PCOS Research Update Latest Findings

Polycystic ovary syndrome (PCOS) is a condition that, even after hearing it explained several times, leaves you thinking "so what exactly is it?" This is because the very name "syndrome" means a state in which not a single cause but several aspects overlap and appear. In the clinic, many people come having already encountered the basic concept through other articles or videos. So this article, rather than explaining from scratch what PCOS is, focuses on how the care recommendations presented by international academic societies have recently been updated. The reference document is the international multidisciplinary PCOS assessment and management guideline published in 2023.

The 2023 guideline is an international recommendation that updated the 2018 edition after six years, and is in effect the standard reference document for PCOS care. While the previous edition put weight on organizing the diagnostic criteria, the 2023 edition handles, as one package, lifelong management ranging from diagnosis, assessment, lifestyle, and medication to pregnancy and mental health. It was jointly developed by multinational societies including Australia's NHMRC, and was also adopted by the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE).

Based on a vast systematic review, dozens of evidence-based recommendations and consensus recommendations, and over 100 practice points were organized. What matters more than the numbers is the direction. The point is that it defined PCOS not merely as a problem of menstrual irregularity or infertility, but as a lifelong management disease encompassing metabolic, cardiovascular, and mental health.

The most notable change is that, in adult diagnosis, the AMH (anti-Müllerian hormone) blood test can be used as an alternative to ultrasound. The existing Rotterdam (2003) criteria diagnosed when two of 1) clinical or biochemical hyperandrogenism, 2) ovulatory dysfunction, and 3) polycystic ovarian findings on ultrasound were met.

The 2023 edition, in addition, recommended that in adults, instead of confirming ovarian findings by ultrasound, polycystic ovarian morphology can be defined by the blood AMH value. AMH was deferred in 2018 because the evidence was insufficient, but it is an item that was elevated to a recommendation as data accumulated in the meantime. In the clinic, for those who find pelvic ultrasound burdensome or hard to access, the option of a blood test has now arisen.

The point to note is also clear. PCOS is not asserted by AMH alone; it is used as one piece of the diagnostic puzzle after excluding other causes. How AMH assists diagnosis is organized in more detail in the article dealing with PCOS diagnosis and the AMH test.

In adolescents, the diagnostic criteria were rather kept conservative. This is because, in puberty, menstruation is irregular and acne is common, so it is hard to distinguish the normal developmental process from PCOS.

The guideline had it that, for adolescents, both irregular ovulation and hyperandrogenism must be confirmed for a diagnosis to be considered. Ultrasound or AMH is not recommended for adolescent diagnosis. It means that even the same test has different meaning in adults and adolescents.

• Adults: two of hyperandrogenism, ovulatory dysfunction, ultrasound or AMH
• Adolescents: both irregular ovulation and hyperandrogenism are needed
• Common: first exclude other causes that produce similar symptoms, such as thyroid disease

So when menstruation is erratic in adolescence, it is often not immediately concluded to be PCOS, but tracked over time. If the menstrual cycle itself bothers you, we recommend reading why you should not neglect menstrual irregularity together.

Another axis the 2023 edition emphasized is comorbidities. It is the view that PCOS is not a problem of the ovary alone but is connected to systemic metabolism. The main risks the guideline organized are as follows.

Among these, insulin resistance is recognized as a core characteristic of PCOS, but the guideline specified that tests routinely measuring insulin resistance in clinical practice are not recommended because their accuracy is low. The message is that, rather than increasing test items, it is more reasonable to take care of indicators that lead to actual management, such as weight, blood sugar, and blood pressure. If you are curious about the relationship between weight change and amenorrhea, the connection between weight gain and amenorrhea is also a reference.

The biggest change in attitude in the 2023 guideline is the point of establishing mental health as one pillar of care. Depression and anxiety symptoms are reported to be significantly more common in women with PCOS, and the guideline recommends screening for depression and anxiety for all women with PCOS.

The appropriate cycle for screening has not yet been determined, but an approach is presented of confirming once at the time of diagnosis and afterward repeating it by clinical judgment considering risk factors and life events. Eating disorders and disordered eating habits, lowered body image, self-esteem problems, and sexual function problems were also specified as items to consider together. In the clinic, it is not uncommon for the story "I feel withdrawn because of body hair or weight," rather than test values, to become the thread of recovery.

The principle that lifestyle management rather than medication is first-line was maintained in the 2023 edition too. However, what changed is the point of emphasizing, together, not narrowing the goal to weight loss alone but also the improvement of quality of life. Medication recommendations are easier to understand when organized by symptom.

• Menstrual irregularity and hirsutism: oral contraceptives are the first choice
• Metabolic symptoms: improvement is attempted with metformin, and it is reported to have clearer clinical evidence than inositol, which is commonly mentioned like an artificial sweetener
• Ovulation induction: letrozole is the first choice
• Adjunct therapy: anti-androgens, and for hirsutism, laser hair removal and the like

The drug is only a tool to manage symptoms, not the whole of management. If the discomfort from hirsutism is great, an auxiliary method such as Brazilian hair removal is sometimes used in parallel. Which drug to use when may have individual variation, so adjustment through care rather than self-judgment is needed.

For PCOS women planning pregnancy, the preparation stage is especially important. Because PCOS is reported to have a high risk of pregnancy complications, the guideline first recommends pre-pregnancy management of weight, blood sugar, and blood pressure.

There is a recommended sequence in infertility treatment. The order is to use letrozole first, and if the effect is insufficient, combine clomiphene with metformin, then gonadotropin or ovarian surgery, and finally in vitro fertilization (IVF). Behind letrozole being recommended as first-line are data reporting a higher live birth rate in randomized clinical trials compared with clomiphene.

What matters is that this sequence is not a formula applied "the same to everyone." The starting point and pace differ according to age, comorbidities, and the will to conceive. So PCOS and pregnancy planning are not a one-time decision but closer to a process adjusted together through a regular visit cycle.

PCOS is not a disease that ends after one treatment, but a chronic disease that accompanies you, changing its aspect from the moment of diagnosis until after menopause. In adolescence, caution in diagnosis; in the reproductive years, pregnancy and metabolic management; and after that, management of endometrial and cardiovascular risk each carry weight.

The message the 2023 guideline throws out is, in the end, two things. First, that the diagnostic tools have widened (AMH) but that one must still be cautious in adolescents. Second, that consideration for lifestyle, mental health, and social stigma is as much a part of treatment as the drug. The specific topics will be dealt with in more depth in the following articles.

If any one among the menstrual cycle, weight, body hair, and changes of the heart bothers you, rather than ending it with searching alone, we recommend getting it checked once. If you need a consultation, please feel free to inquire.

Author: Lee Dong-hee Chief Director · Obstetrician-Gynecologist · View staff profile

First published September 27, 2025 · Last reviewed May 30, 2026

References: 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (2023), Monash University PCOS Guideline (2023), ASRM (2023), ESHRE (2023)

This article is intended to provide general health information and does not replace individual diagnosis or treatment. If you have symptoms, please consult through a medical examination.