But heading into 2026, something feels different.

PCOS research, technology, and clinical care are slowly beginning to catch up to the lived reality of millions of people with the condition. This isn’t about a single miracle cure - it’s about momentum.

Here’s 5 genuinely exciting areas about where PCOS is headed.

1. Treatments Are Moving Beyond “Band-Aids”

Historically, PCOS treatment focused on masking symptoms rather than addressing root causes. That’s starting to change.

Metabolic-Focused Therapies

Newer medications originally developed for diabetes and obesity - particularly GLP-1 and dual-agonist drugs — are being explored more seriously in PCOS care. Why this matters:

• PCOS is fundamentally a metabolic-hormonal condition

• Insulin resistance drives many symptoms (irregular cycles, high androgens, weight gain)

• Treating metabolism can improve multiple PCOS features at once

In 2026, we’re likely to see clearer guidance on who benefits most, how these drugs fit into long-term care, and how to use them responsibly.

Better Anti-Androgen Strategies

Researchers are also working on more targeted ways to address excess androgens - the hormones behind acne, hair loss, and hirsutism — with fewer side effects than current options.

The shift is subtle but important: less “one-size-fits-all,” more precision.

2. AI and Smarter Diagnosis Could End the Guessing Game

Many people with PCOS spend years trying to get a diagnosis. Some are dismissed because they don’t “look” like the stereotype.

That may finally start to change - with common language being developed alongside extensive datasets.

AI-assisted diagnostic tools can help:

• Combine lab data, symptoms, cycle patterns, and imaging

• Reduce bias across body sizes and ethnic backgrounds

• Catch PCOS earlier

This doesn’t replace doctors, it supports them - and helps patients be taken seriously sooner. Everyone will benefit from tools like ChatGPT Health connecting the dots before an appointment, making patients more informed and make the most of their time when talking to a clinician.

3. Lifestyle Care Is Becoming More Personalised

Lifestyle interventions aren’t going away - but they’re becoming more nuanced.

Instead of:

• “Just lose weight”

• Generic diet plans

• Overexercise recommendations

The future looks like:

• Personalised nutrition based on insulin response

• Movement for hormone regulation, not punishment

• Supplements backed by real data (like inositols, vitamin D, and Omega3)

• Mental health support as a core part of PCOS care

This is a significant shift from blanket approach to data-informed collaboration.

4. Genetics and Epigenetics Are Rewriting the Story

PCOS often runs in families, but not in a simple genetic way.

Recent research into epigenetics (how gene expression changes based on environment, hormones, and early development) suggests:

• PCOS risk may be influenced before birth

• Metabolic and hormonal environments matter deeply

• Early intervention could one day reduce severity later in life

This reframes PCOS from a personal failure to a biological inheritance shaped by environment - a powerful shift away from shame.

5. The Name and Narrative of PCOS May Finally Change

There’s growing momentum to rename PCOS - not as a rebrand, but as a correction.

Polycystic ovary syndrome was coined in the 1930s by two American gynecologists, Dr. Irving Stein and Dr. Michael Leventhal, and was also known as Stein-Leventhal syndrome. However, PCOS:

• Centers ovaries, even when cysts aren’t present

• Ignores metabolic and neurological drivers

• Confuses patients and clinicians alike

By 2026, we may see consensus around language that better reflects the condition’s complexity and reduces stigma. Some of the suggestions include “Ovarian Dysmetabolic Syndrome” and “Metabolic Reproductive Syndrome”, highlighting the hormonal imbalances and metabolic disturbances associated with the condition.

Words matter. Especially in medicine.

Thanks for reading all the way - please like if you found this interesting 🩵 I’m especially excited about AI improving the understanding of PCOS and bridging the gap between clinicians and patients —

Welcome to PCOS Basics series - a guide to Polycystic Ovary Syndrome. Whether you’ve just been diagnosed, think you might have PCOS, or simply want to understand it better, this series walks you through diagnosis, symptoms, treatment, and long-term health so you can feel informed and in control.

