The Many Faces of Polycystic Ovarian Syndrome

The Many Faces of Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) is considered to be the leading cause of female infertility, with nearly 5 million women in the United States alone carrying the markers for this disease.

Women diagnosed with PCOS typically fall into two categories; insulin resistant and non-insulin resistant, but did you know there may be up to 5 variations of PCOS?

Women diagnosed with PCOS typically fall into two categories; insulin resistant and non-insulin resistant, but did you know there may be up to 5 variations of PCOS?

Symptoms can include:

  • Excessive hair growth on the face, chest, stomach and back
  • Irregular or absent periods
  • Acne and oily skin
  • Ovarian cysts
  • Excessive weight carried around the stomach
  • Pelvic pain
  • Skin tags
  • Sleep apnea
  • Infertility

In order to meet the diagnostic criteria, a patient must present with at least two of the following three issues:

    1. Increased Testosterone
    2. Abnormal Ovulatory Patterns
    3. Polycystic Ovaries

For women with PCOS, this is all basic knowledge. What they may not fully understand, however, is how their presentation of PCOS may differ from the experiences of others.

Two Main Types of PCOS

Presentations of PCOS can typically be broken down into two categories: Insulin-Resistant PCOS and Non-Insulin-Resistant PCOS. The variations in these presentations can create confusion surrounding the disease, as well as the best treatment options.

Insulin-Resistant PCOS

Insulin-Resistant PCOS is also referred to as Type 1 PCOS, and it is what is most often associated with the classic symptoms of PCOS. These include weight gain, ovulatory interruptions, facial hair, hair loss and acne. Those with Insulin-Resistant PCOS also exhibit a greater potential for developing diabetes and increased testosterone levels – both of which are actually caused by the underlying insulin and leptin resistance.

In fact, the insulin and leptin resistance experienced by these patients is the culprit behind many of the unbecoming symptoms they face at the hands of this disease. It leads to the increased weight gain, for instance, and the resulting excess in testosterone is to blame for the combined hair loss and facial hair growth.

The goal for treating Insulin-Resistant PCOS is to improve insulin sensitivity. Often doctors will prescribe weight loss, but it can be difficult for patients with this type of PCOS to lose weight. It requires extra dedication to both diet and exercise, and an understanding that the weight will not come off as quickly as it may for others. However, when weight loss is achieved, symptoms do typically subside. Medications to lower blood sugar are also often prescribed, although there have been natural alternatives – such as D-Chiro-Inositol – which have been found to be just as effective in some cases.

Non-Insulin Resistant PCOS

There are some women who meet the diagnostic criteria for PCOS, but who don’t present with insulin resistance. This is what is referred to as Type 2, or Non-Insulin Resistant, PCOS. There can be a variety of causes for this type of PCOS, including Vitamin D or Iodine deficiency, hormone-disrupting toxins, thyroid disease, and adrenal stress. For women experiencing Non-Insulin Resistant PCOS, blood sugar lowering drugs will have no effect on the condition, and neither will reducing weight or going on the pill.

The treatment options in this case tend to be more natural. Patients may be encouraged to avoid dairy while also being prescribed supplements such as Iodine, Vitamin D, Magnesium, and Zinc, along with herbal formulas to reduce testosterone. Natural progesterone may also be prescribed in an attempt to balance hormones and encourage ovulation.

Other Potential Combinations

While the two types of PCOS described above tend to be the most typical presentations, there are some who break the categories down to as many as five different types:

1. Type 1 PCOS:

    The classic PCOS presentation described above, with ovulatory issues, increased testosterone, and insulin-resistance.

2. Type 2 PCOS:

    The non-insulin-resistant PCOS we have already described, with ovulatory issues and increased testosterone levels.

3. Non-Traditional PCOS 1:

    Presents with ovulatory issues, normal testosterone levels, obesity and insulin-resistance.

4. Non-Traditional PCOS 2:

    Presents with normal ovulatory patterns, increased testosterone levels and mild insulin-resistance.

5. Idiopathic Hirsutism:

    Presents with normal ovulatory patterns, increased testosterone levels and no insulin-resistance.

As you can see, there are many variations when it comes to this condition, which can make finding the appropriate treatment for individual patients difficult. Understanding the factors behind your own case of PCOS, and finding a specialist you trust to help you seek the answers you need is the best way to combat this disease which affects so many others as well.


