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Polycystic ovary syndrome

Nature Reviews Disease Primers volume 2, Article number: 16057 (2016) Cite this article

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Abstract

Polycystic ovary syndrome (PCOS) affects 5–20% of women of reproductive age worldwide. The condition is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology (PCOM) — with excessive androgen production by the ovaries being a key feature of PCOS. Metabolic dysfunction characterized by insulin resistance and compensatory hyperinsulinaemia is evident in the vast majority of affected individuals. PCOS increases the risk for type 2 diabetes mellitus, gestational diabetes and other pregnancy-related complications, venous thromboembolism, cerebrovascular and cardiovascular events and endometrial cancer. PCOS is a diagnosis of exclusion, based primarily on the presence of hyperandrogenism, ovulatory dysfunction and PCOM. Treatment should be tailored to the complaints and needs of the patient and involves targeting metabolic abnormalities through lifestyle changes, medication and potentially surgery for the prevention and management of excess weight, androgen suppression and/or blockade, endometrial protection, reproductive therapy and the detection and treatment of psychological features. This Primer summarizes the current state of knowledge regarding the epidemiology, mechanisms and pathophysiology, diagnosis, screening and prevention, management and future investigational directions of the disorder.

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Figure 1: Diagnostic criteria and phenotypes of PCOS.
Figure 2: The pathophysiology of PCOS.
Figure 3: Ovarian follicular maturation arrest in PCOS.
Figure 4: Molecular mechanisms of insulin resistance in muscle in PCOS.
Figure 5: Molecular mechanisms of insulin resistance in adipose tissue in PCOS.
Figure 6: Typical polycystic ovarian morphology.

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Acknowledgements

The authors thank Y.-H. Chen, Augusta University, Georgia, USA.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, CB-2209, 30912, Georgia, USA

    Ricardo Azziz & Daria Lizneva

  2. Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA

    Ricardo Azziz

  3. Department of Health Sciences and Mother and Child Care, University of Palermo, Palermo, Italy

    Enrico Carmina

  4. Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China

    ZiJiang Chen

  5. Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China

    ZiJiang Chen

  6. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Andrea Dunaif

  7. Division of Reproductive Medicine, Department of OBGYN, Erasmus Medical Centre, Rotterdam, The Netherlands

    Joop S. E. Laven

  8. Department of Obstetrics and Gynecology, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA

    Richard S. Legro

  9. Department of Reproductive Health Protection, Scientific Center of Family Health and Human Reproduction, Irkutsk, Russian Federation

    Daria Lizneva

  10. Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA

    Barbara Natterson-Horowtiz

  11. Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University in partnership with Monash Health, Clayton, Victoria, Australia

    Helena J. Teede

  12. Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Hacettepe, Turkey

    Bulent O. Yildiz

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  1. Ricardo Azziz
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  2. Enrico Carmina
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Contributions

Introduction (R.A.); Epidemiology (R.A.); Mechanisms/pathophysiology (R.A., E.C., Z.-J.C., A.D., J.S.E.L., H.J.T. and B.O.Y.); Diagnosis, screening and prevention (R.A. and H.J.T.); Management (R.A., E.C., Z.-J.C., R.S.L., D.L. and B.O.Y.); Quality of life (E.C. and B.O.Y.); Outlook (R.A., B.N.-H., D.L. and R.S.L.); Overview of Primer (R.A.).

Corresponding author

Correspondence to Ricardo Azziz.

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Competing interests

R.A. has a consulting agreement with KinDex Pharmaceutical Inc., is on the advisory board of Global PET Imaging, and has a consulting appointment with Selge Holdings and Ventures. J.S.E.L. has received unrestricted research grants from Ferring, Merck-Serono, MSD, Schering Plough, Serono and Okganon. R.S.L. is a consultant for Takeda, KinDex, Euroscreen and Ferring, and has received research funding from and is a consultant for Ferring. All other authors declare no competing interests.

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Azziz, R., Carmina, E., Chen, Z. et al. Polycystic ovary syndrome. Nat Rev Dis Primers 2, 16057 (2016). https://doi.org/10.1038/nrdp.2016.57

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