The Different Types of PCOS/PMOS: Why Your Symptoms May Not Look Like Someone Else’s

Polycystic ovary syndrome, or PCOS/PMOS, is often talked about as one condition. But anyone who works with women’s hormones knows that PCOS/PMOS rarely looks the same from person to person.

One woman may have irregular cycles, acne, and high androgens. Another may have insulin resistance and weight gain. Someone else may have elevated AMH, polycystic-appearing ovaries, and difficulty ovulating, but very little metabolic dysfunction.

This is one of the reasons PCOS/PMOS can feel confusing, frustrating, and under-personalized. The diagnosis is real, but the presentation is highly individual.

Newer research is helping us understand PCOS/PMOS less as a single “type” of hormone imbalance and more as a spectrum with distinct patterns. A large 2025 study published in Nature Medicine identified four reproducible PCOS/PMOS subtypes using clinical and hormone data from more than 11,000 women, with validation across multiple international cohorts.¹ This does not replace a clinical diagnosis, but it does give patients and practitioners a more nuanced way to think about symptoms, risks, and care.

First, What Is PCOS/PMOS?

PCOS/PMOS is a common endocrine and metabolic condition that can affect menstrual cycles, ovulation, androgen levels, fertility, skin, hair growth, insulin sensitivity, and long-term cardiometabolic health.²

Most clinicians diagnose PCOS/PMOS using the Rotterdam criteria, which require at least two of the following after other causes are excluded:

• Irregular ovulation or irregular menstrual cycles
• Clinical or biochemical signs of hyperandrogenism, such as acne, hirsutism, or elevated testosterone
• Polycystic ovarian morphology on ultrasound or, in some cases, elevated anti-Müllerian hormone, also known as AMH²,³

But these criteria do not tell the whole story. Two people can both meet diagnostic criteria for PCOS/PMOS and have completely different root drivers, symptoms, fertility patterns, and metabolic risks.

This is also one reason some experts and organizations have begun using the term PMOS (Polyfollicular Metabolic Ovarian Syndrome) alongside or instead of PCOS. The traditional name, polycystic ovary syndrome, can be misleading because the ovaries do not actually contain cysts, and not everyone with the condition has polycystic-appearing ovaries. The newer terminology aims to better reflect the metabolic, hormonal, and reproductive features of the condition rather than focusing on a single ovarian finding. Regardless of the name used, the underlying message remains the same: PCOS/PMOS is a highly diverse condition that can present differently from person to person.

That is where subtyping may be helpful.

Why PCOS/PMOS Subtypes Matter

Understanding PCOS/PMOS subtypes can help shift the conversation from “Do you have PCOS/PMOS?” to “What pattern of PCOS/PMOS are we seeing, and what does your body need most?”

This distinction matters because PCOS/PMOS can involve different combinations of:

• Androgen excess
• Insulin resistance
• Ovulatory dysfunction
• Higher AMH or ovarian follicle activity
• Changes in body composition
• Inflammation and cardiometabolic risk
• Fertility and pregnancy-related risks

Earlier research identified reproductive and metabolic subtypes of PCOS/PMOS, suggesting that PCOS/PMOS patterns may reflect different underlying biology rather than one uniform condition.⁴ The newer 2025 study expanded this work and identified four data-driven subtypes: hyperandrogenic PCOS/PMOS, obesity-associated PCOS/PMOS, high-SHBG PCOS/PMOS, and high-LH/AMH PCOS/PMOS.¹

These categories are not meant to put anyone in a box. Instead, they can help guide more personalized screening, lifestyle support, fertility planning, and long-term prevention.

Type 1: Hyperandrogenic PCOS/PMOS

Hyperandrogenic PCOS/PMOS is characterized by higher androgen levels, especially testosterone and DHEA-S.¹ Androgens are sometimes called “male-type” hormones, but all women naturally produce them. The issue in PCOS/PMOS is not the presence of androgens, but excess androgen activity or sensitivity.

This subtype may be associated with:

• Acne
• Excess facial or body hair growth
• Scalp hair thinning
• Irregular cycles
• Higher testosterone or DHEA-S
• Possible lipid changes
• Increased risk of metabolic dysfunction over time¹

In the 2025 study, the hyperandrogenic subtype had the highest incidence of dyslipidemia during follow-up and was also associated with a higher risk of second trimester pregnancy loss in IVF data.¹ This does not mean that every woman with high-androgen PCOS/PMOS will experience these outcomes, but it does suggest that androgen-dominant PCOS/PMOS deserves careful cardiometabolic and reproductive monitoring.

For this subtype, care often focuses on reducing androgen burden, supporting ovulation, improving insulin sensitivity when relevant, and monitoring cholesterol, blood pressure, and glucose markers.

