PCOS is a complex, multi-system disorder that affects different individuals differently; researchers have identified four different types of PCOS based on core symptoms.[1]

In this article we explore four different types or phenotypes of PCOS.

The most common type of PCOS, affecting c.70% of individuals with the condition, combines all three diagnostic criteria including androgen excess, ovarian dysfunction and polycystic ovaries:[2]

• Androgen excess (AE) (or hyperandrogenism), higher than usual levels of androgens, a type of sex hormone naturally produced in the ovaries and in the adrenal gland located on the top of your kidneys;[3],[4]

• Ovarian dysfunction (OD), failure to ovulate on a regular cycle leading to irregular or absent periods; and

• Polycystic ovaries (PCO), the presence of multiple follicles or cysts around the outside of the ovary, often referred to as a “string of pearls”.[5]

In addition to these diagnostic criteria, PCOS is associated with:

• High body mass index (BMI), the ratio of your weight in kilogram divided by the square of your weight in meters, with higher than 25 or 30 being classified as overweight or obese respectively;[6]

• High ovarian reserve, an estimate of the number of remaining eggs compared to the average for individuals your age (noting that this is not a measure of quality of the eggs);[7]

• High fasting insulin, the level of insulin (the natural hormone that turns food into energy)[8] in your bloodstream, with levels great than 25 milli international units per liter (mIU/L) in a fasting test classified as hyperinsulinemia;[9]

• High cholesterol in the form of high levels (>150 milligram per deciliter) of low-density lipids (LDLs) and low levels of high-density lipids (HDLs);[10]

• High levels of anti-Mullerian hormone (AMH),[11] a protein produced by granulosa cells within ovarian follicles and a measure of ovarian reserve;[12] and

• Higher resistance to clomiphene, failure to ovulate over the course of 3 cycles when treated with clomiphene citrate (CC), the medication commonly used to stimulation ovulation during fertility treatment.[13],[14],[15]

  
  

Another c.20% of individuals with PCOS exhibit androgen excess (AE) and polycystic ovaries (PCO) but not ovarian dysfunction (OD).[16]

A further c.10% of individuals with PCOS exhibit androgen excess (AE) and ovarian dysfunction (OD) but not polycystic ovaries (PCO).[17]  

The remaining c.5% of individuals with PCOS exhibit ovarian dysfunction (OD) and polycystic ovaries (PCO) but not androgen excess (AE).

Reviewed by Dr. Elisabet Stener-Victorin, principal investigator of the Reproductive Endocrinology and Metabolism research group at the Department of Physiology and Pharmacology at Karolinska Institutet, Stockholm, Sweden and Chief Scientific Officer of the AE-PCOS Society

Sources

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310679/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683693/

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9541126/

[4] https://my.clevelandclinic.org/health/articles/22002-androgens

[5] https://www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics/

[6] https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html

[7] https://my.clevelandclinic.org/health/diagnostics/25142-ovarian-reserve-testing

[8] https://my.clevelandclinic.org/health/body/22601-insulin

[9] https://www.verywellhealth.com/hyperinsulinemia-is-associated-with-type-2-diabetes-1087717

[10] https://www.uptodate.com/contents/high-cholesterol-and-lipids-beyond-the-basics/

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006968/

[12] https://www.womenandinfants.org/services/medical-screening/amh-test

[13] https://www.jsafog.com/abstractArticleContentBrowse/JSAFOG/10874/JPJ/fullText

[14] https://www.sciencedirect.com/science/article/abs/pii/S2468784717301393

[15] https://my.clevelandclinic.org/health/drugs/19178-clomiphene-tablets

[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310679/

[17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310679/