Beyond weight loss: toward phenotype-guided, regionally calibrated interventions in polycystic ovary syndrome (PCOS)

Abstract Polycystic ovary syndrome (PCOS) management mainly revolves around general lifestyle modifications that almost always include weight loss, an approach that fails to reflect the biological and ethnic diversity of the condition. Clinical and epidemiological evidences are suggestive of PCOS-associated metabolic and reproductive risk varying markedly across phenotypes and populations. These include obese, hyperandrogenic presentations to metabolically vulnerable women with lean-PCOS. Thus, universal lifestyle advice frequently delivers inconsistent or limited benefit. In this article, we propose a phenotype-guided and regionally informed approach to lifestyle intervention that incorporates hormonal, metabolic, and contextual factors, and this may allow PCOS care to move toward more precise and clinically meaningful intervention.