Polycystic ovary syndrome (PCOS) affects approximately 1 in 10 women of reproductive age, making it one of the most common hormonal disorders.
However, PCOS isn’t a single disease, but rather a collection of symptoms with different underlying causes. Understanding the four main functional types of PCOS can help you get the targeted treatment your body needs.
Learn more about PCOS and how proper diagnosis can transform your health journey.
The importance of understanding different types of PCOS
Identifying your specific type of PCOS is crucial for developing an effective, personalised treatment approach. Each type has different underlying causes, which means they require different management strategies to address the root cause, rather than just masking the symptoms.
When you understand your PCOS type, you can target the specific mechanisms driving your symptoms, leading to improved symptom management and better long-term reproductive health outcomes. This personalised approach often results in more successful PCOS treatment results and helps prevent complications like type 2 diabetes and cardiovascular disease.
The four functional types of PCOS
The four types of PCOS are classified based on their underlying causes and are typically listed in order of prevalence.
It’s important to note that many women may have characteristics of multiple types, with one being the primary driver of their symptoms. Understanding this hierarchy helps healthcare providers prioritise treatment approaches for optimal results.
Insulin-resistant PCOS
Insulin-resistant PCOS is the most common type, affecting approximately 65-70% of women diagnosed with PCOS. This type occurs when cells become resistant to insulin, causing the body to produce more insulin to maintain normal blood sugar levels.
Unfortunately, high insulin levels signal the ovaries to produce excess androgens (male hormones), which leads to many classic PCOS symptoms. This creates a cycle where insulin resistance worsens PCOS symptoms, and PCOS symptoms can worsen insulin resistance.
Symptoms of insulin-resistant PCOS
Women with insulin-resistant PCOS often experience:
- Weight gain, particularly around the midsection, and difficulty losing weight.
- Dark skin patches (acanthosis nigricans), especially around the neck, underarms, or groin.
- Intense food cravings, particularly for carbohydrates and sugar.
- Fatigue, especially after meals.
- High fasting insulin levels on blood tests.
- Elevated blood sugar levels.
Insulin-resistant PCOS management
Managing insulin-resistant PCOS focuses on improving insulin sensitivity through:
- Dietary changes: Following a low glycemic index diet that emphasises whole foods, lean proteins, and complex carbohydrates while limiting processed foods and refined sugars.
- Regular exercise: Combining both cardiovascular exercise and strength training to improve insulin sensitivity.
- Weight management: Even a 5-10% reduction in body weight can significantly improve insulin sensitivity.
- Targeted supplements: Inositol, chromium, and alpha-lipoic acid may help improve insulin function.
Post-pill/Pill-induced PCOS
Post-pill or pill-induced PCOS occurs when PCOS-like symptoms develop after discontinuing hormonal birth control. This happens because certain birth control pills suppress natural hormone production, and when stopped, there can be a temporary surge in androgens as the body readjusts. True pill-induced PCOS typically appears within 3-6 months of stopping the pill and should resolve within 16-18 months as hormones rebalance.
However, it’s important to distinguish this from underlying PCOS that was simply masked by the pill’s hormone-suppressing effects. Read more about PCOS and the oral contraceptive pill to understand this complex relationship.
Pill-induced PCOS management
Supporting your body through the post-pill transition involves:
- Patience and time: Allowing 6-18 months for natural hormone production to normalise.
- Stress management: High stress levels can prolong the hormone rebalancing process.
- Nutritional support: Ensuring adequate intake of certain minerals, such as magnesium, zinc, and selenium, which women with PCOS often have “sub-optimal” concentrations of.
- Liver support: Helping your body process and eliminate excess hormones through foods like cruciferous vegetables and milk thistle (which studies have found to be very effective in hormonal regulation).
Inflammatory PCOS
Inflammatory PCOS is driven by chronic, low-grade inflammation that stimulates the ovaries to produce excess testosterone. While inflammation plays a role in all types of PCOS, it’s the primary driver in this type.
This inflammation can stem from various sources, including food sensitivities, gut health issues, environmental toxins, or autoimmune conditions. Women with inflammatory PCOS often have other inflammatory conditions such as irritable bowel syndrome (IBS), autoimmune diseases, skin conditions like eczema, or frequent infections.
Inflammatory PCOS management
Reducing inflammation is key to managing this type:
- Identifying and eliminating triggers: Common culprits include gluten, dairy, processed foods, and environmental toxins.
- Anti-inflammatory diet: Emphasising omega-3 fatty acids, antioxidant-rich fruits and vegetables, and anti-inflammatory spices like turmeric.
