Cited by 676Ovarian function and disordersDiabetes, Cardiovascular Risks, and LipoproteinsEndometriosis Research and Treatment

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The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

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Conway, Gerard, Dewailly, Didier, Diamanti-Kandarakis, Evanthia, Escobar-Morreale, Héctor F, Franks, Stephen, Gambineri, Alessandra, Kelestimur, Fahrettin, Macut, Djuro, Micic, Dragan, Pasquali, Renato, Pfeifer, Marija, Pignatelli, Duarte, Pugeat, Michel, Yildiz, Bulent O·2014·European Journal of Endocrinology

DOI 10.1530/eje-14-0253

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Abstract

Polycystic ovary syndrome (PCOS) is the most common ovarian disorder associated with androgen excess in women, which justifies the growing interest of endocrinologists. Great efforts have been made in the last 2 decades to define the syndrome. The presence of three different definitions for the diagnosis of PCOS reflects the phenotypic heterogeneity of the syndrome. Major criteria are required for the diagnosis, which in turn identifies different phenotypes according to the combination of different criteria. In addition, the relevant impact of metabolic issues, specifically insulin resistance and obesity, on the pathogenesis of PCOS, and the susceptibility to develop earlier than expected glucose intolerance states, including type 2 diabetes, has supported the notion that these aspects should be considered when defining the PCOS phenotype and planning potential therapeutic strategies in an affected subject. This paper offers a critical endocrine and European perspective on the debate on the definition of PCOS and summarises all major aspects related to aetiological factors, including early life events, potentially involved in the development of the disorder. Diagnostic tools of PCOS are also discussed, with emphasis on the laboratory evaluation of androgens and other potential biomarkers of ovarian and metabolic dysfunctions. We have also paid specific attention to the role of obesity, sleep disorders and neuropsychological aspects of PCOS and on the relevant pathogenetic aspects of cardiovascular risk factors. In addition, we have discussed how to target treatment choices based according to the phenotype and individual patient's needs. Finally, we have suggested potential areas of translational and clinical research for the future with specific emphasis on hormonal and metabolic aspects of PCOS.

