Polycystic Ovary Syndrome: Diagnosis and Management

Polycystic ovary syndrome (PCOS) is a prevalent endocrine-metabolic disorder in women of reproductive age, associated with various comorbidities and characterized by symptoms such as hirsutism, acne, menstrual irregularity, subfertility, and male pattern hair loss. The complex pathophysiology involves insulin resistance, hyperandrogenism, and neuroendocrine contributors. Diagnosis is based on the Rotterdam criteria, and there are four recognized phenotypes, with classic PCOS (phenotypes A and B) having a higher incidence of insulin resistance and metabolic dysfunction. Management is patient-specific, with goals including suppressing androgen secretion, improving menstrual dysfunction, metabolic status, and ovulatory fertility. Lifestyle modifications are the first line of treatment, with a 5% to 10% weight loss shown to improve various symptoms and insulin resistance. Pharmacologic treatments, which are individualized and symptom-oriented, include combined oral contraceptive pills, metformin, antiandrogens, and various therapies for hirsutism and alopecia. For anovulatory infertility, letrozole is the first-line pharmacologic treatment. Early diagnosis, screening for comorbidities, patient counseling, and evidence-based management are crucial for improving outcomes.