NATUROPATHIC DOCTOR IN ONTARIO
The Four Types of PCOS
And Why Your Treatment Should Match Yours
Types of PCOS
If you’ve tried the supplements your friend swears by, or followed a PCOS diet plan to the letter, only to find it did very little for you — this post is for you.
One of the most important and least discussed aspects of PCOS is that it isn’t a single condition. It’s a syndrome — a cluster of symptoms with multiple possible underlying drivers. Two women can both carry a PCOS diagnosis and have almost entirely different hormonal pictures underneath. This is why a one-size-fits-all approach so often falls short, and why understanding your specific type of PCOS is the essential first step toward treatment that actually works.
In naturopathic practice, we recognize four main types of PCOS, each with distinct underlying mechanisms, different presentations, and different treatment priorities. Let’s walk through each one.
Type 1: Insulin-Resistant PCOS
The most common type — and the one most often missed in slim or “normal weight” women.
Insulin-resistant PCOS is estimated to affect somewhere between 50–70% of people with the condition, making it by far the most prevalent driver. And yet, it’s frequently overlooked in women who don’t fit the stereotypical image of insulin resistance, because many people assume that insulin problems only affect those who are overweight.
That assumption causes real harm.
What’s happening in the body
Insulin is a hormone produced by the pancreas whose primary job is to move glucose out of the bloodstream and into cells for energy. When cells become resistant to insulin’s signal — a state called insulin resistance — the pancreas compensates by producing more and more insulin to get the same result.
Here’s where PCOS enters the picture: elevated insulin directly stimulates the ovaries to produce more testosterone. High testosterone then interferes with the normal maturation and release of eggs, disrupting ovulation and leading to the irregular cycles, follicle accumulation on the ovaries, and androgen-related symptoms that define PCOS.
It’s a self-reinforcing loop — and breaking it requires addressing insulin sensitivity directly.
How it presents
- Irregular or absent periods
- Cravings for carbohydrates or sugar, especially in the afternoon
- Energy crashes after meals
- Difficulty losing weight, or unexplained weight gain (especially around the abdomen)
- Skin tags, or darkened skin in the armpits or back of the neck (acanthosis nigricans)
- Acne along the jawline and chin
- Elevated fasting insulin, glucose, or HbA1c on bloodwork
What helps
Treatment focuses on improving insulin sensitivity through a low-glycemic or Mediterranean-style diet, strength and resistance exercise, and targeted supplementation — particularly myo-inositol and D-chiro-inositol, which are among the most well-researched interventions for this type. Berberine, magnesium, and vitamin D also play supportive roles.
Type 2: Inflammatory PCOS
When chronic inflammation is fuelling androgen excess.
Inflammatory PCOS is less commonly discussed but important to recognize, particularly in women whose PCOS doesn’t fully respond to insulin-focused interventions or who don’t have significant insulin resistance on testing.
What’s happening in the body
Chronic low-grade inflammation — the kind that simmers in the background without obvious symptoms — directly stimulates the ovaries to over-produce androgens. It also impairs ovulation and can worsen insulin signalling, meaning inflammation and insulin resistance often overlap and amplify each other.
Sources of chronic inflammation in PCOS can include gut dysbiosis (an imbalanced microbiome), food sensitivities, environmental exposures, excess refined and processed food, nutrient deficiencies, and chronic stress. Identifying and addressing these triggers is central to treatment.
How it presents
- PCOS symptoms alongside frequent headaches, joint discomfort, or fatigue
- Skin issues such as eczema, rosacea, or persistent inflammatory acne
- Digestive symptoms: bloating, irregular bowel habits, food reactions
- Elevated inflammatory markers on bloodwork (hsCRP, ferritin)
- Symptoms that flare with dietary indiscretions or high stress periods
- Normal or only mildly elevated fasting insulin
What helps
An anti-inflammatory dietary approach is central here — emphasizing omega-3 fatty acids (found in fatty fish, walnuts, and flaxseed), colourful vegetables, olive oil, and reducing ultra-processed foods, refined seed oils, and excess sugar. Gut health assessment and support may be warranted if digestive symptoms are present. Supplements with anti-inflammatory and antioxidant properties — including NAC, omega-3s, and curcumin — are commonly used.
Type 3: Adrenal PCOS
When stress hormones are the primary driver — not the ovaries.
Adrenal PCOS is a less common but distinct presentation that’s frequently missed because it doesn’t fit the typical PCOS pattern. The key distinguishing feature is that the excess androgens come from the adrenal glands rather than the ovaries — a clinically meaningful difference that changes the entire approach to treatment.
What’s happening in the body
The adrenal glands produce a range of hormones, including the stress hormone cortisol and an androgen called DHEA-S. In adrenal PCOS, DHEA-S is elevated — often in response to chronic stress, HPA axis dysregulation, or heightened adrenal sensitivity — while other androgen markers (testosterone, LH) may be within normal range.
