Types of PCOS — Understanding the Different Presentations
By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham
PCOS (polycystic ovary syndrome) is not a single condition — it is a heterogeneous syndrome with several distinct presentations, each driven by different underlying mechanisms. Understanding which type of PCOS you have is important because the treatment approach differs significantly. This is one of the areas where traditional Chinese medicine excels, as it has always approached PCOS through the lens of individualised pattern diagnosis rather than a one-size-fits-all protocol.
The Four Phenotypes of PCOS
The Rotterdam criteria (the most widely used diagnostic framework) allow for four different phenotypes based on the presence or absence of three features: irregular or absent ovulation, elevated androgens, and polycystic ovarian morphology on ultrasound. Diagnosis requires at least two of the three features. This means women with PCOS can have quite different symptom profiles:
- Phenotype A (Classic) — all three features present. The most severe form, typically associated with significant insulin resistance, high androgens, and anovulation.
- Phenotype B — irregular ovulation and elevated androgens, but no polycystic morphology on ultrasound. Metabolic features similar to Phenotype A.
- Phenotype C (Ovulatory PCOS) — elevated androgens and polycystic morphology, but regular ovulation. Often the mildest presentation; fertility may be preserved.
- Phenotype D (Non-androgenic PCOS) — irregular ovulation and polycystic morphology, but normal androgens. Often associated with hypothalamic dysfunction rather than insulin resistance.
Insulin-Resistant PCOS
The most common type, affecting the majority of women with Phenotypes A and B. Insulin resistance drives excess androgen production in the ovaries, disrupts follicular development, and prevents regular ovulation. It is associated with weight gain, acne, hirsutism, and a tendency towards blood sugar dysregulation. In TCM, this maps closely to kidney yang deficiency with phlegm-dampness — insufficient metabolic energy combined with the accumulation of dampness (the TCM equivalent of insulin resistance and metabolic sluggishness). Treatment focuses on warming kidney yang, resolving phlegm-dampness, and strengthening the spleen.
Adrenal PCOS
In approximately 20–30% of women with PCOS, elevated androgens originate primarily from the adrenal glands rather than the ovaries — this is often triggered or exacerbated by chronic stress. Elevated DHEA-S (the adrenal androgen marker) is the distinguishing feature. In TCM, this pattern involves kidney yin deficiency with empty heat — the adrenal stress response depletes yin, generating heat that produces the androgen excess. Managing stress and nourishing kidney yin are central to treatment.
Post-Pill PCOS
Some women develop PCOS-like symptoms after stopping the combined pill — irregular cycles, elevated androgens, and polycystic morphology on ultrasound. This often resolves within 3–6 months as the HPO axis re-establishes itself, and may not represent true PCOS. See our article on post-pill amenorrhoea.
Inflammatory PCOS
Chronic low-grade inflammation drives androgen production and impairs follicular development in some women. Elevated inflammatory markers (CRP, white cell count) and symptoms including fatigue, headaches, and bowel irregularity alongside PCOS features suggest this pattern. In TCM, damp-heat in the lower burner is the closest equivalent.
TCM Treatment Approach
Because each PCOS type has a distinct underlying pattern, treatment in my clinic is always individualised after full assessment. Acupuncture is effective for all types — it regulates the HPO axis, stimulates ovulation, and reduces insulin resistance. Chinese herbal medicine is prescribed based on the specific pattern, with kidney yang tonics and phlegm-resolving herbs for the most common insulin-resistant type, and kidney yin nourishing formulas for adrenal and inflammatory types. Diet and lifestyle modification is tailored to the underlying mechanism.
To discuss PCOS treatment, contact me or book a consultation in Wokingham.
