Wondering If Your Symptoms Might Be Signs of PCOS?
From irregular periods to stubborn acne, PCOS symptoms can look different for everyone.1 For some women, they get suspicious when they gain weight without changing their diet, while others deal with unwanted hair growth or trouble getting pregnant.1,2 But again, not all PCOS looks the same.
In this blog, we’ll break down the major PCOS Types researchers are looking into, what symptoms they usually come with, and how understanding your pattern can help guide better care decisions—with your doctor by your side.
A Hypothetical Journey: Meet Sarah
Imagine Sarah, a 28-year-old teacher who spent three years bouncing between doctors, trying to figure out why her periods were all over the place and why she couldn't shake those extra 20 pounds no matter how hard she tried. One doctor told her to "just lose weight," another suggested she was "stressed," and a third handed her birth control pills without much explanation.
Finally, Sarah found a healthcare provider who took the time to really listen. After some tests, Sarah learned she had PCOS - but here's the kicker: her PCOS looked completely different from her friend Lucia's PCOS. Lucia dealt with facial hair and severe acne, while Sarah's main struggles were irregular periods and stubborn weight gain. Both had PCOS, but their experiences were totally different.
This hypothetical story illustrates something super important: PCOS isn't a one-size-fits-all condition. Understanding your specific pattern can be a total game-changer for getting the right treatment and feeling like yourself again.
Up to 70% of PCOS Cases Are Undiagnosed
You know what's wild? PCOS affects somewhere between 6-13% of women of reproductive age, making it one of the most common hormonal conditions out there.1 Yet somehow, it feels like every person's PCOS story is completely different, which can lead to underdiagnosis. In fact, the WHO estimates that up to 70% of PCOS cases are undiagnosed!1
PCOS Facts
• PCOS impacts approximately 6% to 13% of women of reproductive age.1
• Globally, as many as 70% of women with PCOS are not diagnosed.1
• It is the most frequent cause of anovulation (lack of ovulation) and a primary contributor to infertility.1
• PCOS is linked to various long-term health issues that can affect both physical and emotional health.1
• The condition often has a familial link, and its presentation and effects can differ among various ethnic groups.1
• If you've ever felt confused about why your PCOS symptoms don't match what you read online, or why treatments that work for your friend don't work for you, you're definitely not alone. Actually, some researchers believe that PCOS shows up in four distinct types, and understanding which type you might have could make all the difference in your treatment journey.2
But there’s an important caveat: The idea of PCOS "types" is still a theory that's actively debated in the medical community. Not all healthcare providers are familiar with this classification system, and there's ongoing disagreement about whether there are truly four distinct types, more than four, or if this approach is even helpful.3 So while we'll explore these types, keep in mind that your healthcare provider might have a different perspective.
What Are the Types of PCOS? Quick Definitions (Because Nobody Likes Feeling Lost)
OK, let's make sure we're all speaking the same language:
• Androgen - A category of sex hormones that are typically seen in larger amounts in men.4
• Hirsutism - Excessive hair growth, on a woman, in areas where men typically grow hair, such as the face, chest, or back. This happens when your body produces too many androgen hormones.4
• Metabolic - Related to how your body processes food and energy. When we talk about metabolic complications in PCOS, we're referring to issues like obesity, insulin resistance, type 2 diabetes, unhealthy blood lipid levels, and cardiovascular disease.5
• Phenotype - The specific way a medical condition shows up in your body.6 It is the specific combination of symptoms and characteristics you experience.2
• Rotterdam Criteria - The three-part checklist most commonly used to diagnose PCOS. You need at least 2 out of 3 criteria.7 (We’ll tell you how it works as you keep reading.)
• Cyster - Pronounced the same as “sister”, this is what we lovingly call each other in the PCOS community. Welcome to the Cysterhood!