P.S. If you’d like to dive deeper, the post contains multiple links to research papers. (check out my guide on how to read a research paper).

Why PCOS is Called a Syndrome

The word syndrome is key to understanding PCOS. Unlike a disease with a single known cause (like the flu, which is caused by a virus), a syndrome is a collection of symptoms that tend to occur together, even when we don’t fully understand why.

PCOS isn’t one thing going wrong in your body - it’s multiple systems that aren’t communicating properly. Think of it like a group project where everyone’s working from different instructions. Your hormones, your metabolism, and your ovaries are all involved, and they’re all affecting each other in complex ways.

This is why there’s no single “PCOS test.” Instead, doctors diagnose PCOS by looking at a combination of features. I break down the diagnostic criteria in detail in my previous PCOS Basics post, but here’s the TLDR: you need two out of three - high androgens, irregular ovulation, or polycystic ovaries on ultrasound.

What Is Actually Happening in Your Body

At its core, PCOS involves a vicious cycle of hormonal and metabolic dysfunction. Here’s what’s going wrong.

The Hormone Disruption

Your hypothalamus and pituitary gland (in your brain) normally send carefully timed signals to your ovaries to control your menstrual cycle. In PCOS, this communication system is disrupted. Your pituitary releases too much luteinising hormone (LH) relative to follicle-stimulating hormone (FSH), which throws off the whole process.

This hormonal imbalance means your ovaries produce too many androgens -hormones like testosterone that are typically thought of as “male” hormones but are naturally present in women too. These excess androgens can cause symptoms like acne, excess facial or body hair, and scalp hair loss.

The Insulin Problem

About 70% of women with PCOS have insulin resistance, meaning their cells don’t respond properly to insulin. When this happens, your pancreas pumps out even more insulin to compensate (hyperinsulinemia).

Here’s where it gets worse: excess insulin actually signals your ovaries to make even more androgens. It also suppresses a protein called sex hormone-binding globulin (SHBG), which normally keeps androgens in check. With less SHBG around, you have more “free” androgens circulating in your bloodstream, amplifying symptoms.

The Ovarian Changes

All of this hormonal chaos affects your ovaries directly. Follicles (the fluid-filled sacs that contain eggs) start developing but get stuck at an early stage instead of maturing properly. This creates the characteristic “string of pearls” appearance on ultrasound - multiple small follicles arrested in development around the edge of the ovary.

Because follicles aren’t maturing properly, ovulation often doesn’t happen, leading to irregular or absent periods. When you don’t ovulate regularly, you also don’t produce enough progesterone, which can cause other issues down the line.

Why Symptoms Vary So Much Between People

This is where PCOS gets really complex. To be diagnosed, you need to meet 2 out of 3 criteria, which creates four different combinations (aka phenotypes) of PCOS:

• Phenotype A (Full PCOS): High androgens + irregular ovulation + polycystic ovaries

• Phenotype B (Non-PCO PCOS): High androgens + irregular ovulation (but normal-looking ovaries)

• Phenotype C (Ovulatory PCOS): High androgens + polycystic ovaries (but regular ovulation)

• Phenotype D (Non-hyperandrogenic PCOS): Irregular ovulation + polycystic ovaries (but normal androgen levels)

Research shows these aren’t just arbitrary categories - they represent genuinely different presentations with different metabolic risks and genetic underpinnings.¹²

But It Gets Even More Complex…

Beyond these four official phenotypes, there’s enormous variation based on:

Genetics: PCOS runs in families, but the specific genes involved are still being identified. Recent research suggests there may be distinct genetic subtypes with different underlying mechanisms. This means your PCOS might genuinely be different from someone else’s at a biological level.

Ethnicity: PCOS presents differently across ethnic groups. East Asian women with PCOS tend to have less severe hirsutism and lower rates of obesity compared to women of European descent, while South Asian, Middle Eastern, and Hispanic women often experience more severe hirsutism and metabolic dysfunction.

Body Weight: Obesity amplifies many PCOS symptoms, particularly insulin resistance and metabolic problems. But about 30% of women with PCOS are lean, and they can have a significantly different clinical picture.

