Polycystic ovary syndrome (PCOS): current insights, emerging therapeutics, and future treatment strategies

Polycystic ovary syndrome (PCOS) is a common gynaecological disorder, clinically characterized by chronic anovulation and hyperandrogenism. Despite its high prevalence, no curative treatment exists, and managing the syndrome remains challenging. A strong association between PCOS and metabolic syndrome, particularly insulin resistance, adversely influences fertility, leading to an increased worldwide demand for advanced treatment options. Although the exact aetiology and pathophysiology of the syndrome remain unclear, an intricate interaction of ovarian, endocrine, and metabolic factors is highly likely. During the last two decades, several pathophysiological factors have been identified, and growing evidence suggests that PCOS is not solely a reproductive endocrinologic disorder but a multisystem syndrome with reproductive, endocrine, metabolic, and psychiatric manifestations. Diagnostic criteria such as the Rotterdam criteria, the NIH-NIHCD criteria, and the Androgen Excess Society (AES) criteria have uncovered a wide spectrum of clinical manifestations. Lifestyle modification and insulin sensitizers remain the gold standard for management in obese PCOS women. Emerging therapeutics include novel insulin-sensitizing agents, such as glucagon-like peptide 1 receptor agonists, sodium-glucose co-transporter 2 inhibitors, and dipeptidyl peptidase-4 inhibitors. Nutraceuticals and herbal remedies, surgical interventions, which have undergone modifications and refinements over time, facilitate follicle growth by increasing endogenous gonadotropin secretion as an alternative to ovulation induction in clomiphene-resistant PCOS women. Treatment of infertility resulting from PCOS is demanding, and current approaches are neither uniformly successful nor universally accepted. Future directions involve exploring the potential of vaginal microbiota and photothermogenesis for comprehensive management.