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Comparison of single and combined treatment with exenatide and metformin on menstrual cyclicity in overweight women with polycystic ovary syndrome
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Increased Prevalence of Obstructive Sleep Apnea Syndrome in Obese Women with Polycystic Ovary Syndrome1
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Exercise therapy in polycystic ovary syndrome: a systematic review
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Vitamin D deficiency is common and associated with metabolic risk factors in patients with polycystic ovary syndrome
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Altered Vascular Function in Young Women with Polycystic Ovary Syndrome
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Women with polycystic ovary syndrome are often depressed or anxious—A case control study
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Comparison of Spironolactone, Flutamide, and Finasteride Efficacy in the Treatment of Hirsutism: A Randomized, Double Blind, Placebo-Controlled Trial
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Metformin: an old medication of new fashion: evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome
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Toward Excellence in Testosterone Testing: A Consensus Statement
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Induction of ovulation with low-dose gonadotropins in polycystic ovary syndrome: an analysis of 109 pregnancies in 225 women
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Characteristics and metabolic effects of estrogen and progestins contained in oral contraceptive pills
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Cardiovascular Disease and Risk Factors in PCOS Women of Postmenopausal Age: A 21-Year Controlled Follow-up Study
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Polycystic Ovary Syndrome Is a Risk Factor for Type 2 Diabetes
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Increased Risk for Abnormal Depression Scores in Women With Polycystic Ovary Syndrome
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Placental steroidogenesis in pregnant women with polycystic ovary syndrome
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Treatment with Flutamide, Metformin, and Their Combination Added to a Hypocaloric Diet in Overweight-Obese Women with Polycystic Ovary Syndrome: A Randomized, 12-Month, Placebo-Controlled Study
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Is polycystic ovary syndrome associated with high sympathetic nerve activity and size at birth?
Sverrisdóttir, Y. B., Mogren, T., Kataoka, J., Janson, P. O., & Stener-Victorin, E. (2008) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00725.2007 · Cited by 216 · cited 2×
“Moreover, hyperinsulinaemia exerts a direct hypertrophic effect on the vascular endothelium and the vascular smooth muscle cells and in concert with insulin resistance stimulates endothelin-1 (ET1) production, thus exaggerating endothelial dysfunction (174).”
Quality of life and psychological morbidity in women with polycystic ovary syndrome: body mass index, age and the provision of patient information are significant modifiers
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Anti-Müllerian hormone and polycystic ovary syndrome: a mountain too high?
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Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome
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Health-related quality of life in women with polycystic ovary syndrome: A comparison with the general population using the Polycystic Ovary Syndrome Questionnaire (PCOSQ) and the Short Form-36 (SF-36)
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A More Atherogenic Serum Lipoprotein Profile Is Present in Women with Polycystic Ovary Syndrome: A Case-Control Study
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The Polycystic Ovary Post-Rotterdam: A Common, Age-Dependent Finding in Ovulatory Women without Metabolic Significance
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Insulin-sensitising drugs versus the combined oral contraceptive pill for hirsutism, acne and risk of diabetes, cardiovascular disease, and endometrial cancer in polycystic ovary syndrome
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Referral Bias in Defining the Phenotype and Prevalence of Obesity in Polycystic Ovary Syndrome
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Effects of Exercise on Insulin Resistance and Body Composition in Overweight and Obese Women with and without Polycystic Ovary Syndrome
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Testosterone Increases Lipolysis and the Number of β-Adrenoceptors in Male Rat Adipocytes*
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Inappropriate Gonadotropin Secretion in Polycystic Ovary Syndrome: Influence of Adiposity 1
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Predictors of Endothelial Dysfunction in Young Women with Polycystic Ovary Syndrome
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Age-Specific Reference Ranges for Serum Testosterone and Androstenedione Concentrations in Women Measured by Liquid Chromatography-Tandem Mass Spectrometry
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The genetics of the polycystic ovary syndrome
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Lifestyle Modification Programs in Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis
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Using an electrocautery strategy or recombinant follicle stimulating hormone to induce ovulation in polycystic ovary syndrome: randomised controlled trial
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Androgen Receptor Gene CAG Repeat Polymorphism in the Development of Ovarian Hyperandrogenism
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Short-term combined treatment with liraglutide and metformin leads to significant weight loss in obese women with polycystic ovary syndrome and previous poor response to metformin
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Carotid artery intima-media thickness in polycystic ovary syndrome: a systematic review and meta-analysis
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“A recent systematic review of the studies has conﬁrmed that C-IMT was thicker in women with PCOS in comparison with controls (204).”
Identification of Virilizing Adrenal Tumors in Hirsute Women
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Differential Gene Expression Profile in Omental Adipose Tissue in Women with Polycystic Ovary Syndrome
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Increased serum advanced glycation end‐products is a distinct finding in lean women with polycystic ovary syndrome (PCOS)
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Polycystic Ovary Syndrome
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Lipids and lipoprotein subfractions in women with PCOS: relationship to metabolic and endocrine parameters
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Depression, anxiety and cardiometabolic risk in polycystic ovary syndrome
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Inflammatory and endothelial markers in women with polycystic ovary syndrome
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Antiandrogens for the Treatment of Hirsutism: A Systematic Review and Metaanalyses of Randomized Controlled Trials
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The Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ): a validation