Age: PCOS symptoms can change throughout your life. They often emerge or worsen during puberty, may improve with lifestyle changes or treatment during your reproductive years, and shift again as you approach menopause.

The Bottom Line

PCOS is complex by nature. It’s not that doctors don’t know what they’re talking about or that you’re a medical mystery - it’s that PCOS is genuinely a heterogeneous condition with multiple subtypes and presentations.

Understanding that PCOS is a syndrome - a cluster of related symptoms with multiple underlying causes - can help make sense of why your experience might be so different from someone else’s, why treatment approaches need to be individualised, and why there’s no one-size-fits-all solution.

The good news? Research is increasingly recognising these different subtypes and working toward more personalised approaches to diagnosis and treatment. The more we understand about PCOS heterogeneity, the better we can tailor management to each person’s specific presentation.

Please give this post a ❤️ if you found it valuable!

But… what if diagnosing PCOS was as simple as a blood test?

New research suggests we might be heading in that direction. Today, I’m breaking down a hot-off-the-press study on RNA biomarkers that could transform how we diagnose polycystic ovary syndrome.

Quick Stop: What Are RNA Biomarkers?

Before we dive in, let’s demystify the science. The researchers studied circulating non-coding RNAs - gene-regulating molecules that float around in your blood:

• miRNAs (microRNAs): Tiny molecules that act like dimmer switches for your genes, controlling how much of certain proteins your cells make. They influence everything from metabolism and hormones to immunity and inflammation.

• lncRNAs (long non-coding RNAs): Longer RNA molecules that help organise and control how genes are expressed.

The beauty of these molecules? They can be detected in a simple blood draw.

What This Study Found

Researchers conducted a systematic review and meta-analysis of studies from 2014–2024, examining circulating RNAs as potential diagnostic biomarkers for PCOS, endometrial cancer, and ovarian cancer. For PCOS specifically, they analysed 46 studies and found the following:

1. PCOS Has a Distinct Blood RNA Signature

The analysis identified 30 different circulating biomarkers (mostly miRNAs, with some lncRNAs) that can distinguish women with PCOS from healthy controls. This means PCOS isn’t just about ultrasound findings and hormone levels - it leaves a detectable molecular fingerprint in your blood.

2. The Biology Connects to Clinical Reality

These RNA markers aren’t random signals. They map directly onto the hallmark features of PCOS:

• Insulin resistance and metabolic dysfunction

• Excess androgen production

• Disrupted follicle development and ovarian function

• Chronic inflammation and abnormal cell proliferation

This alignment between molecular markers and clinical symptoms strengthens the case for their diagnostic potential.

3. A Possible Window Into Cancer Risk

Here’s where it gets especially interesting: many of these “PCOS RNAs” are also involved in cancer pathways. Several are already recognised as oncogenic or tumour-suppressor RNAs in breast, liver, colorectal, and ovarian cancers.

This connects to existing data showing women with PCOS face elevated risks of endometrial and ovarian cancer. In the future, these biomarkers might do double duty - not only helping diagnose PCOS but also identifying which patients face higher long-term cancer risk. (Important caveat: this is still speculative and needs dedicated research to confirm.)

What This Could Mean for PCOS Diagnosis

In an ideal scenario, a validated RNA blood test could:

✓ Enable earlier, more objective PCOS diagnosis
✓ Reduce reliance on subjective criteria like ultrasound interpretation
✓ Identify women at higher risk for metabolic or gyneacologic complications
✓ Support personalised treatment approaches

Before you ask your doctor for this test, here’s what you need to know:

Major limitations:

• Most studies are small and from single centres, which typically inflates reported accuracy

• Significant variation in methods (sample types, technologies, cut-off values) makes it hard to create a unified, reliable test

• Only a handful of markers have been validated across multiple independent studies

• None are currently validated enough to replace or formally enhance existing PCOS diagnostic criteria

Bottom Line

This research strongly supports the concept of a future PCOS blood test based on RNA panels. The science is sound, the biological rationale is compelling, and the preliminary data are promising. But we’re still in the research pipeline - not ready for clinical rollout.

