Polycystic Ovary Syndrome: Definition, Aetiology, Diagnosis and Treatment
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders in premenopausal women. Heterogeneous by nature, PCOS is defined by a combination of signs and symptoms of androgen excess and ovarian dysfunction in the absence of other specific diagnoses. The aetiology of this syndrome remains largely unknown, but mounting evidence suggests that PCOS might be a complex multigenic disorder with strong epigenetic and environmental influences, including diet and lifestyle factors. PCOS is frequently associated with abdominal adiposity, insulin resistance, obesity, metabolic disorders and cardiovascular risk factors. The diagnosis and treatment of PCOS are not complicated, requiring only the judicious application of a few well-standardized diagnostic methods and appropriate therapeutic approaches addressing hyperandrogenism, the consequences of ovarian dysfunction and the associated metabolic disorders. This article aims to provide a balanced review of the latest advances and current limitations in our knowledge about PCOS while also providing a few clear and simple principles, based on current evidence-based clinical guidelines, for the proper diagnosis and long-term clinical management of women with PCOS.
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PCOS does not appear in every woman with IR or hyperinsulinemia and not every woman suffering from PCOS presents IR, suggesting that there must be another malfunction that favors androgen excess in response to insulin or other triggering factors.
“However, the fact that PCOS does not appear in every woman with IR or hyperinsulinemia and the fact that not every woman suffering from PCOS presents IR, suggests that there must be another malfunction that favors androgen excess in response to insulin or other triggering factors [8].”
From The Role of Glp-1 Receptor Agonists in Insulin Resistance with Concomitant Obesity Treatment in Polycystic Ovary Syndrome (2022) · cites this paper as [8]
The non-hyperandrogenic phenotype presents with oligo-ovulation, PCOM and has the weakest connection with IR and metabolic comorbidities.
“The least severe is the non-hyperandrogenic phenotype, which presents with oligo-ovulation, PCOM and has the weakest connection with IR and metabolic comorbidities [8].”
From The Role of Glp-1 Receptor Agonists in Insulin Resistance with Concomitant Obesity Treatment in Polycystic Ovary Syndrome (2022) · cites this paper as [8]
Women with increased insulin levels (regardless of their endo- or exogenous origin) have increased prevalence of PCOS.
“Because of these reasons, women with increased insulin levels (regardless of their endo-or exogenous origin) have increased prevalence of PCOS.”
From The Role of Glp-1 Receptor Agonists in Insulin Resistance with Concomitant Obesity Treatment in Polycystic Ovary Syndrome (2022) · cites this paper as [8]
The ovulatory PCOS phenotype comprises hyperandrogenism and PCOM and co-occurs with moderate IR and metabolic dysfunction.
“The next phenotype is ovulatory PCOS which comprises hyperandrogenism and PCOM. It co-occurs with moderate IR and metabolic dysfunction.”
From The Role of Glp-1 Receptor Agonists in Insulin Resistance with Concomitant Obesity Treatment in Polycystic Ovary Syndrome (2022) · cites this paper as [8]
Hyperinsulinemia is the main reason for increased androgen secretion because insulin acts as a co-gonadotropin on the ovary, facilitates androgen secretion from the adrenal glands, and modulates releasing of luteinizing hormone (LH).
“It is believed that hyperinsulinemia is the main reason for increased androgen secretion because insulin acts as a co-gonadotropin on the ovary, facilitates androgen secretion from the adrenal glands, and modulates releasing of luteinizing hormone (LH) [8].”
From The Role of Glp-1 Receptor Agonists in Insulin Resistance with Concomitant Obesity Treatment in Polycystic Ovary Syndrome (2022) · cites this paper as [8]
The classic phenotype of PCOS consists of hyperandrogenism and oligo-ovulation and is linked with the most severe insulin resistance and metabolic comorbidities.
“The classic phenotype consists of hyperandrogenism and oligo-ovulation. It is linked with the most severe insulin resistance and metabolic comorbidities.”
From The Role of Glp-1 Receptor Agonists in Insulin Resistance with Concomitant Obesity Treatment in Polycystic Ovary Syndrome (2022) · cites this paper as [8]
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Cited by
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Novel Role of the SIRT1 in Endocrine and Metabolic Diseases
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Polycystic Ovary Syndrome: Pathophysiology and Therapeutic Opportunities
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Differential Expression Profile of Plasma Exosomal MicroRNAs in Women with Polycystic Ovary Syndrome
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PCOS and nutritional approaches: Differences between lean and obese phenotype
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Machine-aided self-diagnostic prediction models for polycystic ovary syndrome: observational study
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“The prevalence of PCOS ranges from 6% to 20%, depending on the population and the diagnostic criteria reported in previous studies [4-6].”
BackgroundDo GLP-1 Analogs Have a Place in the Treatment of PCOS? New Insights and Promising Therapies
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Does the Ketogenic Diet Improve the Quality of Ovarian Function in Obese Women?
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Polycystic ovary syndrome management: a review of the possible amazing role of berberine
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Chronotype: A Tool to Screen Eating Habits in Polycystic Ovary Syndrome?
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“Hyperandrogenism is one of the main features of PCOS and evidence supports that it is one of the most used markers to assess severity of PCOS [3].”
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Depressive Symptoms and Control of Emotions among Polish Women with Polycystic Ovary Syndrome
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Polycystic Ovary Syndrome (PCOS): From Diagnosis to Treatment
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- Authors
- Escobar-Morreale, H. F.
- Affiliations
- Universidad de Alcalá (ES)
- Corresponding author
- Escobar-Morreale, Héctor F.
- Venue
- Nature Reviews Endocrinology
- Published
- 2018-03-23
- Volume
- 14
- Issue
- 5
- Pages
- 270-284
- ISSN
- 1759-5029 (ISSN-L)
- 1759-5037
- OpenAlex
- W2793887346
- Semantic Scholar
- 370da203f6b1c460009e19dec22b635d9fe01f28
- Cited by
- 2,083
- References
- 195
- Citations by year
- 2026: 244 · 2025: 303 · 2024: 353 · 2023: 445 · 2022: 295 · 2021: 228 · 2020: 120 · 2019: 73 · 2018: 21 · 2017: 1
- FWCI
- 16.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ministerio de Economía y Competitividad
- European Regional Development Fund
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- polycystic ovary syndrome, hyperandrogenism, ovarian dysfunction, insulin resistance, obesity, abdominal fat, metabolic disorders, cardiovascular risk, epigenetics, PCOS diagnosis, PCOS treatment, premenopausal women
- MeSH terms
- Animals, Female, Humans, Insulin Resistance, Metabolic Diseases, Obesity, Polycystic Ovary Syndrome, Hyperandrogenism
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