More than Cysts: Decoding Polycystic Ovarian Syndrome from Cells to Solutions

Polycystic ovarian syndrome (PCOS) is a heterogeneous endocrine syndrome that affects a significant proportion of women of reproductive age, with implications for fertility, metabolic health, and overall well-being. This review examines the intricate pathogenesis of PCOS, highlighting key factors such as hyperandrogenism, hyperinsulinemia, and neuroendocrine dysfunction. Emerging evidence also suggests that genetics, epigenetics, and proinflammatory cytokines contribute to the development of PCOS. Additionally, we explore the influence of external factors, including environmental chemicals that may induce PCOS-like symptoms, and mechanisms related to follicular endoplasmic reticulum stress. Recent findings underscore the role of gut microbiota and bile acid metabolism in modulating PCOS, along with immune system regulation and the involvement of immune cells in its pathophysiology. This review further investigates the impact of saturated fatty acids and vitamin D on PCOS, emphasizing their roles in disease progression. In terms of treatment, both pharmacological and nonpharmacological approaches are discussed. Non-pharmacological interventions such as lifestyle modifications (diet, exercise, and acupuncture), supplements, herbs, and emerging strategies like seed cycling are explored as adjuncts to managing symptoms and improving quality of life. Pharmacological treatments, including hormonal therapies, insulin-sensitizing agents, and antiandrogen drugs, are commonly used to address symptoms. Overall, this review provides an indepth analysis of the multifaceted nature of PCOS and offers a holistic overview of current and emerging diagnostic and therapeutic strategies for effective management.