For now, PCOS diagnosis remains clinical, based on the Rotterdam criteria. But this field is advancing quickly, and within the next several years, we may see validated RNA biomarker tests becoming part of standard PCOS evaluation.

Important Note: This paper is currently unedited, meaning the manuscript may still change during peer review. The findings I’ve discussed are preliminary.

Bonus: Tips for Reading Research Papers

Since I referenced a research paper here, let me share some practical tips for navigating scientific literature on your own:

Start with abstracts and conclusions – These give you the big picture without getting lost in methodology

Don’t read linearly – Jump to figures and tables after the abstract; they often tell the story more clearly than dense text

Use the introduction as your guide – It’s written for a broader audience and explains why the research matters

Expect confusion – Even researchers don’t understand everything on first read. Decide what you actually need to grasp versus what you can skip

Look for review papers first – Systematic reviews and meta-analyses (like this one) summarise multiple studies and explain concepts more thoroughly

Check for conflicts of interest – Note who funded the research, as this can influence study design and which results get emphasised

Happy reading!

Welcome to PCOS Basics series - a guide to Polycystic Ovary Syndrome. Whether you’ve just been diagnosed, think you might have PCOS, or simply want to understand it better, this series walks you through diagnosis, symptoms, treatment, and long-term health so you can feel informed and in control.

If you’ve been Googling your symptoms late at night - irregular periods, unexplained weight fluctuations, acne that won’t quit, excess hair growth - you’ve probably stumbled across PCOS. But here’s what’s confusing: PCOS diagnosis isn’t straightforward. There’s no single test that definitively says “yes” or “no.”

Instead, doctors use a set of diagnostic criteria, and the most widely accepted are the Rotterdam criteria. Let’s break down exactly what these are, how they work, and what you need to know about getting diagnosed.

Why Is PCOS Diagnosis Complicated?

Unlike many conditions, PCOS doesn’t have a single biomarker or definitive test. You can’t just check one hormone level or run one scan and get a clear answer.

PCOS is a syndrome - a collection of symptoms and signs that tend to occur together. This means diagnosis requires piecing together clinical evidence from:

• Your menstrual history

• Physical exam findings

• Blood work

• Ultrasound imaging

• Ruling out other conditions that can mimic PCOS

Different medical organisations have also proposed different diagnostic criteria over the years, which adds to the confusion.

The Three Main Diagnostic Criteria Sets

1. NIH Criteria (1990) – The Original

The most restrictive criteria, requiring BOTH:

• Chronic anovulation (irregular or absent ovulation)

• Clinical or biochemical signs of hyperandrogenism (excess male hormones)

2. Rotterdam Criteria (2003) – The Current Gold Standard

The most widely used criteria globally. You need 2 out of 3 of the following:

• Irregular or absent ovulation

• Clinical or biochemical signs of hyperandrogenism

• Ultrasound findings of polycystic-appearing ovaries or elevated anti-Müllerian hormone (AMH) levels (the second part was only added in 2023 - watch a useful recap here)

3. Androgen Excess Society (AE-PCOS) Criteria (2006)

A middle ground, requiring:

• Hyperandrogenism (clinical or biochemical) PLUS

• Ovarian dysfunction (irregular ovulation) OR polycystic ovaries

For the rest of this post, I’ll focus on the Rotterdam criteria since they’re the most commonly used worldwide.

Next week, we’ll review latest findings which could change how PCOS is diagnosed. Stay tuned… 👀

Breaking Down the Rotterdam Criteria

Remember: you need to meet 2 out of 3 criteria, AND other conditions must be ruled out.

Criterion #1: Oligo-ovulation or Anovulation

What it means: Irregular or absent ovulation, which typically shows up as irregular periods.