The Theory Behind PCOS Patterns (And Why It's Controversial)
Here's where things get really interesting - and complicated. The Rotterdam Criteria, established in 2003, broadened the definition of PCOS to include any two of three features: irregular periods, high androgen levels, and polycystic ovaries.7 This created four possible combinations that some researchers consider distinct "phenotypes" - basically, different ways PCOS can show up in your body.8
But here's the catch: This classification system is hotly debated. Some medical experts argue that the Rotterdam criteria are "premature" and that we don't have enough long-term data on these newer patterns.9 Others believe there should be more or fewer categories. Many healthcare providers, especially in primary care, may not be very very familiar with these PCOS phenotype classifications.10
The controversy stems from several issues:
• Limited research on long-term health outcomes for each phenotype10
• Disagreement about whether all phenotypes truly represent "PCOS"10
• Concerns that some phenotypes may not carry the same health risks10
• The variability and reliance on specific technology and operator skill impacting polycystic ovary diagnoses (How skilled is the person who is conducting your ultrasound? How up-to-date is the equipment they’re using? Etc… )10
So, while we'll explore these four phenotypes, remember that this is an evolving area of research, not established medical fact.
The 4 PCOS Phenotypes
Type A: “Classic” PCOS
What researchers think it includes: High androgens + irregular periods + polycystic ovaries (Androgen excess/hyperandrogenism + ovulatory dysfunction + polycystic ovarian morphology (AE/HA + OD + PCOM)).2,10,11
This is what most people think of when they hear "PCOS." Research suggests that people with this phenotype often have the highest risk for metabolic complications like insulin resistance and type 2 diabetes.2,10,11
Common signs you might notice:
• Periods that show up whenever they feel like it (or not at all)
• Unwanted hair growth, especially on your face, chest, or back
• Stubborn acne, particularly along your jawline
• Multiple small follicles visible on ovary ultrasounds
• Weight that seems impossible to lose
Type B: “Non-PCO” PCOS
What researchers think it includes: High androgens + irregular periods (but normal-looking ovaries). (Androgen excess/hyperandrogenism + ovulatory dysfunction (AE/HA + OD))2,10,11
Some studies suggest this phenotype carries similar metabolic risks to Type A, just without the visible ovarian changes.2,10,11
Common signs you might notice:
• Irregular or completely missing periods
• Hirsutism (excess hair growth)
• Intense acne
• Normal-appearing ovaries on ultrasound
Type C: “Ovulatory” PCOS
What researchers think it includes: High androgens + polycystic ovaries (but regular periods). (Androgen excess/hyperandrogenism + polycystic ovarian morphology (AE/HA + PCOM)) 2,10,11
This type can be tricky because you might have fairly regular periods, which makes it easy to dismiss other symptoms.2,10,11
Common signs you might notice:
• Periods that come pretty regularly10,11
• Unwanted hair growth or male-pattern hair loss10,11
• Persistent hormonal acne10,11
• Multiple small follicles showing up on ovarian ultrasounds10,11
Type D: “Non-hyperandrogenic” PCOS
What researchers think it includes: Irregular periods + polycystic ovaries (but normal androgen levels). (Ovulatory dysfunction + polycystic ovarian morphology (OD + PCOM))2,10
Research suggests Type D may have the mildest long-term health risks.2,10
Common signs you might notice:
• Irregular or missing periods (your main complaint)
• Multiple small follicles on ovarian ultrasounds
• Fewer of the "classic" PCOS symptoms like excess hair growth
• Often normal weight, which can make diagnosis tricky
Working with Your Healthcare Provider
What Your Doctor Will Look For
Getting a PCOS diagnosis involves several steps, regardless of which classification system your doctor uses:
• Medical history and symptom tracking - They'll want to know about your periods, hair growth, acne, weight changes, and family history.12,13
• Physical examination - Your doctor will look for signs of hirsutism and other physical symptoms.12,13
• Blood tests - Hormone level checks are crucial. They'll likely test your androgens (this includes testosterone), LH, FSH, and likely your insulin levels too.12,13
• Pelvic ultrasound - This would show whether you have multiple small follicles on your ovaries.12,13
• Ruling out other conditions - Your doctor will want to make sure your symptoms aren't caused by other conditions such as thyroid issues, adrenal problems, or other hormonal conditions.12,13
Important Questions to Ask
• "Which diagnostic criteria are you using for my PCOS diagnosis?" - Don’t be afraid to ask your doctor what their methods and criteria are.
