Why One-Size-Fits-All PCOS Treatment Fails

and locking in for winter arc

If you’ve tried enough treatments for Polycystic Ovary Syndrome (PCOS), you’ve probably noticed something frustrating: what works for one woman doesn’t always work for you.

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 👇

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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!

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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!

1. think of it like sorting a mixed bag of fruit by letting someone group “similar items” rather than telling them to separate apples from bananas.

2. a focused self-improvement challenge that runs over the colder months. The idea is to use the final quarter of the year to level up physically, mentally, and in other areas of life before the new year begins.