PCOS in 2025 - Insights and Innovations.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, with broad implications for reproductive, metabolic, cardiovascular, and psychological health. Anti-Müllerian hormone (AMH) has emerged as a unique biomarker reflecting both ovarian reserve and possibly playing a significant role as a neuroactive hormone in the pathogenesis of PCOS. Beyond reproductive concerns, PCOS confers an elevated lifetime risk of obesity, metabolic syndrome and type 2 diabetes. With increasing evidence for risk of myocardial infarction and stroke even in the reproductive years, PCOS is now considered a cardiovascular disease risk enhancing factor. Novel insights into the alterations observed in the gut microbiome in PCOS suggest possible contributions to metabolic dysfunction and inflammation, opening avenues for innovative therapeutic strategies. Expanding on the gut-PCOS connection, the high prevalence of mental health disorders such as depression and anxiety observed in PCOS may be linked to gut dysbiosis. Although recent studies indicate differences in neuroimaging and cognitive function in women with PCOS compared to controls, rigorous evaluation accounting for other factors influencing cognition and longitudinal changes are needed. Given the increased prevalence of multisystem comorbidities, early diagnosis, especially in adolescence will allow appropriate counselling and implementation of early prevention and frequent cardiometabolic screening. Together, these developments will ultimately allow for development of novel therapies and result in comprehensive, patient-centered, and evidence-based care. Advances in understanding the pathogenesis of PCOS and its associated comorbidities and recognizing PCOS as a CVD risk enhancing condition hold promise for improving long-term outcomes and quality of life for women living with PCOS.