AN INTEGRATED APPROACH TO POLYCYSTIC OVARY SYNDROME: DIAGNOSIS, PHARMACOLOGICAL TREATMENT AND BEHAVIOURAL INTERVENTIONS

Keywords: Polycystic Ovary Syndrome, Polycystic Ovary Syndrome/Diagnosis, Polycystic Ovary Syndrome/Therapy, Phenotype, Infertility, Life Style

Abstract

Introduction and Objective: Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting women of all ages. PCOS is one of the most common causes of anovulatory infertility, affecting up to 47% of patients. This work aims to present diagnostic methods, the importance of lifestyle management, and treatment methods in women with PCOS.

Review Methods: A literature review was conducted using the PubMed database to identify relevant articles related to polycystic ovary syndrome (PCOS) using keywords: “Polycystic Ovary Syndrome”, “Polycystic Ovary Syndrome/diagnosis”, “Polycystic Ovary Syndrome/therapy”, “Phenotype”, “Infertility”, and “Life Style”.

Brief description of the state of knowledge: PCOS typically presents with hyperandrogenism, polycystic ovarian morphology, and oligoovulation. It also affects metabolism, body weight, cardiovascular and mental health. Diagnosis is based on the modified Rotterdam criteria, which require two of three conditions: oligo/amenorrhea, hyperandrogenism, or polycystic ovaries, while excluding similar disorders. Treatment should be individualized and address infertility, menstrual disturbances, or androgen-related symptoms. Lifestyle interventions, including diet, regular physical activity, and weight control, are the first-line strategy in PCOS management.

Summary: PCOS requires early diagnosis and individualized treatment tailored to the patient's symptoms and reproductive goals. Lifestyle modifications, including diet and physical activity, play a key role in improving hormonal balance, metabolic health, and fertility outcomes in affected women.

References

Bozdag, G., Mumusoglu, S., Zengin, D., Karabulut, E., & Yildiz, B. O. (2016). The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Human reproduction (Oxford, England), 31(12), 2841–2855. https://doi.org/10.1093/humrep/dew218

Azziz R. (2021). How polycystic ovary syndrome came into its own. F&S science, 2(1), 2–10. https://doi.org/10.1016/j.xfss.2020.12.007

Sirmans, S. M., & Pate, K. A. (2013). Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical epidemiology, 6, 1–13. https://doi.org/10.2147/CLEP.S37559

Pasquali, R., Pelusi, C., Genghini, S., Cacciari, M., & Gambineri, A. (2003). Obesity and reproductive disorders in women. Human reproduction update, 9(4), 359–372. https://doi.org/10.1093/humupd/dmg024

Dunaif, A., Xia, J., Book, C. B., Schenker, E., & Tang, Z. (1995). Excessive insulin receptor serine phosphorylation in cultured fibroblasts and in skeletal muscle. A potential mechanism for insulin resistance in the polycystic ovary syndrome. The Journal of clinical investigation, 96(2), 801–810. https://doi.org/10.1172/JCI118126

Dunaif A. (1997). Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocrine reviews, 18(6), 774–800. https://doi.org/10.1210/edrv.18.6.0318

Joshi A. (2024). PCOS stratification for precision diagnostics and treatment. Frontiers in cell and developmental biology, 12, 1358755. https://doi.org/10.3389/fcell.2024.1358755

Christ, J. P., & Cedars, M. I. (2023). Current Guidelines for Diagnosing PCOS. Diagnostics (Basel, Switzerland), 13(6), 1113. https://doi.org/10.3390/diagnostics13061113

Franks S. (2008). Polycystic ovary syndrome in adolescents. International journal of obesity (2005), 32(7), 1035–1041. https://doi.org/10.1038/ijo.2008.61

Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and sterility, 81(1), 19–25. https://doi.org/10.1016/j.fertnstert.2003.10.004

Teede, H. J., Tay, C. T., Laven, J. J. E., Dokras, A., Moran, L. J., Piltonen, T. T., Costello, M. F., Boivin, J., Redman, L. M., Boyle, J. A., Norman, R. J., Mousa, A., & Joham, A. E. (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. The Journal of clinical endocrinology and metabolism, 108(10), 2447–2469. https://doi.org/10.1210/clinem/dgad463

Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R. J., & International PCOS Network (2019). Erratum. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human reproduction (Oxford, England), 34(2), 388. https://doi.org/10.1093/humrep/dey363

Teede, H. J., Misso, M. L., Deeks, A. A., Moran, L. J., Stuckey, B. G., Wong, J. L., Norman, R. J., Costello, M. F., & Guideline Development Groups (2011). Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. The Medical journal of Australia, 195(6), S65–S112. https://doi.org/10.5694/mja11.10915

Kim, C. H., Chon, S. J., & Lee, S. H. (2020). Effects of lifestyle modification in polycystic ovary syndrome compared to metformin only or metformin addition: A systematic review and meta-analysis. Scientific reports, 10(1), 7802. https://doi.org/10.1038/s41598-020-64776-w

Karimzadeh, M. A., & Javedani, M. (2010). An assessment of lifestyle modification versus medical treatment with clomiphene citrate, metformin, and clomiphene citrate-metformin in patients with polycystic ovary syndrome. Fertility and sterility, 94(1), 216–220. https://doi.org/10.1016/j.fertnstert.2009.02.078

Steinberg Weiss, M., Roe, A. H., Allison, K. C., Dodson, W. C., Kris-Etherton, P. M., Kunselman, A. R., Stetter, C. M., Williams, N. I., Gnatuk, C. L., Estes, S. J., Sarwer, D. B., Coutifaris, C., Legro, R. S., & Dokras, A. (2021). Lifestyle modifications alone or combined with hormonal contraceptives improve sexual dysfunction in women with polycystic ovary syndrome. Fertility and sterility, 115(2), 474–482. https://doi.org/10.1016/j.fertnstert.2020.08.1396

Rodriguez Paris, V., Solon-Biet, S. M., Senior, A. M., Edwards, M. C., Desai, R., Tedla, N., Cox, M. J., Ledger, W. L., Gilchrist, R. B., Simpson, S. J., Handelsman, D. J., & Walters, K. A. (2020). Defining the impact of dietary macronutrient balance on PCOS traits. Nature communications, 11(1), 5262. https://doi.org/10.1038/s41467-020-19003-5

Gautam, R., Maan, P., Jyoti, A., Kumar, A., Malhotra, N., & Arora, T. (2025). The Role of Lifestyle Interventions in PCOS Management: A Systematic Review. Nutrients, 17(2), 310. https://doi.org/10.3390/nu17020310

Nader, S., & Diamanti-Kandarakis, E. (2007). Polycystic ovary syndrome, oral contraceptives and metabolic issues: new perspectives and a unifying hypothesis. Human reproduction (Oxford, England), 22(2), 317–322. https://doi.org/10.1093/humrep/del407

Badawy, A., & Elnashar, A. (2011). Treatment options for polycystic ovary syndrome. International journal of women's health, 3, 25–35. https://doi.org/10.2147/IJWH.S11304

Li, J., Ren, J., & Sun, W. (2017). A comparative systematic review of Yasmin (drospirenone pill) versus standard treatment options for symptoms of polycystic ovary syndrome. European journal of obstetrics, gynecology, and reproductive biology, 210, 13–21. https://doi.org/10.1016/j.ejogrb.2016.11.013

Mathur, R., Levin, O., & Azziz, R. (2008). Use of ethinylestradiol/drospirenone combination in patients with the polycystic ovary syndrome. Therapeutics and clinical risk management, 4(2), 487–492. https://doi.org/10.2147/tcrm.s6864

Stańczak, N. A., Grywalska, E., & Dudzińska, E. (2024). The latest reports and treatment methods on polycystic ovary syndrome. Annals of medicine, 56(1), 2357737. https://doi.org/10.1080/07853890.2024.2357737

Collée, J., Mawet, M., Tebache, L., Nisolle, M., & Brichant, G. (2021). Polycystic ovarian syndrome and infertility: overview and insights of the putative treatments. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 37(10), 869–874. https://doi.org/10.1080/09513590.2021.1958310

