Polycystic ovary syndrome: An insight into pathophysiology, current management, and emerging therapeutic approaches

PCOS is the most prevalent heterogeneous endocrine disorder, characterized by hyperandrogenism, anovulation, ovarian dysfunction, and polycystic ovarian morphology. Its pathogenesis involves interconnected pathways, including neuroendocrine dysregulation, elevated GnRH pulsatility, insulin resistance, alterations in ovarian steroidogenesis, an imbalance in LH/FSH ratios, adiposity, and chronic inflammation. This review provides a comprehensive overview of the epidemiology and pathophysiology of PCOS, along with current pharmacological and non-pharmacological management strategies. Recent advances in drug repurposing and the emergence of novel therapeutic targets, such as kisspeptin pathways, neurokinin B receptor modulators, glucagon-like peptide (GLP-1) agonists, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors, highlight promising approaches for developing more precise and individualized therapies. However, further research is needed to establish phenotype-specific, long-term clinical-outcomes-based treatments that can more effectively address menstrual irregularity, metabolic dysregulation, and infertility associated with PCOS.