Polycystic ovary syndrome: A female endocrine metabolic reproductive syndrome in the context of rising global obesity

The global prevalence of obesity among women has increased dramatically over 3 decades, profoundly impacting reproductive health. Polycystic ovary syndrome (PCOS), affecting 12% of women, exemplifies the intersection of metabolic and reproductive pathology. This narrative review synthesizes epidemiological data from 200 countries (1990–2022), 52 systematic reviews from the International PCOS Guideline development, and recent genetic studies, including Mendelian randomization analyses exploring BMI-PCOS relationships. PCOS demonstrates bidirectional relationships with obesity: elevated BMI increases PCOS risk while PCOS predisposes to weight gain, with Mendelian randomization confirming causal relationships. Higher BMI exacerbates PCOS severity through enhanced hyperandrogenism and insulin resistance, driving ovulatory dysfunction, infertility, pregnancy complications, and elevated long-term risks, including diabetes and cardiovascular disease. The International PCOS Guideline emphasizes evidence-based, life-course management incorporating lifestyle intervention, pharmacotherapy, and surgical options. Addressing PCOS requires multidisciplinary approaches integrating metabolic and reproductive health strategies to improve outcomes for millions of affected women worldwide.