Helpful clinical areas to assess may include:

• Total and free testosterone
• DHEA-S
• SHBG
• Fasting insulin and glucose
• Hemoglobin A1c
• Lipid panel
• Cycle regularity and ovulation patterns

Type 2: Metabolic PCOS/PMOS

The obesity-associated PCOS/PMOS subtype is characterized by higher BMI, fasting glucose, and fasting insulin.¹ This pattern tends to overlap strongly with insulin resistance, although insulin resistance can occur in PCOS/PMOS at any body size.

This subtype may be associated with:

• Weight gain or difficulty losing weight
• Insulin resistance
• Higher fasting insulin
• Higher fasting glucose
• Increased risk of type 2 diabetes
• Higher blood pressure
• Higher triglycerides or cholesterol changes
• Fatigue or blood sugar instability¹,⁵

In the 2025 study, this subtype had the most severe metabolic complications, including the highest prevalence of type 2 diabetes, dyslipidemia, and hypertension at baseline. During follow-up, it also had the highest incidence of type 2 diabetes.¹

This is one reason it is so important not to treat PCOS/PMOS as only a fertility or menstrual cycle issue. PCOS/PMOS is also a long-term metabolic health condition for many women. Large reviews have found that PCOS/PMOS is associated with increased cardiometabolic risk, including higher risk of impaired glucose regulation and type 2 diabetes.⁵

Support for this subtype often focuses on insulin sensitivity, metabolic flexibility, strength training, adequate protein, fiber intake, sleep, stress physiology, and medications when appropriate. In some cases, metformin or other metabolic therapies may be considered as part of a personalized plan.²

It is also important to avoid framing this subtype as a willpower issue. Weight and insulin resistance are not simply behavioral problems. They are influenced by hormones, genetics, muscle metabolism, inflammation, sleep, stress, medications, and environment.

Type 3: High-SHBG PCOS/PMOS

SHBG stands for sex hormone-binding globulin. It is a protein made by the liver that binds hormones like testosterone and estrogen in the bloodstream. When SHBG is higher, there is generally less free, biologically active testosterone available.

In the 2025 study, the high-SHBG subtype had the highest SHBG levels and the lowest BMI among the four groups. It was also associated with lower testosterone and LH levels, more favorable reproductive outcomes, and the lowest incidence of diabetes and hypertension during follow-up.¹

This subtype may be associated with:

• Irregular cycles
• Ovulatory dysfunction
• Polycystic ovarian morphology or elevated ovarian follicle markers
• Less obvious androgen excess
• Lower metabolic risk compared with other subtypes¹

This pattern may be confusing for patients because they may not “look like” the stereotypical PCOS/PMOS presentation. They may not have significant acne, facial hair growth, weight gain, or insulin resistance, yet they may still struggle with irregular cycles or ovulation.

This is a good reminder that PCOS/PMOS is not always visible from the outside. A person does not need to have every classic symptom to deserve proper evaluation and care.

For this subtype, the focus may be more reproductive and ovulatory than metabolic, though metabolic screening is still recommended for all people with PCOS/PMOS.²

Type 4: High-LH/AMH PCOS/PMOS

The high-LH/AMH subtype is characterized by elevated luteinizing hormone, or LH, and elevated anti-Müllerian hormone, or AMH.¹

LH is a brain-derived reproductive hormone involved in ovulation. AMH is produced by ovarian follicles and is often elevated in PCOS/PMOS because there may be a higher number of small developing follicles.

This subtype may be associated with:

• Irregular or absent ovulation
• Longer or unpredictable cycles
• Elevated AMH
• Elevated LH
• Polycystic ovarian morphology
• Higher risk of ovarian hyperstimulation during IVF¹

In the 2025 study, this group had the lowest PCOS/PMOS remission rate during follow-up and the greatest risk of ovarian hyperstimulation syndrome during IVF treatment.¹ This may be especially relevant for women pursuing fertility treatment, since elevated AMH and high follicle activity can affect ovarian stimulation response.

This subtype often reflects a more reproductive or ovarian-driven PCOS/PMOS pattern. Management may focus on supporting ovulation, carefully monitoring fertility treatment if needed, and avoiding overly aggressive ovarian stimulation.

What About “Lean PCOS/PMOS”?

Many people use the term “lean PCOS/PMOS” to describe PCOS/PMOS in individuals with a lower body weight or BMI. While this can be a useful descriptive term, it is not a complete subtype on its own.

Body size alone does not determine the underlying hormonal or metabolic pattern. A person with lean PCOS/PMOS may still experience insulin resistance, androgen excess, ovulatory dysfunction, or other features commonly associated with the condition.

Someone with lean PCOS may fall into a high-SHBG pattern, a high-LH/AMH pattern, or a hyperandrogenic pattern. They may also still have insulin resistance, even if their BMI is considered normal.

