A Comprehensive Review of Polycystic Ovary Syndrome (PCOS): Pathophysiology, Diagnosis and Management
DOI:
https://doi.org/10.22270/ajprd.v14i2.1716Abstract
Polycystic Ovary Syndrome (PCOS) is one of the most prevalent endocrine and metabolic disorders affecting women of reproductive age worldwide. It is characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Beyond reproductive abnormalities, PCOS is strongly associated with insulin resistance, obesity, dyslipidemia, and chronic low-grade inflammation, predisposing affected individuals to type 2 diabetes mellitus, cardiovascular disease, and endometrial hyperplasia. The pathophysiology of PCOS is multifactorial, involving genetic predisposition, neuroendocrine dysregulation, metabolic disturbances, and environmental influences. Diagnosis is primarily based on the Rotterdam consensus criteria. Management strategies include lifestyle modification, pharmacological therapy tailored to symptom profile, and fertility-directed interventions where required. This review comprehensively summarizes the epidemiology, mechanisms, clinical manifestations, diagnostic criteria, therapeutic approaches, and emerging trends in PCOS management.
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Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Hum Reprod Update. 2023;38(9):1655–1679.
Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ, Boyle J. Polycystic ovary syndrome. Lancet Diabetes Endocrinol. 2022;10(9):668–680.
Dong J, Rees DA. Polycystic ovary syndrome: Pathophysiology and therapeutic opportunities. BMJ Med. 2023;2(1):e000548.
Lau GM, Ross RJ, Brittenden J. A systematic review of lived experiences of people with polycystic ovary syndrome. Front Endocrinol (Lausanne). 2022;13:1064937.
Millán-de-Meer M, Luque-Ramírez M, Nattero-Chávez L, Escobar-Morreale HF. PCOS during the menopausal transition and after menopause: a systematic review and meta-analysis. Hum Reprod Update. 2023;29(6):741–772.
Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447–2469.
Pugliese G, Mele C, Piro S. Syndrome dell’ovaiopolicistico: ruolo del glucagon-like peptide-1 in terapia e gestioneclinica. J Endocrinol Invest. 2023;46(5):871–884.
Mousa A, Tay CT, Teede HJ. Technical report for the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Monash University Report. 2023; [Monash Univ Publication].
Rathi S, Shah S, Raval AM, Patel D, Goswami A. Physicochemical characterization and in-vitro dissolution enhancement of ranolazine using solid dispersion method. J Emerg Technol Innov Res. 2019;6(3):866–883.
Kim CH, Lee SH. Effectiveness of lifestyle modification in polycystic ovary syndrome patients with obesity: a systematic review and meta-analysis. Life (Basel). 2022;12(2):308.
Ee C, Ameratunga R, et al. Pharmacological management of polycystic ovary syndrome: clinical considerations and treatment strategies. J Endocrinol Invest. 2024;47(5):857–871.
Gautam R, Sharma A, Singh N. The role of lifestyle interventions in the management of polycystic ovary syndrome: a systematic review. Nutrients. 2025;17(2):310.
Stańczak NA. Current treatment methods and lifestyle recommendations for polycystic ovary syndrome: a comprehensive review. J ObstetGynaecol. 2024;44(8):1512–1525.
Maan P, Ahmed S, et al. Non-pharmacological treatment options in PCOS: systematic review of diet and lifestyle modifications. Pharmaceutics. 2025;18(5):680.
Malik S, Khan A, et al. Alternative and adjunct therapies for polycystic ovary syndrome: medications, herbs, and phytochemicals review. Front Endocrinol (Lausanne). 2024;14:1294406.
Rankin KW, Rasheed MW, et al. Investigating drug treatments and comparative outcomes for PCOS: a systematic assessment. Sci Rep. 2025;15(1):99508.
Brand KM, et al. The therapeutic role of metformin in polycystic ovary syndrome: metabolic and reproductive outcomes. J Clin Med. 2025;14(10):2156–2172.
Palomba S, et al. Lifestyle management in women with PCOS: evidence beyond diet and exercise. BMC EndocrDisord. 2023;23(1):14.
Raval AM, Bhavsar PR, Pandya FU, Patel D. Co-processed excipients in pharmaceutical formulation: Advances, characterization, and applications. Asian J Pharm Res Dev. 2026;14(1):105–113. doi:10.22270/ajprd.v14i01.1705.
Quintero-Montoya D, et al. Letrozole versus clomiphene citrate for ovulation induction in PCOS: updated meta-analysis and clinical implications. Fertil Steril. 2022;117(2):256–268.
Maan P, et al. Interventions for polycystic ovary syndrome in Indian women: systematic review and evidence base for region-specific management. J ObstetGynaecol India. 2025;75(1):45–56.
Jain A, et al. Nutritional management of polycystic ovary syndrome: diet strategies and clinical evidence. BioMed Pharmacol J. 2025;18(1):215–224.
Ghafari A, et al. Polycystic ovary syndrome in 2025 — insights and innovations in diagnosis and management. Clin Endocrinol (Oxf). 2025;103(4):441–455.
Diakosavvas M, et al. Weight management strategies to reduce metabolic risk in PCOS: pharmacologic and lifestyle approaches. Horm Metab Res. 2025;57(5):307–318.
