Living with PCOS: A Narrative of its Biology, Diagnosis, and Evolving Treatment

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder characterized by hyperandrogenism, ovarian dysfunction, and metabolic abnormalities. It affects between 4% and 21% of females of fertile age. The present review provides a comprehensive analysis of PCOS, covering pathophysiology, diagnostic criteria, prevalence, biochemical markers, and demographic influences. It examines genetic, hormonal, and lifestyle variables, contributing to the conditions, highlighting ethnic disparities in prevalence.

To systematically analyse current data and refine evidence-based diagnosis and management guidelines, published in 2018, a global team was assembled. A systematic literature search was conducted across major academic databases, including PubMed, Scopus, Web of Science, and Google Scholar, to identify relevant studies on PCOS pathophysiology, diagnosis, and emerging therapies. Based on the global team's view, our generalised narrative review explores metabolic implications such as glucose intolerance, obesity, and type-2 diabetes, as well as hormonal imbalances involving androgens, luteinizing hormone, and prolactin.

Lifestyle factors, socioeconomic status, and ethnicity significantly influenced PCOS expression. Advancements in diagnosis, including AI-driven evaluation and precision medicine approaches, are discussed, alongside improvements in biochemical testing and treatment strategies.

PCOS expression varies by lifestyle, ethnicity, and socioeconomic status. Emerging diagnostics like AI and precision medicine enhance detection, treatment, and understanding of its metabolic complexity.

The review emphasizes the importance of personalized interventions and integrated healthcare approaches to enhance PCOS management and patient outcomes.