PCOS Explained: Symptoms, Diagnosis, and the Four Types of PCOS
You may have heard of PCOS and wondered what the acronym stands for. Maybe you have never heard of it, but are curious to learn more. Perhaps you suspect you have it. Or maybe you have been told you have “some elements” of PCOS but don’t fit the classic picture.
PCOS is one of the most common hormone imbalances affecting women of reproductive age, yet it is also one of the most misunderstood.
Below, we’ll break down:
- What PCOS actually is
- The most common symptoms
- How it is diagnosed
- The four different types of PCOS
- Some of the underlying causes often seen in functional medicine
What Is PCOS?
PCOS stands for Polycystic Ovarian Syndrome.
It is a complex hormonal condition that affects women during their reproductive years. Women may suspect they have PCOS if they experience symptoms such as:
- Excess hair growth on the face, nipples, back, or thighs (called hirsutism)
- Acne, especially along the jawline, chin, chest, or back
- Irregular menstrual cycles or missed periods
- Insulin resistance
- Weight gain or difficulty losing weight
- Elevated testosterone levels
- Increased libido due to elevated testosterone
- Multiple follicles on the ovaries are seen on ultrasound
- Fertility challenges
PCOS is called a syndrome because it is not a single disease with one clear cause.
Instead, it is a collection of hormonal and metabolic imbalances that tend to occur together.
The name itself can also be misleading. Not every woman with PCOS has cysts on her ovaries. In fact, many women with the condition do not develop ovarian cysts at all.
For this reason, many experts believe the name may eventually change to better reflect the full spectrum of hormonal imbalances involved.
How PCOS Is Diagnosed
Diagnosing PCOS can be complicated because symptoms can vary significantly from woman to woman.
The current diagnostic standard used by most physicians is called the Rotterdam Criteria.
According to this criteria, a woman must have two of the following three conditions to be diagnosed with PCOS:
Hyperandrogenism
Elevated androgen hormones such as testosterone or DHEA.
This may appear on blood tests or through symptoms like:
- Acne
- Excess hair growth
- Increased libido
Irregular Ovulation
Also called oligomenorrhea, this includes irregular, infrequent, or missing menstrual cycles due to delayed ovulation.
Polycystic Ovaries
Multiple follicles seen on the ovaries during an ultrasound.
Because only two of the three criteria are required, women with PCOS can present very differently.
The Four Different Types of PCOS
Since PCOS diagnosis requires only two of the three criteria, researchers have identified four distinct PCOS patterns.
These categories were outlined in the book 8 Steps to Reverse Your PCOS by Dr. Fiona McCulloch, ND.
When PCOS was first studied, doctors believed all women with PCOS fit the classic presentation: excess weight, acne, facial hair, and irregular cycles.
Over time we’ve learned that PCOS shows up in many different ways.
Some women are thin. Some have regular periods. Some do not show clear androgen symptoms.
The four types of PCOS include:
Type A PCOS
Delayed ovulation, elevated androgens, and polycystic ovaries on ultrasound.
This is often considered the classic presentation of PCOS.
Type B PCOS
Delayed ovulation and elevated androgens, but normal ovaries on ultrasound.
Type C PCOS
Elevated androgens and polycystic ovaries, but regular ovulation.
Type D PCOS
Delayed ovulation and polycystic ovaries without elevated androgens.
As you can see, PCOS is not a one-size-fits-all condition.
This is why proper testing and evaluation are so important.
Functional Medicine Perspectives on PCOS
While the Rotterdam Criteria helps identify PCOS, functional and naturopathic medicine looks deeper to understand why the imbalance is happening.
Two patterns commonly seen in women with PCOS include insulin resistance and hormonal signaling imbalances.
Insulin Resistance and PCOS
One of the most common underlying drivers of PCOS is insulin resistance.
Insulin is the hormone that allows glucose (sugar) from carbohydrates to enter our cells and be used for energy.
When the body becomes resistant to insulin, the pancreas produces more of it.
Elevated insulin can then stimulate the ovaries to produce more androgens (such as testosterone), which disrupts ovulation and contributes to many PCOS symptoms.
Insulin resistance can also contribute to:
- Weight gain
- Difficulty losing weight
- Increased inflammation
- Hormonal imbalance
Addressing insulin resistance is often one of the most important steps in improving PCOS symptoms.
Hormonal Signaling: The FSH and LH Ratio
Another clue we often see in lab work is the relationship between two hormones that come from the brain:
- FSH (Follicle Stimulating Hormone)
- LH (Luteinizing Hormone)
These hormones signal the ovaries to develop follicles and ovulate an egg.
In many women with PCOS, LH is significantly higher than FSH, often two times higher.
This imbalance can disrupt the normal ovulation process and lead to delayed or irregular cycles.
While this pattern does not occur in every PCOS case, it is commonly seen in women with ovulatory dysfunction.
What To Do If You Suspect PCOS
If you frequently experience symptoms associated with PCOS, it is important to work with a qualified healthcare practitioner for proper diagnosis and guidance.
Untreated PCOS can increase the risk of long-term health issues such as:
- Infertility
- Insulin resistance
- Type 2 diabetes
- Metabolic syndrome
Working with a practitioner who understands hormone balance from a root-cause perspective can make a significant difference.
While conventional treatment often focuses on medications for blood sugar or hormonal suppression, there are many lifestyle, nutrition, and hormonal factors that can also be addressed to support the body more holistically.
Want to Start Supporting Your Hormones Naturally?
If you suspect your hormones may be out of balance or want to begin supporting your hormone health more intentionally, I created a free guide to help you get started.
Free Guide: Balancing Your Hormones — Quick Start Guide
This guide walks you through the foundational shifts that support hormone balance, energy, and overall well-being.
Inside you’ll learn:
• Early signs your hormones may be out of balance
• Lifestyle factors that influence hormone health
• Simple steps to begin restoring balance naturally
Final Thoughts
PCOS is a complex condition that can show up in many different ways.
Understanding the underlying patterns behind hormone imbalances is the first step toward supporting your body and improving long-term health.
With the right guidance and a root-cause approach, many women are able to rebalance their hormones, improve ovulation, and restore their overall sense of well-being.
