Polycystic Ovary Syndrome (PCOS): a Comprehensive Review

Abstract

Executive Summary: PCOS is a common, complex endocrine disorder affecting women of reproductive age. Its prevalence is around 8–13% worldwide (up to 20% with broad criteria)[1][2]. PCOS is defined by a combination of ovulatory dysfunction, hyperandrogenism, and/or polycystic ovarian morphology[3][4]. Patients often present with irregular menses, hirsutism, acne, and obesity. PCOS has multi-system effects – it carries significant metabolic risk (insulin resistance, type 2 diabetes, dyslipidemia, cardiovascular disease) and reproductive consequences (infertility, pregnancy complications)[5][6]. Effective management requires a stepwise approach: exclude other causes, apply appropriate diagnostic criteria (Rotterdam, NIH, etc.), and address lifestyle, metabolic, and fertility goals. First-line treatment emphasizes lifestyle modification (diet, exercise) plus tailored pharmacotherapy: e.g. combined oral contraceptives (for cycle regulation/hirsutism) and metformin (for insulin resistance)[7][8]. For fertility issues, letrozole is now the preferred ovulation induction agent[9]. Clinicians must also screen for psychiatric comorbidity; women with PCOS have ~1.2–1.5× higher risk of depression, anxiety, and bipolar disorders[10]. This review covers epidemiology, pathophysiology, clinical features, diagnostic algorithms, management strategies, outcomes and pitfalls, with detailed references. Aim: To review the epidemiology, pathophysiology, clinical features, diagnostic challenges, and management strategies of PCOS. Methods: A narrative review of peer-reviewed articles, clinical guidelines, and global health reports published between 2010 and 2025 was conducted using databases such as PubMed and Google Scholar. Results: PCOS affects approximately 6–20% of women depending on diagnostic criteria. Key features include menstrual irregularities, infertility, insulin resistance, obesity, and increased risk of type 2 diabetes and cardiovascular disease. Diagnostic variability and lack of awareness contribute to delayed diagnosis. Management requires a multidisciplinary approach including lifestyle modification, pharmacotherapy, and long-term monitoring.