In practice:

• Oligomenorrhea: Cycles longer than 35 days or fewer than 8-9 periods per year

• Amenorrhea: No period for 3+ months (if you previously had regular cycles)

• Cycles shorter than 21 days also count

How it’s assessed:

• Your menstrual history

• Progesterone blood tests (low levels mid-luteal phase suggest you didn’t ovulate)

• Ovulation tracking (though this alone isn’t diagnostic)

Important note: If you’re on hormonal birth control, your periods are artificially regulated, so this criterion can’t be properly assessed. Many doctors will ask you to come off birth control for 3-6 months before diagnosis (if medically appropriate).

Criterion #2: Clinical or Biochemical Hyperandrogenism

What it means: Evidence of excess male hormones (androgens).

Clinical Hyperandrogenism (visible signs):

• Hirsutism: Excess hair growth in male-pattern areas (face, chest, back, abdomen). Typically assessed using the Ferriman-Gallwey score - a standardised scoring system of hair growth in 9 body areas

• Acne: Particularly severe, persistent, or adult-onset acne

• Androgenic alopecia: Male-pattern hair loss or thinning at the crown

Important context: What counts as “excess” varies by ethnicity. Hair growth patterns differ significantly across populations, so assessment should be culturally sensitive.

Biochemical Hyperandrogenism (blood tests):

Elevated levels of:

• Total testosterone

• Free testosterone (often more sensitive)

• Androstenedione

• DHEA-S

The tricky part:

• Androgen levels can be normal in some women with PCOS (hence why you only need 2/3 criteria)

• Levels fluctuate throughout your cycle

• Different labs use different reference ranges

• Birth control suppresses androgens, masking results

Criterion #3: Polycystic Ovaries on Ultrasound or AMH levels

What it means: Your ovaries show a specific appearance on ultrasound. In adults, anti-Müllerian hormone (AMH) levels can be used instead of an ultrasound to identify polycystic ovaries.

2018 criteria define polycystic ovaries as:

• 20 or more follicles (small fluid-filled sacs) in at least one ovary, OR

• Ovarian volume greater than 10 mL (in adults)

Because the Rotterdam criteria use a “2 out of 3” approach, women can have PCOS with different combinations of symptoms, creating four distinct phenotypes.

Critical misconceptions to clear up:

❌ These are NOT cysts – They’re follicles, which are normal structures. Every menstruating woman has follicles; in PCOS, you just have more of them arrested in development.

❌ You don’t need polycystic ovaries to have PCOS – Remember, it’s 2 out of 3 criteria. You can have PCOS with completely normal-looking ovaries if you meet the other two criteria.

❌ Having polycystic ovaries alone doesn’t mean you have PCOS – Up to 20-30% of women have polycystic-appearing ovaries on ultrasound but no other symptoms. This is called “polycystic ovarian morphology” and is considered a normal variant.

Technical note: Transvaginal ultrasound is more accurate than abdominal ultrasound for visualising ovarian morphology. The criteria I mentioned (20+ follicles) applies to transvaginal ultrasound. If you haven’t been sexually active, transabdominal or transrectal ultrasound may be used, though they’re less precise.

What Else Needs to Be Ruled Out?

PCOS is a diagnosis of exclusion, meaning your doctor must rule out other conditions that can look like PCOS:

• Thyroid disorders (hypothyroidism can cause irregular periods)

• Hyperprolactinemia (elevated prolactin can disrupt ovulation)

• Non-classic congenital adrenal hyperplasia (genetic disorder affecting hormone production)

• Cushing’s syndrome (excess cortisol)

• Androgen-secreting tumours (rare but serious)

• Pregnancy (obvious, but needs to be ruled out!)

Your doctor will typically order blood tests to check thyroid function (TSH, free T4), prolactin, and sometimes additional tests based on your symptoms.

What to Expect During the Diagnostic Process

Initial Visit:

Your doctor will take a detailed history:

• Menstrual pattern history

• Weight changes

• Skin and hair symptoms

• Family history of PCOS, diabetes, or infertility

• Physical exam looking for clinical hyperandrogenism

Blood Work:

Comprehensive panel typically includes:

• Reproductive hormones: LH, FSH, estradiol, testosterone (total and free), DHEA-S, androstenedione, AMH

• Metabolic markers: Fasting glucose, fasting insulin, HbA1c, lipid panel

• Thyroid function: TSH, free T4

• Prolactin

Timing matters: Ideally, reproductive hormones are checked early in your cycle (days 2-5), but if your cycles are very irregular, timing may be less critical.

