PCOS types: new research

A review of 11,908 women with PCOS

Hello everyone,

Today I bring you the summary of a new research study published at the end of October 2025. New findings reveal types of PCOS beyond the standard ones we hear about.

What does this research mean for me?

I wanted to bring this up at the beginning of the article as I think this is where research has to become relevant to the everyday person navigating this condition.

What I love about this research is that it brings a bit more nuance and blood testing to help us understand more deeply what drives our condition. This can help us create more targeted interventions and work on specific hormones. With this in mind, this study suggests that LH, SHGB, fasting insulin/fasting glucose, and DHTS can surface new insights about this condition. They might be good additions to your next blood test panel.

If you are going for IVF, making sure you bring this research with you is super important, as testing for some of the parameters can help you understand your odds and approach this journey from a data-driven place.

Whilst this research has some positives, it also adds complexity to the condition. I hope this complexity is taken into consideration by doctors and future research.

Let’s see what it uncovered.

We are currently at 1,400 subscribers. I would love to reach 1,500 by the end of the year, so if you know anyone with PCOS, sharing the newsletter will be a great help.

What is showed

For this, they used data from 11,908 women with PCOS across multiple geographical areas, including Europe, China, the USA, Brazil and Singapore. They discovered 4 distinctive groups of women with PCOS:

1. HA-PCOS (25%) - The hyperandrogenic subtype was characterised by high testosterone–dehydroepiandrosterone sulfate (DHEA-S), along with mild metabolic disorders

2. OB-PCOS, 26% - The subtype with obesity was characterised by higher body mass index (BMI), fasting glucose and fasting insulin level, with the highest prevalence of T2DM (7.9%), high cholesterol levels (75.3%) and hypertension (28.7%)

3. SHBG-PCOS, 26% - The high-sex hormone-binding globulin subtype had the highest sex hormone-binding globulin (SHBG) level and lowest BMI among four subtypes, primarily manifested as lower luteinizing hormone (LH) and testosterone levels.

4. LH-PCOS (23%) - The high-LH–AMH subtype was distinguished by elevated levels of LH, follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH).

Past articles that will help you understand this better:

Testosterone and other Androgens #58

SHBG - a PCOS protein #87

6-year follow-up results

Out of the 11,908 women with PCOS, 5,065 were followed up around 6.5 years later, either via phone or physical consultation, to check how their PCOS was evolving. Here is what they found:

1. Women who still displayed the same level of PCOS

HA-PCOS: 67.2%

OB-PCOS: 50.9%

SHBG-PCOS: 52.8%

LH-PCOS: 74.8%

• LH-PCOS showed the lowest remission.

• OB-PCOS + SHBG-PCOS showed the highest remission.

This is super interesting as LH-driven PCOS is probably the hardest to influence through the conventional treatments and is most likely the one driven mostly by genetic changes.

2. Those in the SHBG-PCOS group had the best ovulation recovery and the fewest polycystic ovaries.

I guess this is the most gentle PCOS type, as lower BMI and lower testosterone levels characterise it due to the high SHBG levels.

3. OB-PCOS, unfortunately, displayed the highest level of complication

We know that extra weight, specifically the one around the waist, increases the risk of disease, as this was also confirmed by this study, where women in this group displayed higher levels of type 2 diabetes, hypertension, high cholesterol and MASLD (Metabolically Associated Steatotic Liver Disease- fatty liver).

The good news is that this the type of PCOS that can go into remission the most as it’s the one that is most responsive to lifestyle changes and treatments.

IVF-outcomes specific outcomes

5,418 women with PCOS received IVF treatment in this study. That’s a significant number.

Here are some findings:

1. HA-PCOS - High pregnancy rates but significant pregnancy loss, hypertension risks, PROM risks, and benefits strongly from frozen embryo transfer over fresh.

2. OB-PCOS - Consistently the poorest reproductive outcomes: lowest pregnancy + live birth rates, highest pregnancy loss, highest T2DM/GDM risk, highest LGA babies, and should avoid HRT preparation.

3. SHBG-PCOS - The strongest IVF performers overall: highest live birth, lowest pregnancy loss, best neonatal outcomes, and metabolically safest profile.

4. LH-PCOS High pregnancy success but the highest Ovarian Hyperstimulation Syndrome risk and poorer outcomes with HRT preparation; benefits from standard stimulation but requires careful OHSS prevention.

A significant limitation with PCOS studies is that the recruitment of patients happens within fertility assistance institutions. It’s the easiest way to get clean data in substantial amounts. For this reason, I think a lot of the types represented are pretty severe. From my experience working with women with PCOS and speaking to 1000s, there are also milder PCOS types that don’t display as many of the risks and symptoms. Nonetheless, it’s essential to catch all types and personalise their care.

In the meantime, if you want to work on your PCOS and dig a bit deeper into your condition, you can email me at francesca.abalasei@gmail.com, and I can help guide your next steps.

Have a good Sunday,

Francesca

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1. Gao, X., Zhao, S., Du, Y., Yang, Z., Tian, Y. et al. (2025) ‘Data-driven subtypes of polycystic ovary syndrome and their association with clinical outcomes’, Nature Medicine, published online 29 October. DOI: 10.1038/s41591-025-03984-1.