Misso, M. L., Teede, H. J., Hart, R., Wong, J., Rombauts, L., Melder, A. M., Norman, R. J., & Costello, M. F. (2012). Status of clomiphene citrate and metformin for infertility in PCOS. Trends in endocrinology and metabolism: TEM, 23(10), 533–543. https://doi.org/10.1016/j.tem.2012.07.001

Balen, A. H., Morley, L. C., Misso, M., Franks, S., Legro, R. S., Wijeyaratne, C. N., Stener-Victorin, E., Fauser, B. C., Norman, R. J., & Teede, H. (2016). The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Human reproduction update, 22(6), 687–708. https://doi.org/10.1093/humupd/dmw025

Kousta, E., White, D. M., & Franks, S. (1997). Modern use of clomiphene citrate in induction of ovulation. Human reproduction update, 3(4), 359–365. https://doi.org/10.1093/humupd/3.4.359

Yang, A. M., Cui, N., Sun, Y. F., & Hao, G. M. (2021). Letrozole for Female Infertility. Frontiers in endocrinology, 12, 676133. https://doi.org/10.3389/fendo.2021.676133

Bansal, S., Goyal, M., Sharma, C., & Shekhar, S. (2021). Letrozole versus clomiphene citrate for ovulation induction in anovulatory women with polycystic ovarian syndrome: A randomized controlled trial. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 152(3), 345–350. https://doi.org/10.1002/ijgo.13375

Franik, S., Eltrop, S. M., Kremer, J. A., Kiesel, L., & Farquhar, C. (2018). Aromatase inhibitors (letrozole) for subfertile women with polycystic ovary syndrome. The Cochrane database of systematic reviews, 5(5), CD010287. https://doi.org/10.1002/14651858.CD010287.pub3

Legro, R. S., Brzyski, R. G., Diamond, M. P., Coutifaris, C., Schlaff, W. D., Casson, P., Christman, G. M., Huang, H., Yan, Q., Alvero, R., Haisenleder, D. J., Barnhart, K. T., Bates, G. W., Usadi, R., Lucidi, S., Baker, V., Trussell, J. C., Krawetz, S. A., Snyder, P., Ohl, D., … NICHD Reproductive Medicine Network (2014). Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. The New England journal of medicine, 371(2), 119–129. https://doi.org/10.1056/NEJMoa1313517

Orvieto, R., & Homburg, R. (2009). Chronic ultra-low dose follicle-stimulating hormone regimen for patients with polycystic ovary syndrome: one click, one follicle, one pregnancy. Fertility and sterility, 91(4 Suppl), 1533–1535. https://doi.org/10.1016/j.fertnstert.2008.09.009

Nugent, D., Vandekerckhove, P., Hughes, E., Arnot, M., & Lilford, R. (2000). Gonadotrophin therapy for ovulation induction in subfertility associated with polycystic ovary syndrome. The Cochrane database of systematic reviews, (4), CD000410. https://doi.org/10.1002/14651858.CD000410

Perales-Puchalt, A., & Legro, R. S. (2013). Ovulation induction in women with polycystic ovary syndrome. Steroids, 78(8), 767–772. https://doi.org/10.1016/j.steroids.2013.05.005

Balen A. H. (2013). Ovulation induction in the management of anovulatory polycystic ovary syndrome. Molecular and cellular endocrinology, 373(1-2), 77–82. https://doi.org/10.1016/j.mce.2012.10.008

Farquhar, C., Brown, J., & Marjoribanks, J. (2012). Laparoscopic drilling by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. The Cochrane database of systematic reviews, (6), CD001122. https://doi.org/10.1002/14651858.CD001122.pub4

Melo, A. S., Ferriani, R. A., & Navarro, P. A. (2015). Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics (Sao Paulo, Brazil), 70(11), 765–769. https://doi.org/10.6061/clinics/2015(11)09

Debras, E., Fernandez, H., Neveu, M. E., Deffieux, X., & Capmas, P. (2019). Ovarian drilling in polycystic ovary syndrome: Long term pregnancy rate. European journal of obstetrics & gynecology and reproductive biology: X, 4, 100093. https://doi.org/10.1016/j.eurox.2019.100093