Pelvic Ultrasound:

Transvaginal ultrasound to assess:

• Ovarian morphology (follicle count, ovarian volume)

• Endometrial thickness

• Rule out other pelvic pathology

Follow-up:

If initial findings are ambiguous, your doctor may:

• Repeat blood work at different cycle phases

• Ask you to track cycles for 3-6 months

• Request additional testing

Moving Forward After Diagnosis

If you meet the Rotterdam criteria for PCOS, your doctor should:

1. Assess metabolic health: Screen for insulin resistance, prediabetes, or diabetes

2. Evaluate cardiovascular risk: Check blood pressure, lipid panel

3. Discuss symptom management: Address your specific concerns (acne, hair growth, irregular periods, fertility)

4. Create a monitoring plan: Regular screening for metabolic complications

5. Discuss lifestyle interventions: Diet, exercise, stress management, sleep

The Bottom Line

PCOS diagnosis using the Rotterdam criteria requires:

• 2 out of 3 features: irregular ovulation, hyperandrogenism, or polycystic ovaries

• Exclusion of other conditions that can mimic PCOS

• Comprehensive evaluation including history, physical exam, blood work, and imaging

The diagnosis isn’t always straightforward, and it may take time to gather all the necessary information.

If you suspect you have PCOS:

• Find a doctor knowledgeable about PCOS (reproductive endocrinologist, gynecologist, or endocrinologist)

• Keep detailed menstrual cycle records

• Document your symptoms (photos can be helpful for tracking acne or hair growth)

• Ask questions about which specific criteria you meet

• Request copies of your test results

• Don’t hesitate to seek a second opinion if something doesn’t feel right

Understanding the diagnostic criteria empowers you to be an informed advocate for your own health. PCOS is complex, but with proper diagnosis and management, women with PCOS live full, healthy lives 🩵

Take the pill and come back when you want to have a baby, best if you lose weight in the meantime too.

It’s not simple. We live in a complex system - the way research is funded, how long it takes, how policy is written, who holds power, and what culture normalises.

Our environment praises lean bodies, clear skin, lush long hair, and happy smiling families. Kind of a struggle for women with PCOS who may deal with weight gain, acne, hirsutism, hair loss, or infertility - or maybe they don’t want children at all, in which case they’re given the pill and never guided toward better options.

Naturally, the world won’t change if we don’t speak about it. That’s why Cyster Health exists - consider sharing it with someone who cares about it too 🩵

Share Cyster Health

Now, let’s talk about noise. There’s the noise we need to cut through, and the noise we need to make.

First, I’ve developed a 5W framework to cut through the noise and help you evaluate health advice. While tailored for PCOS here, you can apply it to any health information you come across.

Second, I cover the recent uproar around censorship of women’s health content on the internet, and what we can do to create more noise around it.

Let’s dive in!

Cutting Through the Noise: A 5W Framework for Evaluating Information

The internet is a goldmine of information - but let’s be real, not all of it is reliable. This BBC article - Influencers Selling Fake Cures for Polycystic Ovary Syndrome - not only pushed me to start Cyster Health, but also highlighted just how much false PCOS content is floating around online, which is why critical evaluation is key to managing your health with confidence.

I’ve adapted the 5W framework - WHO, WHAT, WHERE, WHEN, WHY - that can help you cut through the noise.

1. WHO is behind the information?

Before trusting an article, social media post, or video, ask yourself:
🔍 Who is this person? – Are they a doctor, researcher, or registered dietitian? Or someone sharing their personal experience?
💰 Are they selling ? – If someone is pushing a product, they may be more interested in making money than sharing science-backed advice.

🚩 If someone is promoting ‘a single cure for PCOS’, proceed with caution!

