Polycystic ovary syndrome: new trends in diagnosis and treatment

Polycystic Ovary Syndrome (PCOS) — frequent endocrine disease of women of the reproductive period, the prevalence of which ranges from 13 % to 25 %. PCOS is a disease with reproductive and metabolic disorders. This article will discuss innovations in the diagnosis and treatment of PCOS.

An innovation in diagnosis is the determination of AMH levels > 4.7 ng/ml (specificity 92 %, sensitivity 89 %) when ultrasound is unavailable, the refinement of ultrasound markers — ≥ 20 follicles or ovarian volume ≥ 10 ml in adults, and the focus on hyperandrogenism with priority for determining free testosterone, taking into account ethnic characteristics.

In the treatment of PCOS, the emphasis remains on lifestyle modification and on combating obesity. 150–300 minutes of physical activity per week is recommended. Among the pharmacological drugs, metformin, COCs and antiandrogens retain their positions, but there are more and more mentions of inositol isoforms that are recommended for use as experimental therapy. Inositols (myo- and D-chiroinositol in a ratio of 40:1) demonstrate effectiveness in improving ovulation (OR 1.8), reducing free testosterone (15–20 %), and moderately reducing insulin resistance (HOMA-IR -0.8). However, their application requires further research for standardization.

Modern diagnosis of PCOS has become more flexible due to the inclusion of AMH, and therapy combines traditional (COCs, metformin) and promising methods (inositols, aGPP-1). Inositols, despite the limited evidence base, occupy an important place in the treatment, especially for metabolic and reproductive disorders.

1. Parua S, Das A, Hazra A, et al. Assessing body composition through anthropometry: Implications for diagnosing and managing polycystic ovary syndrome (PCOS). Clin Physiol Funct Imaging. 2025;45(1):e12905. DOI:10.1111/cpf.12905.

2. Deswal R, Narwal V, Dang A, et al. The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. J Hum Reprod Sci. 2020;13(4):261–271. DOI:10.4103/jhrs.JHRS_95_18.

3. Dalibalta S, Abukhaled Y, Samara F. Factors influencing the prevalence of polycystic ovary syndrome (PCOS) in the United Arab Emirates. Rev Environ Health. 2022;37(3):311–319. Published 2022 May 11. DOI:10.1515/reveh-2021-0036.

4. Joham AE, Norman RJ, Stener-Victorin E, et al. Polycystic ovary syndrome [published correction appears in Lancet Diabetes Endocrinol. 2022 Nov;10(11):e11. DOI:10.1016/S2213-8587(22)00281-9]. Lancet Diabetes Endocrinol. 2022;10(9):668–680. DOI:10.1016/S2213-8587(22)00163-2.

5. Christ JP, Cedars MI. Current Guidelines for Diagnosing PCOS. Diagnostics (Basel). 2023;13(6):1113. Published 2023 Mar 15. DOI:10.3390/diagnostics13061113.

6. Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Eur J Endocrinol. 2023;189(2):G43–G64. DOI:10.1093/ejendo/lvad096.

7. Sivanandy MS, Ha SK. The Role of Serum Anti-Mullerian Hormone Measurement in the Diagnosis of Polycystic Ovary Syndrome. Diagnostics (Basel). 2023;13(5):907. Published 2023 Feb 27. DOI:10.3390/diagnostics13050907.

8. Ivanova YuA, Mokhort TV. Polycystic ovary syndrome: updated recommendations of the international science-based guidelines for 2023. Reproductive health. Eastern Europe. 2024(14). No 1. In Russian. doi.org/10.34883/PI.2024.14.1.011.

9. Mitra S, Saharia GK, Jena SK. Cardio-metabolic risk in Rotterdam clinical phenotypes of PCOS. Ann Endocrinol (Paris). 2024;85(1):44–47. DOI:10.1016/j.ando.2023.06.001.

10. Chan JL, Legro RS, Eisenberg E, et al. Correlation of Polycystic Ovarian Syndrome PhenotypesWith Pregnancy and Neonatal Outcomes. Obstet Gynecol. 2024;144(4):543–549. DOI:10.1097/AOG.0000000000005702.

11. Sharma A, Welt CK. Practical Approach to Hyperandrogenism in Women. Med Clin North Am. 2021;105(6):1099–1116. DOI:10.1016/j.mcna.2021.06.008.

12. Fedeli V, Catizone A, Querqui A, et al. The Role of Inositols in the Hyperandrogenic Phenotypes of PCOS:Are-Reading of Larner’s Results. Int J Mol Sci. 2023;24(7):6296. Published 2023 Mar 27. DOI:10.3390/ijms24076296.