- Stress reduction: Chronic stress promotes inflammation, so techniques like meditation, yoga, or counselling are beneficial.
Adrenal PCOS
Adrenal PCOS is characterised by elevated DHEAS (dehydroepiandrosterone sulfate) produced by the adrenal glands rather than the ovaries. Around 20-30% of people with PCOS have adrenal androgen (AA) excess. This type is often misdiagnosed or confused with late-onset congenital adrenal hyperplasia.
Key characteristics include elevated DHEAS levels while testosterone and androstenedione remain normal or only mildly elevated. Many women with adrenal PCOS maintain regular menstrual cycles, making diagnosis more challenging. This type is typically triggered by chronic stress, which causes the adrenal glands to overproduce androgens.
Adrenal PCOS management
Supporting adrenal health is the focus for this type:
- Stress management: This is crucial and may include therapy, meditation, regular relaxation practices, and lifestyle changes to reduce stress.
- Adequate sleep: Aim for 7-9 hours of quality sleep nightly to support adrenal recovery.
- Gentle exercise: Avoiding high-intensity workouts that can further stress the adrenals.
- B vitamins and magnesium: These nutrients support adrenal function and stress resilience.
What is hidden-cause PCOS?
Hidden-cause PCOS refers to the underlying medical conditions that can masquerade as or trigger PCOS symptoms. These conditions create similar hormonal imbalances but have different root causes that require specific treatment approaches.
Common hidden causes include:
- Thyroid disorders (particularly hyperthyroidism)
- High prolactin levels
- Non-classical congenital adrenal hyperplasia
- Cushing’s syndrome
You should suspect hidden causes when:
- Treatments don’t respond to standard PCOS treatments
- Insulin levels are normal, but symptoms persist
- There’s a family history of autoimmune or endocrine disorders.
Additional testing beyond standard PCOS panels may be needed, including comprehensive thyroid testing, prolactin levels, and 17-hydroxyprogesterone. Learn more about potential causes of PCOS and when to investigate further.
What if you have multiple types of PCOS?
It’s common for women to have characteristics of multiple PCOS types, but there’s usually one primary driver. Treatment should follow a hierarchy approach, addressing the most significant factor first.
Insulin resistance typically takes precedence because it can worsen other types and has the most significant impact on long-term health. After addressing the primary driver, you can then focus on secondary factors.
Remember: inflammation is present in most PCOS types, so anti-inflammatory strategies often benefit everyone regardless of their primary type.
Getting the right PCOS diagnosis
While there is no single test for PCOS, there are some that are essential for accurate PCOS diagnosis and type identification. Request comprehensive testing that includes:
- Fasting insulin
- Glucose tolerance testing
- Full androgen panel (including DHEAS)
- Inflammatory markers (like CRP)
- Thyroid function tests
- Ovarian ultrasound
It’s important to question a PCOS diagnosis if symptoms don’t fit the typical pattern or don’t respond to treatment. Other conditions, like hypothalamic amenorrhea or high prolactin, can mimic PCOS symptoms.
Working with a healthcare provider with experience in PCOS management can make a significant difference in getting an accurate diagnosis.
How Infolic Alpha can support different types of PCOS
The Inofolic Alpha range offers comprehensive support for all types of PCOS. Infolic AlphaPlus in particular offers a unique combination of myo-inositol: D Chiro-inositol in the optimal 40:1 ratio, together with alpha-lactalbumin. This evidence-based formulation helps improve insulin sensitivity, which benefits insulin-resistant PCOS, while also supporting hormone balance and reducing inflammation that can help other PCOS types.
The addition of alpha-lactalbumin enhances absorption and bioavailability, making it more effective than standard inositol supplements. It has also been shown to reduce inflammation and encourage a more diverse microbiome. Clinical studies demonstrate how the combination can help restore ovarian function, improve metabolic parameters, and support conception.
References
Manta, A., Paschou, S. A., Isari, G., Mavroeidi, I., Kalantaridou, S., & Peppa, M. (2023, August 7). Glycemic index and glycemic load estimates in the dietary approach of polycystic ovary syndrome. * Nutrients, 15(15), Article 3483
Marshall, J. C., & Dunaif, A. (2012). Should all women with PCOS be treated for insulin resistance? Fertility and Sterility, 97(1), 18–22
NHS. (n.d.). Treatment of polycystic ovary syndrome (PCOS). NHS.uk. Retrieved August 2025, from https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/
Yildiz, B. O., & Azziz, R. (2007). The adrenal and polycystic ovary syndrome. Reviews in Endocrine and Metabolic Disorders, 8(4), 331–342
