Comprehensive overview of polycystic ovary syndrome: Pathophysiology, clinical features, and emerging therapeutic approaches

Abstract

Polycystic Ovary Syndrome (PCOS) is the leading cause of anovulatory infertility, affecting 90–95 % of women seeking fertility treatment. It is characterized by hormonal imbalances, such as elevated luteinizing hormone, androgens, and insulin, along with reduced follicle-stimulating hormone (FSH). These imbalances result in clinical features like oligomenorrhea, amenorrhea, and polycystic ovaries, and often lead to complications such as infertility, metabolic disorders, and increased cardiovascular risk. Epidemiological studies show significant regional and age-related variations in the prevalence of PCOS, highlighting the need for further research into its causes and future impact. The pathophysiology of PCOS is complex, involving genetic, endocrine, environmental, and lifestyle factors. Genetic contributors include mutations in the AR, FTO, and FSHR genes, while hyperandrogenism and insulin resistance are key endocrine disruptions. Environmental and lifestyle factors, such as diet, obesity, and exposure to endocrine-disrupting chemicals, also worsen symptoms. Clinically, PCOS presents with a range of symptoms, including menstrual irregularities, hirsutism, infertility, obesity, and associated metabolic and cardiovascular risks. The condition also significantly affects mental health and quality of life. Emerging therapies, including personalized medicine and complementary approaches, offer promise for more effective, individualized treatments. This review provides an overview of PCOS, its pathophysiology, clinical manifestations, diagnostic criteria, and management options, with the aim of informing clinical practice and guiding future research.