Elisabet Stener-Victorin, PhD, highlights 4 unique PCOS subtypes for personalized care

In a recent interview with Contemporary OB/GYN, Elisabet Stener-Victorin, PhD, professor at Karolinska Institutet, discussed new findings on polycystic ovary syndrome (PCOS) subtypes and how they can guide more personalized patient care.^1,2

She explained that the largest study to date has identified 4 distinct PCOS subclusters, each defined by unique hormonal and metabolic profiles that influence clinical risks and treatment needs. The first subtype is the hyperandrogenic phenotype, characterized by elevated androgen levels.

Patients in this group face the highest risk of miscarriage, abnormal lipid profiles, and type 2 diabetes. Because excess androgens drive many of their symptoms, these patients often benefit from treatments specifically aimed at lowering androgen levels, which can help improve ovulation regularity.

The second subtype, the obesity phenotype, is defined by increased body mass index and marked insulin resistance. These individuals also have the greatest risk of developing type 2 diabetes, along with reduced fertility and lower live-birth rates. For this group, addressing obesity and metabolic dysfunction is the primary therapeutic goal, even when high androgens are also present.

A third group is the high–sex hormone binding globulin phenotype, which tends to have the fewest metabolic and reproductive complications. These patients generally experience milder symptoms overall.

Finally, the high luteinizing hormone phenotype, which also features high antimüllerian hormone, is characterized by an accumulation of small ovarian follicles. These patients respond strongly to hormonal stimulation in procedures such as ovulation induction or in vitro fertilization, but they are also more prone to overstimulation.

Stener-Victorin emphasized that recognizing these subtypes can help clinicians tailor treatment by identifying which underlying feature—such as hyperandrogenism, obesity, or hormonal dysregulation—should be prioritized. A web-based tool created as part of the study enables clinicians to enter routine clinical measurements and receive a phenotype classification, although she noted that collecting all relevant metrics may be limited in some settings because pf cost.

Beyond phenotype-specific treatment, she highlighted the broader importance of accurate diagnosis, noting that many women with PCOS remain undiagnosed and therefore miss opportunities for targeted care. Comprehensive management should address the full spectrum of symptoms and concerns, including metabolic complications, reproductive issues, and mental health. She also stressed the need to address bothersome symptoms such as excess hair growth, which often requires additional interventions beyond oral contraceptives.

Overall, applying subtype-based insights alongside holistic, guideline-based care can help clinicians better understand each patient’s symptoms and deliver more effective, individualized treatment for PCOS.

No relevant disclosures.

References

1. Four subgroups of PCOS open up for individualized treatment. Karolinska Institutet. October 29, 2025. Accessed November 3, 2025. https://www.eurekalert.org/news-releases/1103614.
2. Gao X, Zhao S, Du Y, et al. Data-driven subtypes of polycystic ovary syndrome and their association with clinical outcomes. Nat Med. 2025. doi.org:10.1038/s41591-025-03984-1