Uncovering the Metabolic Origins of Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS), now known as polyendocrine metabolic ovarian syndrome (PMOS), though the two terms remain in concurrent use during the ongoing transition, is a common endocrine disorder affecting women of reproductive age, characterized by disrupted hormonal balance and impaired metabolic health. Insulin resistance (IR) is a central pathological feature of PCOS, contributing to a broad spectrum of metabolic, reproductive, and psychological complications. Resulting hyperinsulinemia worsens hyperandrogenism, driving acne, hirsutism, menstrual irregularities, and infertility, while also impairing follicular development and ovulation. Because IR is closely tied to obesity, it further elevates the risk of type 2 diabetes and cardiovascular disease, compounding the long-term health burden of PCOS. This review examines the association between IR and PCOS, with particular attention to its influence on clinical presentation, diagnostic approaches, treatment strategies, and disease progression. A clear understanding of IR's role is essential for effective management, as targeting it through lifestyle modification and pharmacological intervention can improve reproductive outcomes and reduce long-term metabolic and cardiovascular risk in women with PCOS.