Four Kinds of PCOS (and Why That Actually Feels Hopeful)

I’ve had PCOS for as long as I can remember. My periods have never been regular — sometimes showing up after 60 days, sometimes not at all — and acne was a constant companion through my teens and twenties. But unlike many women with PCOS, I don’t have insulin resistance and was never prescribed metformin. My version never quite fit the “textbook” description.

This week, researchers from Karolinska Institutet published a major study in Nature Medicine that might finally explain why. After analyzing data from nearly 12,000 women across multiple countries, they identified four distinct PCOS subgroups, each with its own hormonal and metabolic profile.

There’s HA-PCOS, marked by high androgen levels (think acne and abnormal blood lipids); OB-PCOS, linked to higher BMI and insulin resistance; SHBG-PCOS, a milder form with fewer fertility problems; and LH-PCOS, characterized by elevated luteinizing hormone and AMH, often causing complications during IVF.

It’s the first time researchers have clearly shown that PCOS isn’t just one condition; it’s a spectrum. That might sound like a small distinction, but for the millions of us living with it, it’s huge. It means treatment can finally move from trial-and-error to something more personalized, based on how our bodies actually work.

For me, it’s validating to know my version of PCOS, the one that explains my acne but not the insulin resistance, has a name. It doesn’t change everything overnight, but it feels like the beginning of better answers. 

Ask Clara: How is PCOS diagnosed?