Polycystic Ovary Syndrome: Clinical Presentation, Diagnostic Challenges, and Evolving Management Approaches

Abstract

Polycystic ovary syndrome (PCOS) is a prevalent and complex endocrine disorder affecting individuals of reproductive age, characterized by ovulatory dysfunction, hyperandrogenism, and metabolic disturbances. Its pathophysiology involves genetic susceptibility, insulin resistance, inflammation, and hormonal imbalance. The condition leads to reproductive challenges, dermatological concerns, psychological burden, and long term risks including type II diabetes and cardio-vascular disease. Diagnostic criteria have evolved, with the Rotterdam criteria remaining the most widely used for adults. Management focuses on lifestyle interventions, dietary strategies, and pharmacotherapy tailored to patient needs. Early detection and holistic care are essential to improve long-term health outcomes.

Introduction

Polycystic Ovary Syndrome (PCOS) is a common and complex endocrine disorder affecting women of reproductive age, characterized by irregular ovulation, hyperandrogenism, and polycystic ovarian morphology. Its prevalence ranges from approximately 6% to 20%, depending on diagnostic criteria. PCOS arises from an interplay of genetic, hormonal, metabolic, and environmental factors, with insulin resistance, elevated androgen levels, and chronic low-grade inflammation playing central roles. The condition is associated with long-term health risks including type 2 diabetes, dyslipidemia, cardiovascular disease, endometrial cancer, and psychological disorders.

Historically, PCOS was first described by Stein and Leventhal in 1935, with diagnostic criteria evolving from the NIH definition (1990) to the broader Rotterdam criteria (2003), which remain the most widely used. Current guidelines emphasize individualized, lifelong management addressing both reproductive and metabolic health.

Clinically, PCOS presents with menstrual irregularities, infertility, hirsutism, acne, obesity, insulin resistance, and metabolic abnormalities. Ultrasound imaging and biomarkers such as anti-Müllerian hormone (AMH) assist in identifying polycystic ovarian morphology, although standardization of diagnostic thresholds remains a challenge.

Management of PCOS focuses on lifestyle modification as first-line therapy, including weight management, physical activity, and dietary interventions. The Mediterranean diet is strongly supported due to its benefits in improving insulin sensitivity, reducing inflammation, and lowering cardiovascular risk, while ketogenic diets may offer short-term metabolic improvements. Pharmacological treatments include combined oral contraceptives to regulate menstruation and reduce androgenic symptoms, metformin to address insulin resistance and hormonal imbalance, and clomiphene citrate for ovulation induction in women seeking pregnancy.

Overall, PCOS is a lifelong condition requiring personalized, multidisciplinary care that integrates lifestyle changes, dietary strategies, and pharmacological treatment to manage symptoms, improve fertility outcomes, and reduce long-term metabolic and cardiovascular risks.

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Conclusion

PCOS is a multifactorial disorder with significant implications for reproductive, metabolic, and mental health across the lifespan. Variability in clinical presentation necessitates individualized assessment and treatment guided by current diagnostic standards. Lifestyle modification remains the cornerstone of therapy, supported by pharmacological options such as combined oral contraceptives, insulin-sensitizing agents, and ovulation- induction medications when fertility is desired. Continued research into the mechanisms of PCOS, along with improved diagnostic consistency, is crucial for advancing personalized care and reducing long-term complications.

References

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Copyright

Copyright © 2026 Addepalli Devi Prasanna, Dr. V. Bhaskar Raju, Boggarapu Amrutha, Derangula Ramsai, Dr. Nemala Siva Kumar. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.