PCOS is not one condition. There are four distinct phenotypes – with different root causes, different lab patterns, and different treatment approaches. If you’re treating the wrong driver, you won’t see results.
What Type of PCOS
Do You Have?
PCOS is not one condition. The Rotterdam Criteria define four clinically distinct phenotypes — each with a different combination of features, a different metabolic risk profile, and a different treatment focus. Knowing yours changes everything about how you approach it.
Same diagnosis.
Four very different presentations.
Each phenotype is defined by which two (or three) of the Rotterdam criteria are present: Hyperandrogenism (HA), Ovulatory Dysfunction (OD), and Polycystic Ovarian Morphology (PCOM). The combination determines your metabolic risk, your most significant symptoms, and where treatment should focus.
All three Rotterdam criteria are present. This phenotype carries the most pronounced insulin resistance, the highest androgen levels, and the greatest risk of metabolic complications including dyslipidemia, type 2 diabetes, and cardiovascular disease. Fertility is most significantly impacted.
Hyperandrogenism and ovulatory dysfunction are present, but the ovaries appear normal on ultrasound. Metabolic dysfunction closely resembles Phenotype A. Often missed because imaging is unremarkable. Diagnosis relies on biochemical androgen elevation and cycle irregularity.
Androgen excess and polycystic ovarian morphology are present, but ovulation occurs regularly. Cycles are typically normal in length. Androgenic symptoms (hirsutism, acne, hair thinning) are the primary concern. Fertility is generally less impacted. Lowest metabolic risk among the hyperandrogenic phenotypes.
No androgen excess is present. Ovulation is irregular or absent and polycystic ovarian morphology is confirmed on ultrasound. Generally considered the mildest phenotype metabolically, though fertility and cycle regularity remain significant concerns. Most controversial phenotype — some guidelines require excluding other causes of anovulation first.
Two minutes.
Clinically grounded results.
The three criteria that define
every PCOS phenotype.
This quiz is an educational tool based on the Rotterdam Criteria and is intended to help you understand the PCOS phenotype framework. It does not constitute a clinical diagnosis. PCOS diagnosis requires the exclusion of other conditions that share similar features, including thyroid disorders, hyperprolactinemia, and non-classic congenital adrenal hyperplasia. A definitive phenotype determination requires laboratory testing and assessment by a qualified healthcare provider.
Know your phenotype.
Target your treatment.
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Dr. Frank’s background as a medical laboratory technologist in hospital biochemistry and hematology shapes how she approaches PCOS: through comprehensive lab interpretation and evidence-based root-cause investigation. She has spent over 26 years helping women identify their PCOS phenotype, understand their specific metabolic picture, and follow a targeted treatment protocol — not a one-size-fits-all plan. This quiz reflects the Rotterdam Criteria as applied in current clinical and research practice.
Type of PCOS References
Cussen L, McDonnell T, Bennett G, Thompson CJ, Sherlock M, O’Reilly MW. Approach to androgen excess in women: Clinical and biochemical insights. Clin Endocrinol (Oxf). 2022 Aug;97(2):174-186. doi: 10.1111/cen.14710. Epub 2022 Mar 29. PMID: 35349173; PMCID: PMC9541126.