PCOS stands for Polycystic Ovary Syndrome, but it is not actually exclusively defined by ovarian cysts. PCOS is the most frequent endocrine condition in premenopausal women is (PCOS). The global prevalence of this illness ranges from 6% to 20% depending on the diagnostic criteria used, with a higher prevalence among overweight or obese women and among ethnic groups.

PCOS is a complicated endocrine condition characterized by clinical or biochemical hyperandrogenism, ovarian dysfunction (menstrual irregularities), and polycystic ovarian morphology, among other issues. There is currently a plethora of PCOS diagnosis criteria that include various combinations of its clinical features. The Rotterdam criteria, which is mostly employed for clinical diagnosis, require at least two of the three clinical characteristics listed above.

PCOS is regarded as a major cause of anovulatory infertility and is therefore clinically linked to subfertility or infertility. However, the pathology's negative impact is not limited to reproductive function. PCOS is also connected to numerous metabolic problems such as obesity and insulin resistance (IR). A considerable number of women with PCOS are overweight, and they often have IR with hyperinsulinemia. IR is the most prevalent metabolic perturbation in women with PCOS, affecting 65–70% of all patients. Notably, IR and hyperinsulinemia are metabolic features shared by most slim women with PCOS as well. Hyperinsulinemia also contributes to the development of various phenotypic aspects of PCOS. In conjunction with BETA cell dysfunction, it increases the likelihood of developing other metabolic problems such as type 2 diabetes (T2D), hypertension dyslipidemia, and cardiovascular disease. The frequency of these metabolic comorbidities is high in overweight women with PCOS, mostly due to hormonal imbalances such as elevated luteinizing hormone (LH) and normal or suppressed follicle stimulating hormone (FSH) resulting in an altered LH/FSH ratio.

The clinical features of hyperandrogenism are also related to hyperinsulinemia and insulin resistance. While many elements of PCOS pathogenesis remain unknown, it is believed that hyperandrogenism contributes significantly to the development of many of the reproductive and metabolic abnormalities associated with PCOS. Excess androgen has a detrimental effect on metabolic balance in women with PCOS, affecting a variety of metabolic tissues, including adipose tissue, liver, muscle, pancreas, and the brain. Androgen synthesis in ovarian theca cells is stimulated by insulin. Hyperinsulinemia stimulates cytochrome p450 enzymes in the ovary directly; or indirectly through action of LH or IGF-1, causing hyperandrogenism.

Signs of PCOS

  • Dermatological issues: Increased androgen levels are sometimes linked to dermatological issues. These include hirsutism (coarse, black hair on the face, belly, chest, and back), acne, and balding/alopecia. Teenage skin issues are frequently attributable to puberty, not PCOS.
  • Menstrual disorders: Menstrual abnormalities can range in severity from the complete absence of menstruation (amenorrhea) to menstruation that is delayed by 35 days or more (oligomenorrhea) to profuse bleeding (menorrhagia). Women who experience irregular menstrual cycles have a 91% risk of developing PCOS. In addition, PCOS patients are 15 times more likely to report infertility than non-PCOS patients.
  • Polycystic ovaries: In a single transvaginal ultrasound image, excessive follicles, defined as 25 or more follicles measuring 2 mm to 10 mm, may be seen in PCOS. Additionally, increased ovarian volume, defined as an ovary larger than 10 mL, is also an attribute. Women with PCOS are at risk for developing type 2 diabetes and cardiovascular disease. They are also at a threefold greater risk of developing uterine cancer. In addition, women with PCOS are at higher risk for mental health disorders—such as anxiety and depression. Because of the severe effects of PCOS on many aspects of health, collaborative research efforts will be essential for advancing diagnosis and treatments and reducing the suffering of women with this disorder.

Risk Factors for Developing PCOS

  • Genetics: A recent study documented that pregnant woman with PCOS exhibit increased circulating AMH levels compared with control women. Thus, girls born from mothers with PCOS might be at a greater risk of developing this endocrine disorder not only due to the genetic influence but also due to their in utero exposure to the intrauterine environment of a PCOS mother. Moreover, this study corroborated previous findings that AM Expected levels in pregnant women could be indicative of maternal PCOS status. Women who themselves had PC expected OS exhibited g levels as compared with women expected who did not develop PCOS.
  • Insulin resistance (IR): Insulin resistance (IR) and compensatory hypered insulinemia are viewed as a central and integral part of PCOS. However, while PCOS is closely associated with hyperinsulinemia and insulin resistance, it remains unclear whether insulin resistance is a cause or a consequence of PCOS. Regardless, these metabolic abnormalities contribute to the development of hyperandrogenism, hyperinsulinemia, and inflammation in PCOS.
  • Obesity: A bidirectional relationship exists between PCOS and obesity. Obesity exacerbates insulin resistance and inflammation, which, in turn, exacerbates PCOS. In addition to these metabolic and inflammatory consequences, obesity also contributes to the development of PCOS by directly affecting ovarian function. Obesity alters the ovarian microenvironment, increases androgen synthesis, and induces the arrest of follicle development, contributing to the characteristic polycystic ovarian morphology seen in PCOS.

Management and Treatment

  • Lifestyle modifications: Weight management and a healthy lifestyle are often recommended as the first line of treatment for women with PCOS. This includes regular physical activity and a balanced diet to improve insulin sensitivity and manage weight. Even a modest weight loss of 5-10% can lead to significant improvements in symptoms and overall health.
  • Medications: Various medications may be prescribed to manage specific symptoms of PCOS. These include oral contraceptives to regulate menstrual cycles, anti-androgen medications to address hirsutism and acne, and medications to induce ovulation in women trying to conceive.
  • Fertility treatments: For women facing infertility due to PCOS, fertility treatments such as ovulation induction or in vitro fertilization (IVF) may be recommended. These treatments aim to assist in achieving a healthy pregnancy.


PCOS is a complex and multifaceted condition that affects women's reproductive and metabolic health. It is crucial for healthcare providers to consider the varied manifestations of PCOS and tailor treatment plans to address individual symptoms and concerns. Additionally, ongoing research is essential to deepen our understanding of PCOS and develop more effective diagnostic and therapeutic approaches. Through a comprehensive and personalized approach, it is possible to enhance the quality of life for women living with PCOS and mitigate the long-term health risks associated with this condition.