Summary points

• PCOS is diagnosed in women in the reproductive age group based on the Rotterdam criteria when two out of the following three cri­teria are met—(a) presence of menstrual irregularities, (b) clin- ical/biochemical evidence of androgen excess, or (c) polycystic ovary morphology on ultrasound assessment.

• The pathophysiology of PCOS remains to be determined but it is likely to involve the androgen, insulin, and AMH pathways.

• Ethnic differences can contribute to the differences in prevalence seen in different populations of women with PCOS such as East Asian, Caucasian, and South Asian populations.

• The spectrum of disease involves various phenotypes based on the current diagnostic criteria and this may have reproductive, meta­bolic, and endocrine consequences.

• Reproductive issues include irregular menstrual cycles and anovulation. Treatment modalities include lifestyle modifica­tions such as exercise, weight loss, and calorie-restricted diets; and medications such as clomiphene citrate, letrozole, and gonadotropins for ovulation induction. In some cases, espe­cially in women with normal BMI, ovarian electrocautery may be indicated.

• Metabolic disorders such as insulin resistance, obesity, dyslipidaemia, and hypertension must be screened for in all women who are diagnosed with PCOS. Treatment modalities include lifestyle modifications such as exercise, weight loss, and calorie-restricted diets. Medications such as metformin can be useful in obese women with PCOS, although bariatric surgery may be indicated in some women.

• Endocrine issues such as type 2 diabetes mellitus must be treated in women with PCOS.

• Hirsutism can be managed with different medications ranging from oral contraceptive pills to antiandrogens but bearing in mind the side effects of these medications. Physical modalities such as laser and photoepilation therapies may still be necessary.

• Reproductive ageing appears to be increased in women with PCOS and they seem to undergo menopause at a later age.

• Long-term risks of metabolic and endocrine disorders in women with PCOS still need further confirmation with more robust data.

• Women with PCOS are at higher risk of endometrial hyperplasia and cancer but other cancers such as breast and ovarian cancer are not associated with PCOS.