Zeng W, et al. Global trends and health system impact on polycystic ovary syndrome: reproductive and metabolic perspectives. Front Reprod Health. 2025;3:1642369.
Parker J, et al. Recognizing the role of insulin resistance in polycystic ovary syndrome: implications for clinical practice. J Clin Med. 2025;14(12):4021.
Gautam R, et al. The role of diet and lifestyle interventions in PCOS management: systematic evidence. Nutrients. 2025;17(2):310.
Jakubowska-Kowal K, et al. Treatment and complications of polycystic ovary syndrome in adolescents: endocrine and psychological outcomes. Front Endocrinol (Lausanne). 2024;15:1436952.
Che Y, Shang X, et al. Diet’s role in managing insulin resistance in polycystic ovary syndrome: current evidence and future directions. Nutr Rev. 2025;83(7):810–825
Falwariya R, Jethva T, Raval AM, Lokhande D. Comprehensive review: Microneedle patches – A painless revolution in transderal drug delivery. World J Pharm Med Res. 2026;12(1):199–207.
Jay U, Yadav P, Patel D, Raval AM, Patel J. Review on in-situ depot-based controlled drug delivery for treatment of rheumatoid arthritis. World J Pharm Med Res. 2025;11(11):113–117.
Kushkiwala AM, Zankhwala FM, Patel MD, Raval AM. Flurbiprofen loaded ethosomal gel: Design, optimization, and anti-inflammatory activity. Int J Res Anal Rev. 2024;11(4):709–742.
Mevada J, Patel K, Raval AM. Role of pharmacovigilance in drug safety monitoring. World J Pharm Med Res. 2025;11(11):235–240.
Mevada J, Patel K, Raval AM. Materiovigilance: From device failure to safety reform, the growing importance of materiovigilance systems. Int J Pharm Sci. 2026;4(1):962–974.
Malik S, Khan A, Bashir S, et al. Alternative and adjunct therapies for polycystic ovary syndrome: medications, herbs, and phytochemicals review. Front Endocrinol (Lausanne). 2024;14:1294406.
Jain A, Sharma P, Verma R, Singh S. Nutritional management of polycystic ovary syndrome: diet strategies and clinical evidence. BioMed Pharmacol J. 2025;18(1):215–224.
Gautam R, Sharma A, Singh N, Kaur P. The role of lifestyle interventions in the management of polycystic ovary syndrome: a systematic review. Nutrients. 2025;17(2):310.
Stańczak NA. Current treatment methods and lifestyle recommendations for polycystic ovary syndrome: a comprehensive review. J ObstetGynaecol. 2024;44(8):1512–1525.
Palomba S, Santagni S, Falbo A, La Sala GB. Lifestyle management in women with PCOS: evidence beyond diet and exercise. BMC EndocrDisord. 2023;23(1):14.
Diakosavvas M, Goulis DG, et al. Weight management strategies to reduce metabolic risk in PCOS: pharmacologic and lifestyle approaches. Horm Metab Res. 2025;57(5):307–318.
Mousa A, Tay CT, Teede HJ. Technical report for the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Monash University. 2023.
Wehr E, Pieber TR, Obermayer-Pietsch B. Effect of vitamin D supplementation in women with polycystic ovary syndrome. Eur J Endocrinol. 2011;164(5):741–749.
Oner G, Muderris II. Clinical effects of vitamin D supplementation in women with polycystic ovary syndrome. Eur J ObstetGynecolReprod Biol. 2014;182:130–134.
Maktabi M, Jamilian M, Asemi Z. Magnesium supplementation and metabolic status in women with polycystic ovary syndrome: randomized controlled trial. Biol Trace Elem Res. 2018;181(2):204–211.
Jamilian M, Samimi M, Ebrahimi FA, Hashemi T, Taghizadeh M, Asemi Z. Zinc supplementation effects on metabolic status in women with polycystic ovary syndrome. Biol Trace Elem Res. 2016;171(1):68–75.
Rezvan N, Moini A, Janani L, et al. Omega-3 fatty acid supplementation and metabolic status in women with polycystic ovary syndrome. ReprodBiol Endocrinol. 2016;14:8.
Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in women with polycystic ovary syndrome. Fertil Steril. 2017;107(3):613–620.
Dokras A, Clifton S, Futterweit W, Wild R. Increased prevalence of anxiety symptoms in women with polycystic ovary syndrome: systematic review and meta-analysis. J Clin Endocrinol Metab. 2011;96(1):217–225.
Thomson RL, Buckley JD, Moran LJ, Noakes M, Clifton PM, Norman RJ, Brinkworth GD. Exercise interventions improve metabolic and reproductive outcomes in women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 2012;77(3):343–350.
Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome: diet versus exercise randomized controlled trial. Hum Reprod. 2013;28(9):2362–2373.
Teede HJ, Misso ML, Costello MF, Dokras A, Laven JJE, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Lancet. 2022;399(10332):2346–2358.
Palomba S, Santagni S, Falbo A, La Sala GB. Lifestyle management in women with polycystic ovary syndrome: evidence beyond diet and exercise. BMC EndocrDisord. 2023;23(1):14.
Diakosavvas M, Goulis DG, et al. Weight management strategies to reduce metabolic risk in polycystic ovary syndrome: pharmacologic and lifestyle approaches. Horm Metab Res. 2025;57(5):307–318.
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