Update on PCOS: consequences, challenges, and guiding treatment
Open accessAbstract
Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrine disorders in women and despite this, diagnostic challenges, delayed diagnosis, and less-than-optimal treatment regimens plague the condition. The International PCOS network, consisting of geographically diverse international experts in PCOS as well as consumers, engaged in a multi-year international evidence-based guideline development process that was jointly sponsored by the European Society for Human Reproduction and Embryology (ESHRE) and the American Society of Reproductive Medicine (ASRM). The guideline was published in 2018 and endorsed by more than 40 international societies involved in PCOS. Translation of this evidence-based guideline to medical practice and consumer groups remains a priority. However, there remain many challenges to both understanding the diagnosis and treatment of PCOS. Evidence suggests that both clinicians and consumers are not satisfied with the timeliness of diagnosis and treatment options. This review summarizes the important findings for diagnosis and treatment from the guidelines and expands on recent developments in the literature since its publication. Special attention to diagnosis at the ends of the reproductive spectrum are discussed and remaining areas of controversy are noted. Additionally, the review highlights some of the remaining challenges in the understanding and management of PCOS to help guide clinicians and investigators in this perplexing condition.
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Screening for these conditions is recommended by numerous guidelines to improve well-being, ability to successfully implement and sustain lifestyle changes and manage PCOS.
“Screening for these conditions is recommended by numerous guidelines to improve well-being, ability to successfully implement and sustain lifestyle changes and manage PCOS.”
From 'I'm usually being my own doctor': women's experiences of managing polycystic ovary syndrome in Canada (2023) · cites this paper as [20]
The Management section recommends systematic screening for psychological distress in women with PCOS, and the Behavioral/emotional section links eating disorders and body-image distress to difficulty losing weight. The Lifestyle interventions section also associates higher depressive indices with program attrition. The paper does not establish that screening itself improves well-being, sustained lifestyle changes, or PCOS management, nor does it identify numerous guidelines making that full recommendation. Page numbers were not available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredEvidence indicates that the advice and support for diet-lifestyle management is not consistently provided and may not meet the needs of patients.
“However, evidence indicates that the advice and support for diet-lifestyle management is not consistently provided and may not meet the needs of patients [32].”
From Challenges in diagnosis and health care in polycystic ovary syndrome in Canada: a patient view to improve health care (2023) · cites this paper as [32]
The Abstract (page not available) reports that women with PCOS are dissatisfied with the treatment and recommendations they receive. The Lifestyle interventions section suggests adding behavioral support, but neither passage establishes that diet-lifestyle advice and support are inconsistently provided or specifically fail to meet patients’ needs. (LLM, conf=0.83)
Experimental — accuracy not yet measuredRecent studies including surveys, interviews, and focus groups of those with PCOS reveal a high degree of dissatisfaction with health care and the health care system in many countries.
“Recent studies including surveys, interviews, and focus groups of those with PCOS reveal a high degree of dissatisfaction with health care and the health care system in many countries [2, 28, 30–34].”
From Challenges in diagnosis and health care in polycystic ovary syndrome in Canada: a patient view to improve health care (2023) · cites this paper as [32]
The review’s Abstract (page not provided) says women with PCOS report dissatisfaction with the treatment and recommendations they receive, supporting the core point about dissatisfaction with care. Our copy does not establish that surveys, interviews and focus groups found a high degree of dissatisfaction with health care systems in many countries. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOur findings reinforce other findings in Canada and as well as other countries related to the health care experience of those with PCOS.
“Our findings reinforce other findings in Canada and as well as other countries related to the health care experience of those with PCOS [2, 30–32, 34, 46].”
From Challenges in diagnosis and health care in polycystic ovary syndrome in Canada: a patient view to improve health care (2023) · cites this paper as [32]
Pharmaceuticals such as metformin, lipid-lowering agents and oral contraceptives should be tailored to the individual patient's risk profile and treatment goals.
“Pharmaceuticals such as metformin, lipid-lowering agents and oral contraceptives should be tailored to the individual patient's risk profile and treatment goals.10,13,19,20”
From 'I'm usually being my own doctor': women's experiences of managing polycystic ovary syndrome in Canada (2023) · cites this paper as [20]
Several international evidence-based guidelines and reviews have been established for the diagnosis and management of PCOS, which can be consulted by clinicians in practice.
“Several international evidence-based guidelines and reviews13,20,56 have been established for the diagnosis and management of PCOS, which can be consulted by clinicians in practice.”
From 'I'm usually being my own doctor': women's experiences of managing polycystic ovary syndrome in Canada (2023) · cites this paper as [20]
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The effect of exercise as an intervention for women with polycystic ovary syndrome
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Menstrual Pattern, Reproductive Hormones, and Transabdominal 3D Ultrasound in 317 Adolescent Girls
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Should we individualize lipid profiling in women with polycystic ovary syndrome?
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Stener-Victorin, E., Teede, H., Norman, R. J., Legro, R., Goodarzi, M. O., Dokras, A., Laven, J., Hoeger, K., & Piltonen, T. T. (2024) · Nature Reviews Disease Primers · doi:10.1038/s41572-024-00511-3 · Cited by 495 · see citing works
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“However, evidence indicates that the advice and support for diet-lifestyle management is not consistently provided and may not meet the needs of patients [32].”
BackgroundResultInfluentialDoes the Ketogenic Diet Improve the Quality of Ovarian Function in Obese Women?
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“A hallmark characteristic of PCOS is insulin resistance (IR), which triggers the body to produce excessive insulin to compensate [27].”
Polycystic Ovary Syndrome and the Internet of Things: A Scoping Review
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Depressive Symptoms and Control of Emotions among Polish Women with Polycystic Ovary Syndrome
Pokora, K., Kowalczyk, K., Wikarek, A., Rodak, M., Pędrys, K., Wójtowicz, M., Wyskida, K., & Jonderko, M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192416871 · Cited by 14 · see citing works
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Unraveling PCOS: Exploring its causes and diagnostic challenges
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“Pharmacological treatment is introduced as a second-line therapy and recommended for irregular menstrual cycles, metabolic abnormalities, and hirsutism [9].”
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Wang, Y., Xiang, T., Xia, X., Zhang, H., Geng, S., Yang, G., Qiu, S., He, Y., Liu, R., Li, L., et al. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1010714 · Cited by 5 · see citing works
- Authors
- Hoeger, K. M., Dokras, A., & Piltonen, T.
- Affiliations
- University of Rochester Medicine (US)
- University of Pennsylvania (US)
- Oulu University Hospital (FI)
- Corresponding author
- Hoeger, Kathleen M
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2020-11-19
- Volume
- 106
- Issue
- 3
- Pages
- e1071-e1083
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W3104254993
- Cited by
- 610
- References
- 107
- Citations by year
- 2026: 105 · 2025: 125 · 2024: 160 · 2023: 127 · 2022: 77 · 2021: 16
- FWCI
- 8.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Novo Nordisk Fonden (NNF21OC0070372)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Keywords
- polycystic ovary syndrome, PCOS diagnosis, PCOS treatment, evidence-based clinical guidelines, delayed diagnosis, reproductive endocrine disorders
- MeSH terms
- Diagnostic Techniques, Endocrine, Female, Humans, Infertility, Female, Metabolic Diseases, Polycystic Ovary Syndrome, Practice Guidelines as Topic, Reproductive Medicine, Delayed Diagnosis, Time-to-Treatment
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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