• "Based on my symptoms, do you think I have a specific PCOS phenotype? Are you planning my treatment with this phenotype in mind?" - It’s good to ask about specifics from the get-go.
• "What are my specific risk factors?" - You should know if you’re at a higher risk for certain diseases.
• "What should I be monitoring long-term?" - Understanding what body cues you should monitor most closely can help you care for yourself more effectively.
PSA: It's super important to talk openly and clearly with your healthcare provider.
The more specific details you can share about your symptoms, such as how often your periods are irregular, where you feel pain, or how your body hair has changed, the better they can understand what's going on.
Also, tell them what you hope to achieve, whether it's managing acne, getting pregnant, or just feeling better overall. Giving them all this information helps them guide your care experience, so you can get a treatment plan that addresses your biggest concerns first.
Treatment: It's All About Your Symptoms
The good news? Whether or not your doctor uses the phenotype classification, effective PCOS treatment focuses on your specific symptoms and goals.
Common Treatment Approaches
• Hormone regulation: Birth control pills, anti-androgen medications, or other hormone-balancing treatments.14
• Metabolic support: Metformin is common, along with lifestyle changes that help with insulin sensitivity.14
• Fertility support: If you're trying to conceive, treatments like Clomid or Letrozole can help stimulate ovulation.14
• Appearance concerns: Hair removal treatments, acne medications, and other approaches to manage day-to-day symptoms that impact how you present yourself.14
Lifestyle Approaches That Help Regardless of Phenotype
• Anti-inflammatory eating - Focus on whole foods, plenty of vegetables, whole grains, and omega-3s to fight inflammation and help stabilize blood sugar levels.15
• Regular movement - Finding enjoyable ways to move your body can support hormone balance, cardiovascular health, and insulin sensitivity.15
• Stress management - PCOS and stress are not friends. Find what helps you relax and do that thing regularly.15
• Quality sleep - Regular, high-quality sleep is important for supporting good health.15 Aim for 7-9 hours of good sleep. Your hormones will thank you.
The Bottom Line
Here's what we want every Cyster to understand: PCOS shows up differently in different people, and all of those experiences are completely valid. Whether your healthcare provider uses phenotype classification or focuses on individual symptoms, you should advocate for knowledgeable, compassionate care.
The research on PCOS phenotypes is still evolving, and that's actually exciting - it means scientists are working hard to better understand this complex condition. But try not to get too hung up on which "type" you might have. Focus on working with healthcare providers who listen to your concerns and create treatment plans that address your specific symptoms and goals.
You are not broken. If you have PCOS, you have a real medical condition that affects millions of women, but with the right information and support, you can absolutely live an amazing, healthy, fulfilling life.
Your next step? Talk to your healthcare provider about your symptoms and ask about treatment options that make sense for your situation. You've got this!
Resources for PCOS Support
Don’t do PCOS alone; find some Cyster support! Here are reputable nonprofit organizations that can help:
PCOS Challenge: The National Polycystic Ovary Syndrome Association - The largest nonprofit support organization for people with PCOS, serving nearly 60,000 members.
RESOLVE: The National Infertility Association - For more than 50 years, RESOLVE has provided free support and fought for the rights of people struggling to build families
The Body Positive - Offers evidence-based programs for developing positive body image.
National Eating Disorders Association (NEDA) - The largest nonprofit supporting individuals and families affected by eating disorders.
