POLYCYSTIC OVARY SYNDROME: EXPLORING THE ICEBERG OF A LIFELONG SYSTEMIC DISORDER

Polycystic ovary syndrome (PCOS) represents a common and complex endocrine condition that impacts women at all stages of reproductive development. As 2025 marks the 90th anniversary of its first clinical description by Stein and Leventhal, this review revisits the syndrome through the metaphor of an iceberg: while hyperandrogenism, anovulation, and polycystic ovarian morphology comprise the visible «tip,» a substantial portion of the burden lies beneath the surface. The clinical criteria, while necessary for diagnosis, often overshadow the deeper systemic and psychosocial complexities of PCOS. Beneath these surface manifestations exist significant metabolic disturbances - including insulin resistance, dyslipidemia, and increased cardiometabolic risk - as well as psychological burdens such as depression, anxiety, and impaired quality of life. These dimensions remain insufficiently recognized, leading to delayed diagnosis, fragmented care, and significant unmet patient needs. The persistent underestimation of the syndrome’s breadth reflects a broader disconnect between clinical awareness and the actual experience of patients in the real world. This article explores the historical trajectory of PCOS diagnosis, unpacks the full spectrum of its concealed comorbidities, and highlights the critical importance of a multidimensional, individualized, and holistic clinical strategy. Recognizing the hidden burden of PCOS is not merely a matter of improved diagnostics - it is a call for a paradigm shift toward compassionate, interdisciplinary, and lifelong care.