While PCOS is one diagnosis, research suggests there are distinct underlying drivers. Understanding which type you lean toward can help guide treatment:

1. Insulin-resistant PCOS (most common, ~70%) The primary driver is insulin resistance. Elevated insulin increases androgen production. Signs include weight that's hard to lose (especially around the midsection), sugar cravings, fatigue after meals, and skin tags or darkened skin patches (acanthosis nigricans).

2. Inflammatory PCOS Chronic inflammation drives androgen production. Signs include unexplained fatigue, joint pain, skin issues, headaches, and elevated inflammatory markers (CRP) on blood work. This type may not respond as well to insulin-sensitising treatments alone.

3. Adrenal PCOS (~10%) Excess androgens come primarily from the adrenal glands rather than the ovaries. DHEA-S is elevated while other androgens may be normal. Stress management is especially important for this type.

4. Post-pill PCOS Symptoms appear after stopping hormonal contraceptives. The pill suppresses ovulation, and for some people, the body's hormonal regulation takes time to normalise. This type is sometimes temporary but can unmask underlying PCOS.

Many people have overlapping types. These aren't official medical categories, but understanding the primary driver helps explain why different treatments work for different people.