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Maternal insulin resistance causes oxidative stress and mitochondrial dysfunction in mouse oocytes
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Drospirenone for the Treatment of Hirsute Women with Polycystic Ovary Syndrome: A Clinical, Endocrinological, Metabolic Pilot Study
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Reconciling the Definitions of Polycystic Ovary Syndrome: The Ovarian Follicle Number and Serum Anti-Müllerian Hormone Concentrations Aggregate with the Markers of Hyperandrogenism
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The relationship of serum anti-Mullerian hormone with polycystic ovarian morphology and polycystic ovary syndrome: a prospective cohort study
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Altered Cortisol Metabolism in Polycystic Ovary Syndrome: Insulin Enhances 5α-Reduction But Not the Elevated Adrenal Steroid Production Rates
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Low serum testosterone assayed by liquid chromatography-tandem mass spectrometry. Comparison with five immunoassay techniques
Moal, V., Mathieu, E., Reynier, P., Malthièry, Y., & Gallois, Y. (2007) · Clinica Chimica Acta · doi:10.1016/j.cca.2007.07.013 · Cited by 154
Failure of mathematical indices to accurately assess insulin resistance in lean, overweight, or obese women with polycystic ovary syndrome
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Lifecycle of polycystic ovary syndrome (PCOS): from in utero to menopause
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Randomized, double‐blind clinical evaluation of the efficacy and safety of topical eflornithine HCl 13.9% cream in the treatment of women with facial hair
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Endothelial function measured using flow‐mediated dilation in polycystic ovary syndrome: a meta‐analysis of the observational studies
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Disturbed stress responses in women with polycystic ovary syndrome
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The phenotype of polycystic ovary syndrome ameliorates with aging
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Inappropriate Gonadotropin Secretion in Polycystic Ovary Syndrome: Influence of Adiposity
Arroyo, A. (1997) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.82.11.3728 · Cited by 138
Determinants of emotional distress in women with polycystic ovary syndrome
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Evaluation of Adverse Outcome in Young Women with Polycystic Ovary Syndrome Versus Matched, Reference Controls: A Retrospective, Observational Study
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Renaming PCOS—A Two-State Solution
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Psychological implications of infertility in women with polycystic ovary syndrome
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Treatment of Obstructive Sleep Apnea Improves Cardiometabolic Function in Young Obese Women with Polycystic Ovary Syndrome
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Adipose Tissue Dysfunction in Polycystic Ovary Syndrome
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Are There Any Sensitive and Specific Sex Steroid Markers for Polycystic Ovary Syndrome?
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Vitamin D Regulates Anti-Mullerian Hormone Expression in Granulosa Cells of the Hen1
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Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis
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The role of vitamin D in metabolic disturbances in polycystic ovary syndrome: a systematic review
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Prediction of the individual follicle-stimulating hormone threshold for gonadotropin induction of ovulation in normogonadotropic anovulatory infertility: an approach to increase safety and efficiency
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Mitochondrial Complex I Impairment in Leukocytes from Polycystic Ovary Syndrome Patients with Insulin Resistance
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Polycystic ovarian syndrome: marked differences between endocrinologists and gynaecologists in diagnosis and management
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Effects of Gastric Bypass Surgery on Female Reproductive Function
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Sex Hormone–Binding Globulin, but Not Testosterone, Is Associated Prospectively and Independently With Incident Metabolic Syndrome in Men
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Ontogeny of the ovary in polycystic ovary syndrome
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Women living with facial hair: the psychological and behavioral burden
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Consensus on infertility treatment related to polycystic ovary syndrome.
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Metformin treatment of polycystic ovary syndrome improves health-related quality-of-life, emotional distress and sexuality
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Androgen suppressive effect of GnRH agonist in ovarian hyperthecosis and virilizing turnours*
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Polycystic ovary syndrome in Mexican-Americans: prevalence and association with the severity of insulin resistance
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Authors: Conway, G., Dewailly, D., Diamanti-Kandarakis, E., Escobar-Morreale, H. F., Franks, S., Gambineri, A., Kelestimur, F., Macut, D., Micic, D., Pasquali, R., Pfeifer, M., Pignatelli, D., Pugeat, M., & Yildiz, B. O.
Affiliations: University College Hospital (GB)
National and Kapodistrian University of Athens (GR)
Universidad Complutense de Madrid (ES)
ORCID: Conway, Gerard
Dewailly, Didier
Escobar-Morreale, Héctor F
Gambineri, Alessandra
Pignatelli, Duarte
Venue: European Journal of Endocrinology
Publisher: Oxford University Press (OUP)
Published: 2014-10
Volume: 171
Issue: 4
Pages: P1-P29
ISSN: 0804-4643 (ISSN-L)
1479-683X
DOI: 10.1530/eje-14-0253
OpenAlex: W1963543729
Semantic Scholar: 518b85a010c577bc0434b3172e959aaf7980d719
Cited by: 676
References: 288
Citations by year: 2026: 24 · 2025: 26 · 2024: 45 · 2023: 73 · 2022: 77 · 2021: 68 · 2020: 58 · 2019: 69 · 2018: 84 · 2017: 53 · 2016: 48 · 2015: 43 · 2014: 6
FWCI: 60.60
Type: journal article
Language: en
Open access: green
hdl.handle.net
Licence: other-oa
Locations: European Journal of Endocrinology (publishedVersion)
PubMed (publishedVersion)
HAL (submittedVersion)
Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
UCL Discovery (University College London) (submittedVersion)
Hacettepe University Institutional Repository (hacettepe.edu.tr) (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
Keywords: polycystic ovary syndrome, PCOS diagnostic criteria, PCOS phenotypes, hyperandrogenism, insulin resistance, obesity, type 2 diabetes, impaired glucose tolerance, early life events, PCOS pathogenesis, biomarkers, sleep disorders, neuropsychological aspects, cardiovascular risk factors, treatment targeting
MeSH terms: Androgens, Body Composition, Cardiovascular Diseases, Concept Formation, Female, Glucose, Humans, Hypoglycemic Agents, Infertility, Female, Insulin Resistance, Obesity, Ovary, Phenotype, Polycystic Ovary Syndrome, Quality of Life, Gonadal Steroid Hormones, Testosterone, Ultrasonography, Lipid Peroxidation, Biomarkers, Glucose Intolerance, Risk Reduction Behavior, Bariatric Surgery

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The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

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