2. WHAT is being claimed?

PCOS is a complex condition with no single cure. Be wary of:
🚨 Big promises: “Reverse your PCOS in 30 days!” sounds great, but it’s unrealistic.
🚨 One-size-fits-all advice: PCOS affects people differently (check out my previous blog about it), so what works for one person might not work for everyone.
🚨 Scare tactics: “If you don’t do this one thing, your symptoms will get worse!” -fear-based marketing is a red flag.

What to trust: Look for sources that provide balanced information, including both benefits and limitations of a treatment.

3. WHERE is this information coming from?

Make sure to check out the source of the information - you can usually trust:

• Medical institutions

• Research journals

• Reputable PCOS organisations

• Experts with credentials

🚩 Red flags:

• No citations or references

• Promotion of a product without medical backing

4. WHEN was the information published?

Although PCOS is one of the most under-researched conditions, research is constantly evolving - so make sure the information is still relevant!
📅 Check the date. If an article is more than 5 years old, cross-check it with newer sources.
🔄 Look for updates. Reliable health websites regularly update their information as new research emerges.

5. WHY is this information being shared?

Every piece of content has an agenda - some are educational, while others are designed to sell or scare. Ask yourself:
💰 Is this about profit? If a post is pushing a single diet, supplement, or program, there may be financial motivation behind it.
🎭 Is it overly dramatic? Sensationalised headlines (“PCOS sufferers MUST avoid dairy!”) are often more about engagement than truth.
🎯 Does it align with scientific research? Good health advice is backed by studies, not just opinions.

Next time you see a new TikTok trend or a miracle cure - take a moment to evaluate it using the 5W framework and always consult a healthcare professional for advice tailored to you.

Dear Meta, we will not shut up

ICYMI last week - Bellamoon (advertising their pregnancy pillow) and Hertility (hormonal at-home tests) shared how Meta’s ad policies blocked posts and ads about pregnancy, menopause, and infertility. Meanwhile, men’s erection supplements keep thriving and popping up all over Meta’s platforms.

Let that sink in. Information about women’s biological functions is being censored while male sexual health products run freely. It’s frustrating, it’s discriminatory, and it’s absolutely not normal.

Here’s what you can do:

📢 Share your experience if you’ve ever been silenced too - on your personal platforms, with journalists, and industry. Use platforms that don’t silence you.

✍️ Sign the CensHERship open letter to draw the attention of policymakers, social media platforms, investors, and industry leaders.

We can only make enough noise to change this pattern if we do it together.

Some women struggle primarily with weight and diabetes risk. Others have severe hormonal imbalances but relatively normal metabolism. Some respond beautifully to fertility treatments, while others face repeated challenges.

A recent article published in Nature Medicine has caught my attention as it discusses the subtypes of PCOS - bringing very much needed nuance to discussions around this complex condition. Let’s break it down 👇

A groundbreaking longitudinal study analysed nearly 12,000 women with PCOS in China, validated across five continents.

Here’s what makes this study special: researchers used unsupervised hierarchical clustering - which means they let an algorithm look for patterns in the data instead of imposing predetermined categories themselves.1

Using nine measurements (BMI, hormone levels, blood sugar), they identified four natural groupings:

1. Hyperandrogenic PCOS (HA-PCOS) — 25%

The hallmark: Very high testosterone

• Highest risk of second-trimester pregnancy loss

• Most likely to develop abnormal cholesterol

• Increased risk of severe fatty liver disease

2. PCOS with Obesity (OB-PCOS) — 26%

The hallmark: Higher BMI with insulin resistance

• Most severe metabolic complications (diabetes, hypertension)

• Lowest IVF success rates (48.9% live births)

• Highest risk of gestational diabetes

• 86% develop fatty liver disease

This group also had the highest remission rate - about 50% no longer met PCOS criteria after 6.5 years.

