Advances in the Management of Polycystic Ovary Syndrome (PCOS): A Comprehensive Review

Abstract

Polycystic Ovary Syndrome (PCOS) is a complex endocrine–metabolic condition that clinicians encounter frequently in reproductive-age women. Far beyond a reproductive disorder, PCOS manifests across multiple physiological domains, including metabolic dysfunction, psychological stressors, dermatological symptoms, and long-term cardiometabolic risks. Over the past decade, clinical understanding and management of PCOS have undergone significant refinement, with a shift from uniform treatment strategies toward individualized, phenotype-driven care. This review synthesizes contemporary advances in PCOS management from a clinician’s perspective, integrating mechanistic insights, evidence-based therapeutic innovations, and practical considerations essential for day-to-day practice. Lifestyle modification remains the foundational intervention; however, clinicians now appreciate the need for structured, achievable, and personalized dietary and exercise prescriptions rather than generic weight-loss advice. Pharmacologic therapy has expanded considerably, especially with the emergence of inositols, GLP-1 receptor agonists, SGLT2 inhibitors, newer hormonal formulations, androgen receptor antagonists, and updated ovulation induction protocols. The recognition of letrozole as the superior first-line agent for ovulation induction has significantly improved fertility outcomes, while refinements in assisted reproductive technologies have enhanced safety and efficacy for PCOS patients undergoing IVF. Growing emphasis on mental health and quality-of-life outcomes has led clinicians to adopt more holistic care models addressing anxiety, depression, body-image concerns, and sexual dysfunction. Additionally, dermatologic complications—especially hirsutism, acne, and alopecia—now receive more targeted, integrated management. Emerging research on the gut microbiome, inflammation, vitamin D physiology, and oxidative stress has introduced novel adjunctive therapies and future therapeutic pathways.