INDIVIDUALIZED TREATMENT OF POLYCYSTIC OVARY SYNDROME: A MANIFESTATION-GUIDED PRACTICAL APPROACH

Polycystic ovary syndrome (PCOS) is a highly heterogeneous endocrine-metabolic disorder with reproductive, metabolic, dermatologic, and psychological manifestations that vary substantially across affected women. This marked phenotypic diversity limits the usefulness of a uniform treatment model and supports a more individualized therapeutic strategy. The present review is based on the hypothesis that management of PCOS is most effective when it is guided by the dominant clinical manifestation or cluster of manifestations, rather than by a generalized syndrome-level approach alone. In this context, treatment priorities may differ depending on whether hyperandrogenism, menstrual dysfunction, insulin resistance and metabolic abnormalities, anovulation, or infertility predominate. This review summarizes current evidence on clinically tailored management strategies in PCOS, integrating lifestyle measures, pharmacological treatment, and reproductive interventions. Particular attention is given to aligning therapy with the prevailing clinical presentation and with the woman’s reproductive intentions, metabolic proŷle, and long-term health risks. Lifestyle modification remains a central component of care, while pharmacological options such as combined oral contraceptives, metformin, letrozole, antiandrogens, and emerging agents including GLP-1 receptor agonists and inositols may have differential relevance across phenotypes. A structured, manifestation-guided, and holistic approach may improve short-term symptom control, enhance reproductive outcomes, and reduce long-term cardiometabolic morbidity.