Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility. There are four main causes of this menstrual cycle disorder. Based on these causes, PCOS is classified into four types.
Polycystic ovary syndrome (Polycystic Ovary Syndrome) is one of the most common cycle disorders that can affect your fertility. But: not all PCOS is the same. Many women experience different symptoms and issues related to their cycle. These symptoms are divided into 4 different types. Find out now which PCOS type you belong to!
With PCOS, egg maturation is disrupted, and ovulation therefore occurs much less frequently. This makes it harder to get pregnant. However, you can improve your chances by better understanding your individual PCOS.
This is because there are 4 main causes that can lead to PCOS. Based on these causes, PCOS is classified into 4 types. Find out now which PCOS type you are.
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The following 7 questions in our self-assessment can help you better understand your PCOS.
PCOS stands for Polycystic Ovary Syndrome and is one of the most common causes of infertility. Unfortunately, it is not yet widely known that there are very different causes for PCOS. Did you know that?
The different types of PCOS are also referred to as phenotypes. Accordingly, there are also different primary causes that must be taken into account during treatment. This makes it all the more important for those affected to learn that there are different types of PCOS, what distinguishes them, and what treatment might look like for each.
The 4 types of PCOS are:
PCOS caused by insulin resistance
PCOS caused by silent inflammation
Adrenal-induced PCOS
Post-Pill PCOS
PCOS – Type 1:
This is the most common type of PCOS; it is well known to many doctors and is likely the most studied. It is essentially the “classic PCOS,” as insulin resistance is the most common cause of PCOS*.
50–70% of women with PCOS are overweight or obese and exhibit features of metabolic syndrome. In addition to being overweight, this includes, among other things, a disturbance in glucose metabolism (insulin resistance) as well as lipid metabolism, which contributes to weight gain. Insulin resistance is reported in 30% of normal-weight and 70% of overweight women with PCOS. Insulin resistance can therefore develop independently of body weight. It is believed that, among other factors, a hormonal imbalance between female and male hormones contributes to the development of insulin resistance. It is also believed that insulin resistance is exacerbated by the intake of excess sugar, smoking, environmental toxins, and the consumption of trans fats.
Women with anovulatory cycles are more severely affected by insulin resistance than women with ovulatory cycles. Insulin resistance is also a risk factor for the development of type 2 diabetes mellitus. Furthermore, the risk of gestational diabetes is increased during pregnancy.
Carbohydrate-rich foods are broken down into sugar molecules and enter the bloodstream. To transport glucose into the cells, the body needs the hormone insulin, which it releases when blood sugar levels are elevated. In cases of insulin resistance, the body’s cells no longer recognize insulin properly. As a result, sugar remains in the blood, and the pancreas produces even more insulin. On the one hand, this promotes weight gain; on the other hand, the excess insulin simultaneously stimulates the cells in the ovaries to produce more androgens, i.e., male sex hormones. The PCOS is the result. Since about 70% of women with PCOS have insulin resistance, every PCOS patient should be tested for it. This test should also be performed on slim women.
The key here is to address insulin resistance in order to alleviate the symptoms of PCOS. The best way to do this is through diet, avoiding sugar, and getting enough exercise. Even a 5% weight loss can lead to a reduction in androgens and insulin, as well as a normalization of menstrual cycles and an increase in ovulatory cycles.
PCOS caused by insulin resistance
PCOS – Type 2:
Inflammatory processes play a key role in the body, protecting it from foreign particles, pathogens, and even stress. However, chronic inflammation can impair normal bodily functions, including ovulation, and lead to hormonal imbalances. Inflammation can also trigger testosterone production, which may result in visible changes in the body. For example, it has already been shown in PCOS that markers of oxidative stress and inflammation correlate strongly with circulating androgens. The following symptoms may occur with this type of PCOS in addition to other PCOS symptoms: extreme tiredness and fatigue, infections, skin problems such as eczema or psoriasis, joint pain, digestive issues, chronic headaches, or a constantly stuffy nose.
Silent inflammatory foci are likely to be found in almost all types of PCOS; thus, silent inflammation can almost always be detected in cases of insulin resistance as well (Schultz 2020). However, if you can identify silent inflammation as the sole factor, you likely have PCOS caused by silent inflammation.