13. Leerasiri P, Wongwananuruk T, Indhavivadhana S, et al. Correlation of clinical and biochemical hyperandrogenism in Thai women with polycystic ovary syndrome. J Obstet Gynaecol Res. 2016;42(6):678–683. DOI:10.1111/jog.12945.

14. Pea J, Bryan J, Wan C, et al. Ultrasonographic criteria in the diagnosis of polycystic ovary syndrome: a systematic review and diagnostic meta-analysis. Hum Reprod Update. 2024;30(1):109–130. DOI:10.1093/humupd/dmad027.

15. van der Ham K, Barbagallo F, van Schilfgaarde E, et al. The additional value of ultrasound markers in the diagnosis of polycystic ovary syndrome. Fertil Steril. Published online August 31, 2024. DOI:10.1016/j.fertnstert.2024.08.342.

16. Peña AS, Codner E, Witchel S. Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review. Diagnostics (Basel). 2022;12(8):1931. Published 2022 Aug 10. DOI:10.3390/diagnostics12081931.

17. Lemaitre M, Christin-Maitre S, Kerlan V. Polycystic ovary syndrome and adipose tissue. Ann Endocrinol (Paris). 2023;84(2):308–315. DOI:10.1016/j.ando.2022.11.004.

18. Xu Y, Qiao J. Association of Insulin Resistance and Elevated Androgen Levels with Polycystic Ovarian Syndrome (PCOS): A Review of Literature. J Healthc Eng. 2022;2022:9240569. Published 2022 Mar 21. DOI:10.1155/2022/9240569.

19. Herman R, Sikonja J, Jensterle M, et al. Insulin Metabolism in Polycystic Ovary Syndrome: Secretion, Signaling, and Clearance. Int J Mol Sci. 2023;24(4):3140. Published 2023 Feb 5. DOI:10.3390/ijms24043140.

20. Teede HJ, Hutchison S, Zoungas S, et al. Insulin resistance, the metabolic syndrome, diabetes, and cardiovascular disease risk in women with PCOS. Endocrine. 2006;30(1):45–53. DOI:10.1385/ENDO:30:1:45.

21. Gu Y, Zhou G, Zhou F, et al. Life Modifications and PCOS: Old Story But New Tales. Front Endocrinol (Lausanne). 2022;13:808898. Published 2022 Apr 13. DOI:10.3389/fendo.2022.808898.

22. Aly JM, Decherney AH. Lifestyle Modifications in PCOS. Clin Obstet Gynecol. 2021;64(1):83–89. DOI:10.1097/GRF.0000000000000594.

23. de Medeiros SF, Junior JMS, de Medeiros MAS, et al. Combined oral contraceptive use and obesity in women with polycystic ovary syndrome. A meta-analysis of randomized clinical trials. Arch Gynecol Obstet. 2024;310(4):2223–2233. DOI:10.1007/s00404-024-07637-5.

24. Wilkinson LD, Brady PH, Gin GT, et al. Female Pelvic Conditions: Polycystic Ovary Syndrome. FP Essent. 2022;515:26-31.

25. Sam S, Ehrmann DA. Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome. Diabetologia. 2017;60(9):1656–1661. DOI:10.1007/s00125-017-4306-3.

26. Naderpoor N, Shorakae S, de Courten B, et al. Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis [published correction appears in Hum Reprod Update. 2016 Apr;22(3):408–9. DOI:10.1093/humupd/dmv063]. Hum Reprod Update. 2015;21(5):560–574. DOI:10.1093/humupd/dmv025.

27. Szczesnowicz A, Szeliga A, Niwczyk O, et al. Do GLP-1 Analogs Have a Place in the Treatment of PCOS? New Insights and Promising Therapies. J Clin Med. 2023;12(18):5915. Published 2023 Sep 12. DOI:10.3390/jcm12185915.

28. Pugliese G, de Alteriis G, Muscogiuri G, et al. Liraglutide and polycystic ovary syndrome: is it only a matter of body weight? J Endocrinol Invest. 2023;46(9):1761–1774. DOI:10.1007/s40618-023-02084-6.

29. Alesi S, Forslund M, Melin J, et al. Efficacy and safety of anti-androgens in the management of polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials. EClinicalMedicine. 2023;63:102162. Published 2023 Aug 9. DOI:10.1016/j.eclinm.2023.102162.

