Dr. Chapa’s OBGYN Clinical Pearls “New” PCOS Info: 4 Types (AGAIN)
Nov 5, 2025
Explore the complexities of polycystic ovary syndrome (PCOS) as experts discuss four distinct phenotypes. Discover how new research largely reconfirms existing classifications and the implications for IVF and pregnancy outcomes. Learn that not all PCOS patients experience insulin resistance and that traditional views may overlook critical differences. Delve into lab-based subtypes and the importance of individualized care in managing this heterogeneous condition.
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PCOS Is A Spectrum, Not One Disease
- PCOS is a spectrum of metabolic, endocrine, and ovulatory presentations rather than a single uniform disease.
- Different phenotypes change over time and patients can move between them as physiology and environment change.
The Four Clinical PCOS Phenotypes
- Four clinical phenotypes exist: A (classic), B (no PCO on ultrasound), C (ovulatory hyperandrogenism), and D (non-hyperandrogenic with PCO).
- These phenotypes differ in symptom severity and metabolic risk, with A most common and D least common.
Use Rotterdam Then Subclassify
- Use the Rotterdam criteria (2 of 3: hyperandrogenism, irregular cycles, polycystic ovarian morphology) to screen for PCOS at the bedside.
- Then subclassify clinically into A, B, C, or D to guide risk assessment and counseling.