3. High-SHBG PCOS (SHBG-PCOS) — 26%

The hallmark: High sex hormone-binding globulin, lowest BMI

• Lowest pregnancy loss rates (24.7%)

• Best IVF success (56.3% live births)

• Lowest rates of diabetes and hypertension

4. High-LH-AMH PCOS (LH-PCOS) — 23%

The hallmark: Elevated luteinising hormone and anti-Müllerian hormone

• Greatest risk of ovarian hyperstimulation during IVF

• Lowest remission rate (75% still had PCOS after 6.5 years)

• Most persistent form

Why This Matters

In the age of personalised everything, it seems like breaking down a complex hormonal, metabolic, and psychological condition is the right step to know specific risks and tailor treatments, instead of a blanket approach.

Past PCOS studies may have failed because they mixed all subtypes together. Now researchers can design trials targeting specific subtypes - potentially leading to breakthrough treatments.

You can even input your data into the tool created by the researchers to see which one you’d categorise as.

But Is This Just One Study?

Another study from 2024 which ran in parallel to the one described above, used the same method in a Dutch population to find PCOS subgroups, and they found shockingly similar results.

Both studies together provide strong evidence that PCOS subtypes are reproducible across populations, diagnostic criteria, and geographic regions, representing genuine biological heterogeneity rather than statistical artefacts.

I think we might be getting somewhere?!

The Bottom Line

Breaking down PCOS represents a fundamental shift from one-size-fits-all PCOS care to precision medicine. This will take multiple years to validate and implement, but this could lead to:

✨ Subtype-specific medications

✨ Better genetic studies of each form

✨ Refined screening protocols

✨ Personalised lifestyle interventions

For too long, women with PCOS have heard “lose weight and maybe it’ll help” or “let’s try this and see.” - let the data speak to inform the way forward.

What are your thoughts on PCOS subtypes? Have you noticed patterns in what works (or doesn’t work) for you? Drop a comment below!

Leave a comment

Locking in for Winter Arc

The winter arc2 might be so 2024, but I love the idea of reframing 4pm sunsets into something useful.

For PCOS specifically, consistency is your best friend - think maintaining a good sleeping schedule, prepping healthy meals, taking your supplements, staying physically active, or starting a fun hobby. It’s also a realistic timeframe to try something new and actually see if it’s working for you, whether that’s a new workout routine or a habit you want to build.

Here’s my winter arc. It’s aligned with my wider goals - feel free to steal something if it resonates:

• Pull-up training – I’ve never done one in my life, and I think it’s time to change that.

• Nailing down French tenses – After months of consistent online classes, I’m still struggling to express myself… any tips appreciated!

• Trying one new recipe a week – Time to dust off those cookbooks and bring in some variety into my meal prep.

• Simplifying my skincare routine – After struggling with hormonal acne and skin sensitivity, it’s time to rebuild my skin barrier.

• Committing to Cyster Health – Spending my evenings reading PCOS research, looking through trends, and reaching out to experts - and most importantly, raising awareness of this complex condition.

Please give this post a ❤️ if you found it valuable!

Share Cyster Health

With my analytical hat firmly on, I break down PCOS research, pick apart women’s health trends, consult experts, and translate complex hormone science into practical, digestible insights - so you don’t have to.

I’m just a girl (with PCOS)

I was diagnosed with Polycystic Ovary Syndrome (PCOS) almost ten years ago. I quickly realised PCOS is one of the most under-researched women’s health conditions - despite affecting at least 10% worldwide.

With limited guidance from doctors, I became a study of n=1 - experimenting, learning, and testing what really works. 10 years later, there’s still so much we don’t know about hormones, metabolism, and women’s health.

That’s exactly why I started Cyster Health: to explore, learn, and create the kind of open, evidence-based space I wish I had years ago.

What to Expect

Every Wednesday, you’ll get 3-5 quick insights in your inbox - from PCOS management and hormone balance to nutrition, menstrual cycles, and the broader science of women’s health.

My goal? That each issue gives you at least one idea or data-backed takeaway to help you make smarter health decisions.

By subscribing and sharing, you’re joining a growing community that’s informed, empowered, and just a bit more in sync

Stay curious,
Ieva from Cyster Health