Here, the trigger for the inflammatory processes must first be identified. Possible triggers can include food intolerances, an imbalance in gut flora, or histamine intolerance. It can also be helpful to reduce stress, avoid toxins such as BPA in plastic containers and water bottles, and eliminate inflammatory foods like dairy products, wheat, and sugar from your diet.
Want to learn about your cycle and get pregnant?
Find out if and when you ovulate despite having PCOS.
PCOS – Type 3:
This form of PCOS is primarily caused by excessive stress. Male hormones, known as androgens, are produced not only in the ovaries but also in the adrenal glands. The stress hormones cortisol and adrenaline are also produced there. If the adrenal glands are overstimulated by stress, this can trigger a simultaneous release of androgens. However, in both men and women, only one hormone is produced exclusively in the adrenal glands: the sex hormone DHEAS. DHEAS belongs to the group of male sex hormones, but is produced by both sexes and serves as a precursor for testosterone and estrogen production. If you have exclusively elevated DHEAS levels, it is likely that you fall into the category of adrenal-induced PCOS. In this case, PCOS is driven by an elevated stress response.
Reduce stress and focus on better overall stress management. Relaxation techniques, meditation, and gentle yoga are particularly helpful here. Pay close attention to your body’s needs.
PCOS – Type 4:
This is a type of PCOS that has developed as a result of taking the birth control pill. Common symptoms after stopping the pill include the absence of menstruation or very long or irregular cycles. Essentially, this is not PCOS at all; it could be described more as a temporary condition following discontinuation of the pill and often leads to a misdiagnosis of PCOS.
Birth control pills with androgenic effects can cause elevated androgen levels to remain detectable in blood tests for up to six months after stopping the pill. After stopping the pill, your body needs a lot of time to readjust and eliminate the hormone substitutes from your system. This can take up to a year or even longer. In addition, your body must learn to produce the hormones on its own again in the appropriate amounts. Sometimes, too many androgens are produced initially until the body has readjusted.
You may have post-pill PCOS if you do not have insulin resistance, silent inflammation, or an abnormal stress response, and if you had a “normal” cycle before taking the pill.
Give your body the time it needs to recover after stopping the pill. The absence of menstruation or irregular cycles for up to a year are not uncommon.
It’s entirely possible that you might identify with different types of PCOS. However, the PCOS types are listed here in order of “treatment” priority. This means that if you identify with Type 1 and Type 4, you should first get your insulin resistance under control.
Identifying which of the different PCOS types you fall into can sometimes be quite difficult, and finding the right solutions for you can be just as challenging. Knowing which PCOS type you are helps you take the appropriate steps toward healing. Lifestyle changes that aren’t tailored to your PCOS type can actually worsen your PCOS symptoms. We recommend that you get a thorough examination from a doctor and seek advice from a PCOS expert. For example, in a coaching session with Julia Schultz (GER), you have the opportunity to identify your PCOS type and find solutions that work for you.
It can sometimes be quite difficult to determine which type of PCOS you have, and it can be just as hard to find the right solutions for you. Knowing which type of PCOS you have will help you take the appropriate steps toward recovery. Lifestyle changes that aren’t tailored to your specific type of PCOS can actually make your symptoms worse. We recommend that you get a thorough examination from a doctor and seek advice from a PCOS expert. In a coaching session with Julia Schultz, for example, you have the opportunity to identify your PCOS type and find solutions that work for you.
“All that constant tracking was getting on my nerves, too. It was a hassle and just added more pressure. That’s why I was so happy when I heard about OvulaRing.”
Julia
“Thanks to OvulaRing, I had come to know my cycles very well by then. I knew that I ovulated regularly. So there was really nothing standing in the way of a pregnancy.”
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There are four main types of PCOS:
👉 The OvulaRing PCOS self-test can help you identify your own PCOS type!
Yes, PCOS is also possible even with a regular cycle. Although many women with PCOS have long or irregular cycles, there are also cases of PCOS without obvious menstrual irregularities.
Important signs of PCOS despite a regular cycle include:
👉 A hormone test and cycle tracking can help identify PCOS even without cycle irregularities.
Yes, not every woman with PCOS has insulin resistance. While approximately 70% of women with PCOS have insulin resistance, there are also other causes:
👉 An individualized diagnosis is important for finding the right treatment.