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  1. This is indeed really tricky. Looking at it I wouldn’t fall into any category, but I know I’m type 1 even though I don’t have insulin resistance. I have high testosterone levels, problems with facial and body hair and ovulatory issues. The difference is that I’m lean and instead of insulin resistance I “only” have reactive hypoglycemia that is also a problem with insulin.

  2. Hi! I am thin, no acne, long but regular cycles 32-38 days (ovulating 14 days before period always), normal total testosterone levels in blood tests, polycystic cysts on ovaries seen on ultrasound and only mild hirsutism. Testosterone levels are normal <0.69 nmol/l. What type of PCOS do i have? I am confused and thanks for your reply. I appreciate the help you are giving. I am taking maca, turmeric, omega 3 vitamins and trying to add a healthy lifestyle already. Thanks

    • Dear Charlene,

      There are so many ways PCOS presents itself from what I hear from those who reach out to us. Be sure to ask your healthcare provider to explain to you what type of PCOS it is that you have. It may be non-insulin resistant PCOS (with long cycles, cysts and mild Hirsutism).

      It is great that you have begun taking herbs, supplements and making lifestyle changes. Diet is known to be key! Our guide to
      Important Natural Health Tips for Women with Lean PCOS may be helpful to you.

  3. Hay! I am 25 year old and I have PCOS. I have regular periods. I have never missed my period. I am have excessive hair growth. I went for blood tests and they showed normal ovulation and high testosterone levels. My doctor put me on Metformin. I took it for a few months, then I left it. I want to ask, is it possible to get pregnant with PCOS easily if I am ovulating? What type of PCOS do I have?

    • Dear Nena,

      I can not know if pregnancy with any fertility health condition will be easy. Each case is so very different. If the menstrual cycle, ovulation, uterine lining and eggs, and of course hormone balance are healthy, there may be a chance of natural conception.

      Given what you have shared here and the information in this article, the PCOS experienced most closely resembled #5 Idiopathic Hirsutism. Idiopathic Hirsutism presents as excess hair growth in the pattern of male hair growth (face, chest, back, groin, inner thighs etc.), eleveated testosterone levels, but the women who experience this have normal menstrual cycles including ovulation.

      I am not a medical doctor to determine this specifically, but again based on what you have shared and this article, it may be worth asking your healthcare provider about. Consider also learning about the herb Saw Palmetto as a natural option for women with Hirsutism due to PCOS.

      I hope this is helpful!

  4. I used your Fertility Cleanse and it brought back my period after so many months. I am using your guide for my diet, but what should be my next step?

    • Dear Reishma,

      It is great to hear of how the Fertility Cleanse supported you. If you are interested in sharing your success story, it may encourage others.

      It is difficult for me to answer your question based on just knowing a small piece of the bigger picture of your fertility health. Consider booking a Fertility Consultation to be guided in how to best support your fertility health needs. This allows you to work one on one with our fertility herbalist who will create a natural fertility program for you.

  5. How exactly does PCOS affect fertility?

  6. Hi There can you take Evening Primrose and your natural progesterone cream together, as they are both natural hormones ?

    • Elizabeth Willett, MA, CH

      Hello Hope!

      Fertilica Evening Primrose Oil and Fertilica Natural Progesterone Cream can be taken together yes.

      Take care!

  7. Hi there :),
    Im 30, I had ultrasound and was told I have cyst few years ago, them developed acne, for a while hot flashes, and facial hair. Trying to conceive now, reading everything on the web, Im taking following:
    Evening Primrose oil
    Hemp Oil
    l tyrosine
    Vit D 30000iu
    Just ordered:
    Gymenna, Burdock root, Tribulus, and more Organic vitex to change brands.
    Im coming from an extremely high diet on fruit now eating with your recommendations.
    I dont know which type of PCOS I fall into, would these supplements contraindicated to any type of PCOS??

    I never knew these categories…

    Thanks in advance.

    • Elizabeth Willett, MA, CH

      Hello Maria!

      Without knowing the proper dose or combination that may be right for you, it would really be best to consider a Fertility Consultation with an herbalist or natural healthcare practitioner, such as a naturopath, someone who can help you determine if these herbs and supplements are right for you.

      Best wishes!