30. Armanini D, Boscaro M, Bordin L, et al. Controversies in the Pathogenesis, Diagnosis and Treatment of PCOS: Focus on Insulin Resistance, Inflammation, and Hyperandrogenism. Int J Mol Sci. 2022;23(8):4110. Published 2022 Apr 8. DOI:10.3390/ijms23084110.

31. Dinicola S, Unfer V, Facchinetti F, et al. Inositols: From Established Knowledge to Novel Approaches. Int J Mol Sci. 2021;22(19):10575. Published 2021 Sep 30. DOI:10.3390/ijms221910575.

32. Facchinetti F, Bizzarri M, Benvenga S, et al. Results from the International Consensus Conference on Myo-inositol and d-chiro-inositol in Obstetrics and Gynecology: the link between metabolic syndrome and PCOS. Eur J Obstet Gynecol Reprod Biol. 2015;195:72–76. DOI:10.1016/j.ejogrb.2015.09.024.

33. Laganà AS, Forte G, Bizzarri M, et al. Inositols in the ovaries: activities and potential therapeutic applications. Expert Opin Drug Metab Toxicol. 2022;18(2):123–133. DOI:10.1080/17425255.2022.2071259.

34. Bizzarri M, Monti N, Piombarolo A, et al. Myo-Inositol and D-Chiro-Inositol as Modulators of Ovary Steroidogenesis: A Narrative Review. Nutrients. 2023;15(8):1875. Published 2023 Apr 13. DOI:10.3390/nu15081875.

35. Lepore E, Lauretta R, Bianchini M, et al. Inositols Depletion and Resistance: Principal Mechanisms and Therapeutic Strategies. Int J Mol Sci. 2021;22(13):6796. Published 2021 Jun 24. DOI:10.3390/ijms22136796.

36. Dinicola S, Unfer V, Facchinetti F, et al. Inositol: from accumulated knowledge to innovations (translated by O.A. Pustotina). Effective pharmacotherapy. 2022;18(7):20–42. In Russian. DOI:10.33978/2307-3586-2022-18-7-20-42.

37. Zhao H, Xing C, Zhang J, He B. Comparative efficacy of oral insulin sensitizers metformin, thiazolidinediones, inositol, and berberine in improving endocrine and metabolic profiles in women with PCOS: a network meta-analysis. Reprod Health. 2021;18(1):171. Published 2021 Aug 18. DOI:10.1186/s12978-021-01207-7.

38. Greff D, Juhász AE, Váncsa S, et al. Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Reprod Biol Endocrinol. 2023;21(1):10. Published 2023 Jan 26. DOI:10.1186/s12958-023-01055-z.

39. Stefanyan NA, Khashaeva TH, Abusueva ZA, et al. The effect of drugs containing fractions of myo-inositol and D-chiro-inositol on the endocrinological profile in women with menstrual disorders, hyperinsulinemia and obesity. // Sovremennaya nauka: aktual`ny`e problemy` teorii i praktiki. Seriya: Estestvenny`e i Texnicheskie Nauki=Modern science: actual problems of theory and practice. Series: Natural and Technical Sciences. 2022. No. 05. P. 183–188 In Russian. DOI 10.37882/2223-2966.2022.05.30.

40. Pustotina O, Myers SH, Unfer V, et al. The Effects of Myo-Inositol and D-Chiro-Inositol in a Ratio 40:1 on Hormonal and Metabolic Profile in Women with Polycystic Ovary Syndrome Classified as PhenotypeAby the Rotterdam Criteria and EMS-Type 1 by the EGOI Criteria. Gynecol Obstet Invest. 2024;89(2):131–139. In Russian. DOI:10.1159/000536163.

41. Abusueva ZA, Efendieva RM. A method for correcting menstrual disorders in women with metabolic syndrome. Patent for application No. 2813333C1 dated 02.12.2024. In Russian.

42. Efendieva RM, Abusueva ZA, Stefanyan NA, Seidalieva KL. Assessment of markers of cardiovascular risks in women with polycystic ovary syndrome and obesity. Vestnik Dagestanskoj gosudarstvennoj medicinskoj akademii=Herald of the DGMA. 2025;№1(54):39–43. In Russian.

43. Monastra G, Vazquez-Levin M, Bezerra Espinola MS, et al. D-chiro-inositol, an aromatase down-modulator, increases androgens and reduces estrogens in male volunteers: a pilot study. Basic Clin Androl. 2021 Jun 3;31(1):13. DOI:10.1186/s12610-021-00131-x. PMID:34078260; PMCID: PMC8173878.