There are several ways to determine your PCOS type:
👉 A PCOS online test can provide initial guidance, but it does not replace a medical diagnosis!
Since this type of PCOS is caused by an overproduction of stress hormones, the most important steps are:
👉 Individual adjustments are crucial for restoring hormonal balance.
With PCOS, cycles are often irregular—which is why relying solely on calendar tracking is usually inaccurate. A combined approach is recommended: continuous/regular temperature tracking (to identify trends), supplemented by cervical mucus observation and—if necessary—medical evaluation (e.g., ultrasound/hormone testing) to better understand ovulation windows and cycle patterns. If you’d like to read up on the scientific basis for continuous temperature tracking (OvulaRing), you can find all key sources with DOI/PubMed/PDF here: Studies & Clinical Evidence.
Take control of your fertility today. Easily get to know your PCOS cycle better. Find out if and when you ovulate despite having PCOS.
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Is your cycle super short, extremely long, or even very irregular? OvulaRing tracks your personal cycle, no matter what cycle type you have. The OvulaRing method works for all types of cycles. This has also been confirmed in three medical studies covering a wide variety of cycle types.
With traditional basal body temperature tracking, you don’t measure your temperature continuously, but only once a day. To analyze your personal cycle even more accurately, however, OvulaRing measures around the clock and records 288 data points every day. This provides much more information to accurately determine your fertile days. OvulaRing also recognizes your very own cycle patterns and delivers precise results.
OvulaRing is just as easy to use and less noticeable than a tampon. When you wear OvulaRing, you can go about your daily life just as you always have. For example, you can exercise or go to the sauna. You can still have sex and enjoy your life. The automatic measurement inside your body always provides accurate results. It doesn’t matter what your daily routine looks like—the measurement works regardless.
OvulaRing can reliably tell you whether you’re ovulating. This helps you determine if your cycles are healthy. The app starts by learning your unique cycle patterns in detail. Once your cycle patterns have been identified, it provides you with a daily update on your fertility status.
OvulaRing was developed by renowned gynecologists at the University Women’s Hospital in Leipzig. As a result, the method is based on 40 years of experience and scientific research. In addition, OvulaRing is patented and approved as a medical device. Furthermore, the accuracy of this modern method of cycle monitoring has been demonstrated in several medical studies.
On the one hand, OvulaRing works entirely without hormones. On the other hand, the ring is also free of plasticizers and side effects. It doesn’t put any strain on your body! In addition, OvulaRing is very comfortable to wear and is as easy to use as a tampon. The material’s excellent tolerability has been confirmed in several medical studies.
Anagnostis et al. 2018. Polycystic ovarian syndrome (PCOS): Long-term metabolic consequences. Female Reproductive Endocrinology. Volume 86, p. 33-43. https://doi.org/10.1016/j.metabol.2017.09.016
Briden L. 4 Types of PCOS. https://www.larabriden.com/4-types-of-pcos-a-flowchart/ Zugriff: 10.11.2020
González F. 2012. Inflammation in Polycystic Ovary Syndrome: Underpinning of insulin resistance and ovarian dysfunction. Science Direct. https://doi.org/10.1016/j.steroids.2011.12.003
Insulite Health PCOS. The Phenotypes of PCOS. Which type are you? https://pcos.com/ Zugriff: 10.11.2020
Neumann K und Grisinger G. 2020. Polyzystisches Ovarsyndrom. In: Reproduktionsmedizin. 2. Auflage.
PCOS Living. 4 Types of PCOS and how to treat them. https://www.pcosliving.com/pcos-living-blog/types-of-pcos Zugriff: 11.11.2020
Randeva HS et al. 2012. Cardiometabolic Aspects of the Polycystic Ovary Syndrome. Endocrine Reviews. Volume 33. Issue 5. p. 812–841, https://doi.org/10.1210/er.2012-1003
Schultz J. Die 4 PCOS-Typen. https://www.juliaschultz.net/4-pcos-typen/ Zugriff: 10.11.2020
Stiefelhagen P. Bei PCOS besteht oft eine Insulinresistenz. Info Diabetol 13, 49 (2019). https://doi.org/10.1007/s15034-019-1482-x
Yu HF et al. 2016. Association between polycystic ovary syndrome and the risk of pregnancy complications. A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). doi: 10.1097/MD.0000000000004863
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