Because the ovaries aren’t the primary source of androgen excess in this type, treatments aimed at the ovaries (such as certain supplements or medications targeting LH and FSH) are often less effective. The adrenal glands need to be the focus.
How it presents
- PCOS symptoms that emerged or worsened during a period of significant physical or emotional stress
- Elevated DHEA-S on bloodwork, with normal or only mildly elevated testosterone
- Normal LH:FSH ratio (unlike classic PCOS where LH is often elevated)
- Symptoms of adrenal stress: fatigue, difficulty waking in the morning, feeling “wired but tired,” heightened anxiety
- Irregular periods that correlate with stress levels
What helps
Stress management moves from a lifestyle suggestion to a medical priority in adrenal PCOS. Adaptogenic herbs — such as ashwagandha and rhodiola — help regulate the HPA axis and reduce DHEA-S over time. Sleep hygiene, nervous system regulation practices, and avoiding overtraining (which raises cortisol) are also important levers. The dietary and inositol approaches used for insulin-resistant PCOS are often less central here.
Type 4: Post-Pill PCOS
When stopping hormonal contraceptives disrupts the cycle — temporarily.
Post-pill PCOS is arguably the most hopeful type to have, because it is usually temporary. However, it can be distressing and confusing for women who come off the pill hoping to have regular cycles — only to find their periods become irregular, acne flares, and androgen symptoms emerge that weren’t present before.
What’s happening in the body
Hormonal contraceptives suppress the body’s own production of LH and FSH, essentially overriding the hypothalamic-pituitary-ovarian axis. When the pill is stopped, it can take weeks to months for the body to re-establish its own hormonal signalling rhythm. During this transition, LH surges can stimulate androgen production, leading to a temporary state that looks very much like PCOS on bloodwork and ultrasound.
It’s important to note that post-pill PCOS is not caused by the pill — rather, the pill can mask an underlying tendency toward PCOS, or the post-pill hormonal fluctuation can temporarily mimic it. For many women, cycles regulate within three to six months without intervention. For others, underlying drivers (such as insulin resistance or inflammation) that were masked by the pill become apparent and need to be addressed.
How it presents
- Regular periods while on the pill, followed by irregular or absent cycles after stopping
- New or worsening acne in the months after coming off hormonal contraceptives
- Hair thinning or increased hair growth after stopping the pill
- Elevated LH on bloodwork in the post-pill period
- Often resolves within 3–6 months, but may persist if underlying drivers are present
What helps
Patience is genuinely part of the treatment here. For most women, supporting the body’s hormonal recalibration with nutrition, blood sugar balance, and targeted supplementation is sufficient. Vitex (chaste tree berry) is commonly used to support LH regulation and cycle restoration in this phase. If symptoms persist beyond six months, further investigation is warranted to determine whether an underlying PCOS type is also present.
Why Identifying Your Type Matters
The four types of PCOS aren’t mutually exclusive — many women have overlap between two or more types, which adds complexity and makes comprehensive testing even more important. But understanding the primary driver changes everything about where to direct your efforts.
If you have adrenal PCOS and you spend months focusing exclusively on insulin-sensitizing supplements and a strict low-glycaemic diet, you may see very little benefit — and a lot of frustration. If you have insulin-resistant PCOS and focus primarily on stress management, you’ll be addressing a piece of the puzzle but likely not enough to shift your hormonal picture.
This is why at Sequence Wellness, we don’t begin with a protocol. We begin with a thorough intake and targeted lab work — testing fasting insulin and glucose, a full androgen panel (including DHEA-S to screen for adrenal PCOS), LH and FSH, thyroid function, inflammatory markers, and key nutrient levels — to build a complete picture of what’s actually driving your symptoms before any recommendations are made.
If you’re in Ontario and wondering which type of PCOS applies to you, we’d love to help you find out.
Book a free 10-minute chat with our team — or read more about our comprehensive approach to PCOS care:
[→ A Naturopathic Approach to PCOS: Treating the Root Cause]
[→ PCOS and Insulin Resistance: What Your Blood Sugar Has to Do With Your Hormones]
This article is for informational purposes only and does not constitute medical advice. Please consult a licensed healthcare provider for assessment and treatment recommendations specific to your situation. All Sequence Wellness naturopathic doctors are board certified and licensed by the College of Naturopaths of Ontario (CONO).
Dr. Janna Fung, Naturopathic Doctor
Dr. Janna Fung is a licensed naturopathic doctor with a special interest in dermatology and women’s health. She has a passion for evidence based preventative medicine and strives to empower patients with the knowledge to achieve their optimal health. She understands collaborations is the only way to develop realistic sustainable health/wellness results and strives to develop individualized health goals with patients.