This is why lab testing and symptom patterns matter more than appearance alone.

What This Means for Personalized PCOS/PMOS Care

The most important takeaway is that PCOS/PMOS care should not be one-size-fits-all.

A person with high-androgen PCOS/PMOS may need more support with androgen symptoms, lipid monitoring, and ovulation. A person with metabolic PCOS/PMOS may need more intensive insulin and cardiometabolic support. A person with high-LH/AMH PCOS/PMOS may need fertility planning. A person with high-SHBG PCOS/PMOS may need ovulatory support even if they do not have obvious metabolic symptoms.

A more personalized PCOS/PMOS workup may include:

• Menstrual cycle history
• Ovulation tracking when relevant
• Total and free testosterone
• DHEA-S
• SHBG
• LH and FSH
• AMH
• Fasting glucose
• Fasting insulin
• Hemoglobin A1c
• Lipid panel
• Blood pressure
• Thyroid and prolactin testing when clinically appropriate
• Screening for sleep, stress, mood, and disordered eating risk²

The 2023 International Evidence-Based Guideline for PCOS/PMOS also emphasizes lifelong health, including metabolic screening, emotional wellbeing, fertility support, and individualized lifestyle care.²

Lifestyle Still Matters, But It Should Be Matched to the Person

Lifestyle support is foundational in PCOS/PMOS, but the goal is not to give every woman the same diet or exercise plan.

For many women, the most helpful approach includes:

• Building balanced meals with protein, fiber, and healthy fats
• Supporting muscle through resistance training
• Improving sleep consistency
• Reducing long gaps without nourishment if blood sugar symptoms are present
• Managing stress physiology
• Supporting gut health and regular bowel movements
• Reducing ultra-processed foods without creating unnecessary restriction
• Addressing nutrient deficiencies when present

There is no single “PCOS/PMOS diet” that works for everyone. The best plan is the one that supports insulin sensitivity, hormone balance, nervous system regulation, and long-term consistency without shame or over-restriction.

A Few Important Misconceptions

PCOS/PMOS is not always caused by weight.

Weight can worsen insulin resistance and hormone symptoms for some people, but PCOS/PMOS is not simply a weight-related condition. Lean women can have PCOS/PMOS, and women in larger bodies deserve care that goes beyond weight-loss advice.

Regular periods do not always rule out PCOS/PMOS.

Some women with PCOS/PMOS have cycles that appear somewhat regular but still have androgen excess, polycystic ovarian morphology, or inconsistent ovulation.

High AMH does not always mean better fertility.

AMH can reflect a higher number of ovarian follicles, but in PCOS/PMOS it may also reflect disrupted follicle development and irregular ovulation.

PCOS/PMOS care should not stop after pregnancy.

PCOS/PMOS can affect long-term metabolic and cardiovascular health. Ongoing screening for glucose, lipids, blood pressure, and liver-related risk may be important, especially in more metabolic subtypes.²,⁵

Final Thoughts

PCOS/PMOS is not one single pattern. It is a complex endocrine and metabolic condition with different presentations, different drivers, and different long-term considerations.

Understanding PCOS/PMOS subtypes can help women feel less confused by their symptoms and more empowered in their care. It can also help clinicians move beyond generic advice and toward more personalized strategies.

Whether your PCOS/PMOS pattern is more androgen-driven, metabolic, ovulatory, or ovarian-driven, the goal is the same: to understand your body clearly, support your hormones compassionately, and create a plan that protects your long-term health.

Personalized PCOS/PMOS care is not about labeling you. It is about listening more closely to what your body is already telling us.

References

1. Gao X, Zhao S, Du Y, et al. Data-driven subtypes of polycystic ovary syndrome and their association with clinical outcomes. Nature Medicine. 2025;31(12):4214-4224. https://doi.org/10.1038/s41591-025-03984-1
2. Teede HJ, Tay CT, Laven J, et al. Recommendations from the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Human Reproduction. 2023;38(9):1655-1679. https://doi.org/10.1093/humrep/dead156
3. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Human Reproduction. 2004;19(1):41-47. https://doi.org/10.1093/humrep/deh098
4. Dapas M, Lin FTJ, Nadkarni GN, et al. Distinct subtypes of polycystic ovary syndrome with novel genetic associations: An unsupervised, phenotypic clustering analysis. PLOS Medicine. 2020;17(6):e1003132. https://doi.org/10.1371/journal.pmed.1003132
5. Wekker V, van Dammen L, Koning A, et al. Long-term cardiometabolic disease risk in women with PCOS: A systematic review and meta-analysis. Human Reproduction Update. 2020;26(6):942-960. https://doi.org/10.1093/humupd/dmaa029

Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. New England Journal of Medicine. 2014;371(2):119-129. https://doi.org/10.1056/NEJMoa1313517