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In human women, oogenesis produces one mature egg cell or ovum for every precursor cell that enters meiosis. This process differs in two unique ways from the equivalent procedure of spermatogenesis in males. First, meiotic divisions during oogenesis are asymmetric, meaning that a large oocyte (containing most of the cytoplasm) and minor polar body are produced as a result of meiosis I, and again following meiosis II. Since only oocytes will go on to form embryos if fertilized, this unequal...
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The menstrual cycle includes a critical component known as the ovarian cycle, which undergoes two main phases each month—the follicular phase and the luteal phase. The follicular phase is variable and averaging around 14 days. Ovulation, triggered by a surge in luteinizing hormone (LH), marks the transition between the two phases. The second phase, the luteal phase, is relatively consistent, lasting approximately 14 days, and is marked by the activity of the corpus luteum. While a cycle...
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The ovarian cycle is meticulously regulated by the hypothalamic-pituitary-gonadal axis. This cycle orchestrates the release of a mature oocyte, essential for reproduction.
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Polycystic ovary syndrome.

Anju E Joham1, Robert J Norman2, Elisabet Stener-Victorin3

  • 1Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Monash Health, Melbourne, VIC, Australia.

The Lancet. Diabetes & Endocrinology
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Summary

Polycystic ovary syndrome (PCOS) is a complex reproductive, metabolic, and psychological condition affecting many women. This review updates on PCOS pathophysiology, diagnosis, and management, emphasizing lifestyle and medical interventions.

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Area of Science:

  • Reproductive Endocrinology
  • Metabolic Disorders
  • Women's Health

Background:

  • Polycystic ovary syndrome (PCOS) impacts 5-18% of women, presenting as a complex reproductive, metabolic, and psychological condition.
  • Its etiology involves genetic, epigenetic, hormonal, and metabolic factors, including insulin resistance and androgen excess.
  • Diagnosis typically follows the Rotterdam criteria, requiring two of three: hyperandrogenism, irregular cycles, or polycystic ovarian morphology.

Purpose of the Study:

  • To provide an updated review on the pathophysiology, diagnosis, and clinical features of PCOS.
  • To discuss the needs and priorities for individuals with PCOS, including lifestyle, medical, and infertility treatments.
  • To examine the status of international evidence-based guidelines (EBG) for PCOS management and research.

Main Methods:

  • Literature review of current research on PCOS pathophysiology, diagnosis, and management.
  • Analysis of diagnostic criteria and their application across different age groups.
  • Synthesis of information on lifestyle modifications and pharmacological treatments.

Main Results:

  • PCOS presents with diverse phenotypes and heterogeneous clinical features evolving across lifespan.
  • Effective management combines lifestyle interventions (diet, exercise) with medical treatments (metformin, OCPs, anti-androgens).
  • Adolescent diagnosis requires hyperandrogenism and irregular cycles, excluding ovarian morphology due to specificity issues.

Conclusions:

  • PCOS requires a comprehensive, lifespan approach to management, addressing reproductive, metabolic, and psychological aspects.
  • Evidence-based guidelines are crucial for standardized care, patient self-management, and guiding future research priorities.
  • Continued research is needed to refine understanding and improve treatment strategies for PCOS globally.