Towards consensus: standardizing polycystic ovary syndrome (PCOS) diagnosis in the Middle East and North Africa (MENA) Region

Abstract Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age, yet its reported prevalence across the Middle East and North Africa (MENA) ranges widely due to inconsistent diagnostic approaches. Current literature shows estimates varying from 2% to over 25%, largely determined by whether NIH, Rotterdam, or AES criteria are applied. This diagnostic heterogeneity undermines comparability of studies, creates epidemiological ambiguity, and limits translation of evidence into regional policy. The problem is further compounded by variability in ultrasound thresholds for polycystic ovarian morphology and the lack of standardized biochemical assays for androgen measurement, both of which differ substantially across laboratories and clinical centers in the MENA region. Although the 2023 ESHRE evidence-based guideline refined diagnostic thresholds, emphasizing age-appropriate definitions, updated antral follicle counts, and LC-MS/MS for biochemical validation, most prevalence studies in the region predate these recommendations. Without regional adaptation and harmonization, the true burden of PCOS in MENA will remain obscured. This correspondence underscores the urgency of developing a consensus framework, aligned with ESHRE 2023 but tailored to regional epidemiological and healthcare realities. A unified strategy is essential for reliable prevalence estimates, robust phenotype characterization, and equitable clinical management, ultimately moving the field towards clarity, consensus, and improved women’s health outcomes.