PCOS – symptoms and types

If you read yesterday’s blog post, you’ll be aware that one of the issues involving PCOS is that there is no universal definition of it. It will therefore come as no surprise to you that attempts to classify the types of PCOS are as myriad as the stars in the sky.

Probably the broadest classification is the distinction between the abbreviations PCO and PCOS, which you will occasionally see in scientific articles. Back in 1935, Gynaecologists Stein and Leventhal discovered a link between ovarian cysts and a failure to ovulate (anovulation). They named the syndrome Stein-Leventhal Syndrome. Original, huh? Later it was discovered that high levels of androgens along with anovulation were a better diagnosis, meaning that women could be diagnosed with the disorder without having the polycystic ovaries. Scientists will occasionally differentiate between the two by stating that women who have cysts have Polycystic Ovaries (PCO) and that women who do not but have all the ‘classic’ signs of the disorder have Polycystic Ovary Syndrome (PCOS).

The most common diagnostic tool is the Rotterdam Criteria, which was updated in 2003 to the following:

To be diagnosed with PCOS by the Rotterdam criteria, a woman must have two of the following three manifestations: irregular or absent ovulation, elevated levels of androgenic hormones, and/or enlarged ovaries containing at least 12 follicles each. Other conditions with similar signs, such as androgen-secreting tumors or Cushing’s syndrome, must be ruled out. Polycystic ovaries with normal ovarian function and without hyperandrogenism should not be considered PCOS without further workup.”

When it comes to different “types” of PCOS, there seem to be two schools of thought. One classifies type by cause (examples here and here) and the other by symptom (example here). Neither is perfect. You can have more than type, going by cause, and there are so many symptoms that there is no universally defined classification system that can apply to all sufferers. It’s such a complex syndrome that typing it by any one symptom is an exercise in futility.

From all the research I have done over the last year, and believe me when I say it’s a LOT, it’s become patently clear to me that PCOS is a spectrum. No two people suffer from it the same. In terms of managing the syndrome, it’s perhaps more useful to classify by cause and that’s something we’ll come back to later in the month.

I’ll round off today’s post with a list of the most common symptoms, although bear in mind that not every sufferer will have all or maybe even most of these.

Irregular periods, often with very painful cramps, or no periods at all

Excessive body and/or facial hair

Weight gain/obesity that is hard to shift

Thinning hair/hair loss


Sleep disorders, including insomnia and sleep apnoea


Mood swings, including depression and anxiety


Food intolerances and bloating

Difficulty getting pregnant

Secondary complications of PCOS which develop later in life are often serious and include things like:

Type 2 diabetes

Endometrial cancer

Non-alcoholic steatohepatitis (fatty liver)

Metabolic disorder, including elevated cholesterol, high blood pressure and high blood sugar, increasing the risk of cardiovascular disease

The problems PCOS causes in pregnancy are also severe. Not only does it make it difficult to get pregnant, women with PCOS are at a much higher risk of developing gestational diabetes or gestational high blood pressure, and also a higher risk of miscarriage or premature birth.

The gravity of this illness should not be overlooked.

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