Questions for our Cyster community: Which PCOS symptoms do you struggle with most? Is this your first time learning about PCOS Phenotypes? Find us on Facebook, Instagram, Pinterest, and TikTok!
In parting, remember that eating healthy, whole foods, and lots of plant foods is one of the simplest, safest, and most effective things we can do to promote good health in our bodies. As with every preventative/restorative measure though, sometimes these changes alone are not enough to help our bodies function the way we want or need them to. If you are struggling with health problems, please contact your doctor or other healthcare provider such as a Naturopathic Doctor, Dietitian, or Mental Health Professional to see if they can offer appropriate guidance and care. We at Wholesome Story believe that healthy communities require community effort, so we advise you to keep your healthcare community aware and involved in your journey as you pursue better health.
Sources:
1.World Health Organization. Polycystic ovary syndrome. World Health Organization. Published February 7, 2025. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
2.Daan NMP, Louwers YV, Koster MPH, et al. Cardiovascular and metabolic profiles amongst different polycystic ovary syndrome phenotypes: who is really at risk? Fertility and Sterility. 2014;102(5):1444-1451.e3. doi:https://doi.org/10.1016/j.fertnstert.2014.08.001
3.Legro RS. Evaluation and Treatment of Polycystic Ovary Syndrome. Nih.gov. Published January 11, 2017. https://www.ncbi.nlm.nih.gov/books/NBK278959/
4.Cleveland Clinic. Hirsutism: What It Is, In Women, Causes, PCOS & Treatment. Cleveland Clinic. Published July 8, 2022. https://my.clevelandclinic.org/health/diseases/14523-hirsutism
5.Chen W, Pang Y. Metabolic Syndrome and PCOS: Pathogenesis and the Role of Metabolites. Metabolites. 2021;11(12):869. doi:https://doi.org/10.3390/metabo11120869
6.Phenotype - an overview. Science Direct Topics. Accessed June 1, 2025. https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/phenotype
7.Smet ME, McLennan A. Rotterdam criteria, the end. Australasian Journal of Ultrasound in Medicine. 2018;21(2):59-60. doi:https://doi.org/10.1002/ajum.12096
8.Christakou C, Diamanti-Kandarakis E. Polycystic ovary syndrome – Phenotypes and diagnosis. Scandinavian Journal of Clinical and Laboratory Investigation. 2014;74(sup244):18-22. doi:https://doi.org/10.3109/00365513.2014.936675
9.Dapas M, Lin FTJ, Nadkarni GN, et al. Distinct subtypes of polycystic ovary syndrome with novel genetic associations: An unsupervised, phenotypic clustering analysis. Myers JE, ed. PLOS Medicine. 2020;17(6):e1003132. doi:https://doi.org/10.1371/journal.pmed.1003132
10.Chang S, Dunaif A. Diagnosis of Polycystic Ovary Syndrome. Endocrinology and Metabolism Clinics of North America. 2021;50(1):11-23. doi:https://doi.org/10.1016/j.ecl.2020.10.002
11.DynaMed. Polycystic Ovary Syndrome (PCOS). www.dynamed.com. Published January 7, 2025. Accessed June 1, 2025. https://www.dynamed.com/condition/polycystic-ovary-syndrome-pcos#GUID-17F6832B-0C87-4F5E-99F9-0357045BFA5E
12.Mayo Clinic. Polycystic ovary syndrome (PCOS) - Diagnosis and treatment - Mayo Clinic. Mayoclinic.org. Published September 8, 2022. https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443
13.John Hopkins Medicine. Polycystic ovary syndrome (PCOS). John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos
14.Cleveland Clinic. Polycystic ovary syndrome (PCOS). Cleveland Clinic. Published February 15, 2023. https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos
15.Gautam R, Maan P, Anshu Jyoti, Kumar A, Malhotra N, Arora T. The Role of Lifestyle Interventions in PCOS Management: A Systematic Review. Nutrients. 2025;17(2):310-310. doi:https://doi.org/10.3390/nu17020310