PCOS / PMOS Phenotype Quiz — A, B, C or D?
The Rotterdam criteria (2003, updated 2023) define 4 clinical phenotypes of PCOS/PMOS. 12 questions to identify your probable profile and prepare your consultation.
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Question 1
How regular are your menstrual cycles?
Count the days from the first day of one period to the first day of the next
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Understanding the 4 Rotterdam Phenotypes
The Rotterdam 2003 criteria identify 3 diagnostic axes for PCOS/PMOS: (1) chronic anovulation, (2) clinical or biochemical hyperandrogenism, (3) polycystic ovarian morphology (PCOM) or elevated AMH. A diagnosis requires at least 2 of these 3 criteria — creating 4 distinct phenotypes.
| Phenotype | Anovulation | Hyperandrogenism | PCOM / AMH | Metabolic severity |
|---|---|---|---|---|
| A (classic) | ✓ | ✓ | ✓ | Most severe |
| B | ✓ | ✓ | — | Severe |
| C | — | ✓ | ✓ | Moderate |
| D | ✓ | — | ✓ | Milder |
The 2023 Update (ESHRE/Monash)
The international 2023 guideline (ESHRE + Monash University) confirms the 4 phenotypes while adding two key updates: (1) AMH can replace pelvic ultrasound as the third criterion; (2) specific pediatric criteria exist for adolescents. Source: Teede et al., Nature Medicine 2023.
Why Phenotype Matters for Treatment
Phenotype A calls for close cardiometabolic monitoring (HbA1c, lipids, blood pressure). Phenotype C focuses on dermatological management (acne, hirsutism, alopecia). Phenotype D centres on fertility. This stratification is one of the reasons the Endocrine Society and Monash University proposed the PMOS rename in May 2026 — to acknowledge that the syndrome extends beyond the ovaries.
For more information on each criterion: The 4 PMOS phenotypes explained · What is PMOS? · AMH test and PCOS · Insulin resistance in PCOS
Want a deeper assessment? Try the in-depth 30-question PCOS / PMOS quiz — it adds a Ferriman-Gallwey hirsutism score, a 90-day plan and a free PDF export to take to your appointment.
Frequently Asked Questions
- What are the 4 phenotypes of PCOS/PMOS?
- The Rotterdam 2003 criteria define 4 phenotypes: A (classic, all 3 criteria), B (anovulation + hyperandrogenism, no PCOM), C (hyperandrogenism + PCOM, regular cycles), D (anovulation + PCOM, no hyperandrogenism). Phenotype A is the most metabolically severe.
- Is this quiz a medical diagnosis?
- No. This quiz is a non-diagnostic orientation tool to help you prepare your appointment. Only a doctor can diagnose PCOS/PMOS based on clinical examination, blood tests, and pelvic ultrasound.
- Which phenotype is most common?
- Phenotype A (classic) represents approximately 50–60% of PCOS diagnoses. It combines anovulation, hyperandrogenism, and polycystic ovarian morphology — all 3 Rotterdam criteria.
- Can my phenotype change over time?
- Yes. The phenotype can evolve, especially around puberty, pregnancy, and perimenopause. This is why reclassification at age 18 is recommended for adolescents diagnosed with PCOS.
- Does phenotype D mean my PCOS is milder?
- Phenotype D (anovulation + PCOM without clinical hyperandrogenism) is generally considered less metabolically severe, but it can still cause significant fertility difficulties and irregular cycles requiring treatment.
- Can I have PCOS with regular cycles?
- Yes — this is phenotype C. Hyperandrogenism (acne, hirsutism, elevated testosterone) combined with polycystic ovarian morphology is sufficient for diagnosis even with regular cycles. Phenotype C is frequently under-diagnosed for this reason.
- How do I find out which PCOS / PMOS phenotype I have?
- Your phenotype is simply which 2 or 3 of the Rotterdam criteria you meet, so it is established from three things you may already have: your cycle history (are you ovulating regularly?), a hyperandrogenism assessment (visible signs such as hirsutism or hormonal acne, or a raised total testosterone / free androgen index on bloods), and a pelvic ultrasound — or, in adults since the 2023 international guideline, an AMH level instead. Once you know your answer to each of the three, the letter follows mechanically: all three means A, no polycystic morphology means B, regular cycles means C, no hyperandrogenism means D. This 12-question quiz walks you through those three inputs and names the matching profile, but it is an orientation tool: the criteria that require a blood test or a scan can only be confirmed by a clinician.
- Will my doctor tell me my phenotype?
- Often not spontaneously. Many clinicians record the diagnosis simply as PCOS / PMOS without stating a phenotype letter, even though they have gathered everything needed to assign one. It is a reasonable thing to ask, because the phenotype shapes what should be monitored: phenotypes A and B carry the highest cardiometabolic risk and justify closer glucose and lipid follow-up, while phenotype D is mainly a fertility and cycle question. A useful way to put it is: "Based on my cycles, my androgens and my scan, which Rotterdam phenotype do I fit?"
How was this page written? See our editorial methodology →