The 4 Types Of PCOS | A Naturopathic Doctor’s Guide

pcos Jun 02, 2025

Polycystic ovary syndrome (PCOS) is one of the most common endocrine-metabolic disorders affecting women of reproductive age, impacting up to 15% of women worldwide. Despite its prevalence, PCOS often goes undiagnosed or misunderstood. With its complex symptoms and multifactorial causes, PCOS requires a personalized and holistic approach to manage effectively.

In this article, we’ll examine the four PCOS phenotypes, explore the underlying causes from a naturopathic perspective, and discuss how naturopathic care can help you restore balance and feel your best.

What Are the Four PCOS Phenotypes?

According to current diagnostic criteria (NIH, Rotterdam, and AE-PCOS Society), PCOS can present in different ways, commonly grouped into four phenotypes. These phenotypes describe how the condition manifests, rather than pointing to distinct root causes.

1. Phenotype A: Classic PCOS

This is the most severe and well-recognized form. It is characterized by hyperandrogenism (such as acne, hirsutism, and elevated testosterone levels), ovulatory dysfunction (which can lead to irregular or absent periods), and polycystic ovarian morphology (multiple follicles visible on ultrasound).

2. Phenotype B

Phenotype B includes hyperandrogenism and ovulatory dysfunction but does not present with polycystic ovaries on ultrasound imaging. This form can still significantly affect metabolic and reproductive health.

3. Phenotype C

This phenotype involves hyperandrogenism and polycystic ovaries while maintaining regular ovulation. It is often seen in lean women and may present with milder symptoms, though it still requires attention and care.

4. Phenotype D

Phenotype D is characterized by ovulatory dysfunction and polycystic ovaries without the presence of hyperandrogenism. It is generally considered less metabolically impacted compared to other types.

Understanding the Underlying Causes of PCOS

PCOS is not a one-size-fits-all diagnosis. There are several contributing factors that influence how PCOS presents and progresses.

1. Genetics

PCOS is highly heritable, with studies suggesting up to 70% heritability. Genetic variations play a role in multiple physiological processes, including androgen production (such as mutations in the DENND1A gene), gonadotropin secretion and regulation (involving LH and FSH), insulin signaling and resistance pathways, ovarian follicle development, and the regulation of appetite, metabolism, and energy.

2. Hormonal Dysregulation

Hormonal imbalances are at the core of PCOS. Elevated levels of luteinizing hormone (LH) and an increased LH:FSH ratio can overstimulate the ovarian theca cells, resulting in excess androgen production. At the same time, impaired follicle-stimulating hormone (FSH) activity can lead to poor follicle maturation and disrupted ovulation. Additionally, elevated Anti-Müllerian Hormone (AMH) levels may further suppress follicle development and exacerbate hormonal imbalance.

3. Insulin Resistance

Insulin resistance is present in approximately 50–70% of PCOS cases, even in women who are not overweight. High levels of insulin stimulate the ovaries to produce more androgens, which can disrupt normal hormone signaling. Insulin also suppresses sex hormone-binding globulin (SHBG), leading to increased levels of free testosterone in the bloodstream. These changes contribute significantly to the reproductive and metabolic symptoms of PCOS.

4. Obesity and Energy Regulation

Although not a requirement for a PCOS diagnosis, obesity can worsen insulin resistance and hormonal imbalances. It’s important to note that PCOS can occur in individuals of any body size, and weight gain, while a common symptom, is not the cause of the condition.

5. Environmental Factors

Environmental exposures can significantly impact the development and progression of PCOS. Diets high in refined sugars, processed foods, and inflammatory fats can exacerbate insulin resistance and systemic inflammation. Exposure to endocrine-disrupting chemicals, such as bisphenol A (BPA) and phthalates, may mimic hormones and interfere with the natural endocrine function. Chronic stress and disrupted sleep patterns may also play a role in the expression of PCOS symptoms.

6. Adrenal Component

In some women with PCOS, elevated levels of DHEA-S (an adrenal androgen) indicate that the adrenal glands are contributing to the androgen excess. This adrenal overproduction is usually secondary but can amplify symptoms, particularly those triggered or worsened by stress. Addressing stress through lifestyle changes is essential in managing this component.

7. Medication-Induced PCOS

Certain medications, such as valproic acid (commonly prescribed for epilepsy and bipolar disorder), have been shown to increase the risk of developing PCOS. The mechanism appears to involve stimulation of androgen production in ovarian cells.

What Are the Symptoms of PCOS?

Symptoms of PCOS vary by type, but common ones include:

Irregular or heavy periods
Acne or oily skin
Excess facial or body hair
Male-patterned baldness
Weight gain or difficulty losing weight
Mood changes, such as anxiety or depression
Impaired fertility

If you’re experiencing these symptoms, it’s important to seek a healthcare provider for diagnosis and treatment.

How is PCOS Diagnosed?

PCOS is diagnosed based on a combination of symptoms, lab results, and imaging. Most guidelines require at least two of the following criteria: elevated androgen levels (confirmed by blood tests or physical signs), ovulatory dysfunction, and polycystic ovaries visible on ultrasound. Your healthcare provider may also conduct additional blood work or imaging studies to rule out other hormone-related conditions.

Can PCOS Be Cured?

While there is no permanent cure for PCOS, the condition can be effectively managed. Many women are able to reduce symptoms, regulate their menstrual cycles, and restore hormonal balance through individualized care. A naturopathic approach focuses on identifying the underlying causes and creating a long-term, sustainable plan to support whole-body health.

Why Choose Naturopathic Medicine for PCOS?

Naturopathic care offers a personalized, whole-body approach to managing PCOS. Here’s how it stands out:

Root Cause Focus: Instead of masking symptoms, naturopathic doctors work to uncover and treat the underlying causes of your PCOS.
Holistic Healing: PCOS affects multiple systems in the body, so a comprehensive approach—including diet, lifestyle changes, and natural remedies—is key.
Empowered Patients: Naturopathic medicine is a collaborative process, empowering you to understand and care for your body.

Ready to Take the First Step?

PCOS is a complex condition, but with the right support, it’s possible to manage your symptoms and improve your quality of life. At Naturopathic by Design™, we create customized care plans to address your unique needs and help you feel your best.

Ready to reclaim your health? Book a free 15-minute consultation today to explore how naturopathic medicine can help you navigate your PCOS journey.