Sun, B., Ma, Y., Li, L., Hu, L., Wang, F., Zhang, Y., Dai, S., & Sun, Y. (2021). Factors Associated with Ovarian Hyperstimulation Syndrome (OHSS) Severity in Women With Polycystic Ovary Syndrome Undergoing IVF/ICSI. Frontiers in endocrinology, 11, 615957. https://doi.org/10.3389/fendo.2020.615957

Al-Inany, H. G., Youssef, M. A., Aboulghar, M., Broekmans, F., Sterrenburg, M., Smit, J., & Abou-Setta, A. M. (2011). Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. The Cochrane database of systematic reviews, (5), CD001750. https://doi.org/10.1002/14651858.CD001750.pub3

Kotlyar, A. M., & Seifer, D. B. (2023). Women with PCOS who undergo IVF: a comprehensive review of therapeutic strategies for successful outcomes. Reproductive biology and endocrinology : RB&E, 21(1), 70. https://doi.org/10.1186/s12958-023-01120-7

Walls, M. L., & Hart, R. J. (2018). In vitro maturation. Best practice & research. Clinical obstetrics & gynaecology, 53, 60–72. https://doi.org/10.1016/j.bpobgyn.2018.06.004

Patel S. (2018). Polycystic ovary syndrome (PCOS), an inflammatory, systemic, lifestyle endocrinopathy. The Journal of steroid biochemistry and molecular biology, 182, 27–36. https://doi.org/10.1016/j.jsbmb.2018.04.008

Naderpoor, N., Shorakae, S., de Courten, B., Misso, M. L., Moran, L. J., & Teede, H. J. (2016). Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis. Human reproduction update, 22(3), 408–409. https://doi.org/10.1093/humupd/dmv063

Morley, L. C., Tang, T., Yasmin, E., Norman, R. J., & Balen, A. H. (2017). Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. The Cochrane database of systematic reviews, 11(11), CD003053. https://doi.org/10.1002/14651858.CD003053.pub6

Tasdemir, S., Ficicioglu, C., Yalti, S., Gurbuz, B., Basaran, T., & Yildirim, G. (2004). The effect of metformin treatment to ovarian response in cases with PCOS. Archives of gynecology and obstetrics, 269(2), 121–124. https://doi.org/10.1007/s00404-002-0447-8

Fruzzetti, F., Perini, D., Russo, M., Bucci, F., & Gadducci, A. (2017). Comparison of two insulin sensitizers, metformin and myo-inositol, in women with polycystic ovary syndrome (PCOS). Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 33(1), 39–42. https://doi.org/10.1080/09513590.2016.1236078

Greff, D., Juhász, A. E., Váncsa, S., Váradi, A., Sipos, Z., Szinte, J., Park, S., Hegyi, P., Nyirády, P., Ács, N., Várbíró, S., & Horváth, E. M. (2023). Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Reproductive biology and endocrinology : RB&E, 21(1), 10. https://doi.org/10.1186/s12958-023-01055-z

Rashid, R., Mir, S. A., Kareem, O., Ali, T., Ara, R., Malik, A., Amin, F., & Bader, G. N. (2022). Polycystic ovarian syndrome-current pharmacotherapy and clinical implications. Taiwanese journal of obstetrics & gynecology, 61(1), 40–50. https://doi.org/10.1016/j.tjog.2021.11.009

Falsetti, L., Gambera, A., Platto, C., & Legrenzi, L. (2000). Management of hirsutism. American journal of clinical dermatology, 1(2), 89–99. https://doi.org/10.2165/00128071-200001020-00003

Views:

11

Downloads:

3

Published
2025-07-18
Citations
How to Cite
Aleksandra Dzwonkowska, & Paulina Redel. (2025). AN INTEGRATED APPROACH TO POLYCYSTIC OVARY SYNDROME: DIAGNOSIS, PHARMACOLOGICAL TREATMENT AND BEHAVIOURAL INTERVENTIONS. International Journal of Innovative Technologies in Social Science, (3(47). https://doi.org/10.31435/ijitss.3(47).2025.3472