Unlocking Polycystic Ovary Syndrome: Insights into Pathogenesis, Diagnosis, and Personalized Management

Abstract

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age worldwide. It is characterized by a triad of hormonal imbalances, ovulatory dysfunction, and distinctive polycystic ovarian morphology. The clinical presentation of PCOS is highly heterogeneous, encompassing reproductive issues such as menstrual irregularities and infertility, metabolic disturbances including insulin resistance, obesity, and dyslipidemia, as well as psychological challenges like anxiety and depression. This multifaceted syndrome not only impacts reproductive health but also increases the risk of long-term complications such as type 2 diabetes mellitus and cardiovascular disease. The pathophysiology of PCOS involves complex interactions between genetic predisposition, hormonal dysregulation, and environmental factors. Key features include hyperandrogenism driven by increased ovarian androgen synthesis and insulin resistance, which exacerbates endocrine abnormalities. Inflammation and oxidative stress have also emerged as important contributors to disease progression. Diagnostic criteria, predominantly based on the Rotterdam consensus, require the presence of two out of three key features: oligo/anovulation, hyperandrogenism, and polycystic ovaries on ultrasound. Management of PCOS remains challenging due to its heterogeneous nature and requires an individualized approach. Lifestyle modification focusing on weight management and metabolic improvement is the cornerstone of therapy. Pharmacological options include oral contraceptives, insulin sensitizers, and ovulation induction agents tailored to symptomatology and fertility goals. Recent advances in genetic and molecular research are paving the way for personalized treatment strategies and novel therapeutics targeting underlying mechanisms. This review synthesizes current evidence on PCOS pathogenesis, clinical features, diagnosis, and treatment, highlighting emerging frontiers that promise improved patient outcomes.