Metabolic-Hormonal Interplay and the Case for a Reproductive-Metabolic Framework in the Glucagon-Like Peptide-1 (GLP-1) Era

Polycystic ovary syndrome (PCOS), proposed by some investigators to be more accurately termed polycystic-morphology ovary syndrome (PMOS), reflecting its heterogeneous and not universally cystic pathophysiology, remains the most prevalent endocrine disorder among reproductive-age women worldwide. Despite this, its clinical management continues to be fragmented along specialty lines, with gynecologists addressing menstrual irregularity and contraception, endocrinologists managing insulin resistance and metabolic risk, and dermatologists treating hyperandrogenic manifestations. This editorial proposes the Reproductive-Metabolic Axis (RMA) as a unifying conceptual framework for understanding PCOS/PMOS beyond its phenotypic surface. We argue that contraceptive decision-making in women with PCOS/PMOS cannot be separated from metabolic status, insulin resistance, androgen excess, and cardiovascular risk profiling. In the glucagon-like peptide-1 (GLP-1) receptor agonist era, which has transformed the management of obesity and insulin resistance, new clinical questions arise regarding the interaction between incretin-based therapies, hormonal contraception, and ovarian function restoration. The present editorial does not propose a validated therapeutic protocol, but rather a hypothesis-generating framework that invites further clinical investigation into whether integrated reproductive-metabolic management improves outcomes for women with PCOS/PMOS.