ensure these are detected early.
- Weight – Keeping an eye on your weight can ensure it doesn’t slowly start to creep up. At least every 6 – 12 months is enough. Your doctor may also calculate your BMI (a measure of your weight compared to your height) and waist circumference.
- Blood pressure – Guidelines say that all people with PCOS should have their blood pressure measured yearly, or more frequently if you have additional risk factors for heart disease.
- Lipid profile – Overweight and obese women with PCOS, regardless of age, should have a fasting lipid profile (cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol and triglyceride level at diagnosis). Thereafter, frequency of measurement should be based on the result and risk of cardiovascular disease.
- Cardiovascular risk factors including waist circumference, body mass index (BMI), level of physical activity, cigarette smoking, lipid levels, blood pressure, impaired glucose tolerance, and type 2 diabetes (personal and family history).
- Diabetes screen – Glycemic status should be assessed at baseline in all women with PCOS. Thereafter, assessment should be every one to three years, influenced by the presence of other diabetes risk factors
- Withdrawal bleed – Many women with PCOS have periods that are longer than 35 days. However it is important that you have a period at least every 90 days. This is because the womb lining (also called the endometrial lining) becomes too thick if no period happens. Over time this can increase the risk of endometrial cancer. Your GP will usually prescribe a contraceptive pill to induce a withdrawal bleed.
- NICE Guidelines. Recommendations | Fertility problems: assessment and treatment | Guidance | NICE
- NHS website. Polycystic ovary syndrome – Symptoms – NHS
- Monash University. International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018
- Comparison of the Different PCOS Phenotypes Based on Clinical Metabolic, and Hormonal Profile, and their Response to Clomiphene. G. Sachdeva, S. Gainder,V. Suri, N. Sachdeva, and S. Chopra. Link
- The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. G. Bozdag, S. Mumusoglu, D. Zengin, E. Karabulut, B. Yildiz. Link.