Menu
Home
People
Places
Arts
History
Plants & Animals
Science
Life & Culture
Technology
Reference.org
Polycystic ovary syndrome
open-in-new
<h2 id="signs-and-symptoms">Signs and symptoms</h2> <p>Signs and symptoms of PCOS include <a href="/facts/Irregular_menstrual_periods/06n59DW5">irregular or no menstrual periods</a>, <a href="/facts/Menorrhagia/cQUgAGNk">heavy periods</a>, <a href="/facts/Hirsutism/k8o1X8xP">excess body and facial hair</a>, <a href="/facts/Acne/TKJxhHSd">acne</a>, <a href="/facts/Infertility/emky9q8L">difficulty getting pregnant</a>, and <a href="/facts/Acanthosis_nigricans/yRSED4vd">patches of thick, darker, velvety skin</a>,<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a> ovarian cysts, enlarged ovaries, excess <a href="/facts/Androgen/Rxey0HxX">androgens</a>, and weight gain.<a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a><a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a> </p><p>Associated conditions include <a href="/facts/Type_2_diabetes_mellitus/zCMXksmt">type 2 diabetes</a>, <a href="/facts/Obesity/RBF9y5Vl">obesity</a>, <a href="/facts/Obstructive_sleep_apnea/ojyjhTvz">obstructive sleep apnea</a>, <a href="/facts/Heart_disease/HD420nMv">heart disease</a>, <a href="/facts/Mood_disorder/Y0Mjq3QR">mood disorders</a>, and <a href="/facts/Endometrial_cancer/rh605tHh">endometrial cancer</a>.<a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a> </p><p>Common signs and symptoms of PCOS include the following: </p> <ul><li><a href="/facts/Menstrual_disorder/zfytcBDT">Menstrual disorders</a>: PCOS mostly produces <a href="/facts/Oligomenorrhea/cBAsRfxG">oligomenorrhea</a> (fewer than nine menstrual periods in a year) or <a href="/facts/Amenorrhea/axu8sS38">amenorrhea</a> (no menstrual periods for three or more consecutive months), but other types of menstrual disorders may also occur.<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a></li> <li><a href="/facts/Infertility/emky9q8L">Infertility</a>: This generally results directly from chronic <a href="/facts/Anovulation/nbg5Speh">anovulation</a> (lack of ovulation).<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a></li> <li><a href="/facts/Hyperandrogenism/ATvFXbXX">High levels of masculinizing hormones</a>: Known as hyperandrogenism, the most common signs are <a href="/facts/Acne/TKJxhHSd">acne</a> and <a href="/facts/Hirsutism/k8o1X8xP">hirsutism</a> (male pattern of hair growth, such as on the chin or chest), but it may produce <a href="/facts/Hypermenorrhea/cQUgAGNk">hypermenorrhea</a> (heavy and prolonged menstrual periods), <a href="/facts/Androgenic_alopecia/VzqlyjF9">androgenic alopecia</a> (increased hair thinning or diffuse hair loss), or other symptoms.<a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a><a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a> Approximately three-quarters of women with PCOS (by the diagnostic criteria of NIH/NICHD 1990) have evidence of <a href="/facts/Hyperandrogenemia/ATvFXbXX">hyperandrogenemia</a>.<a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a></li> <li><a href="/facts/Metabolic_syndrome/jI70tRBv">Metabolic syndrome</a>: This appears as a tendency towards <a href="/facts/Central_obesity/VKc32krz">central obesity</a> and other symptoms associated with <a href="/facts/Insulin_resistance/cz6oFqke">insulin resistance</a>, including low energy levels and food cravings.<a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a> Serum <a href="/facts/Insulin/oXG0myt1">insulin</a>, insulin resistance, and <a href="/facts/Homocysteine/m4cgrRBG">homocysteine</a> levels are higher in women with PCOS.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a></li> <li><a href="/facts/Acne/TKJxhHSd">Acne</a>: A rise in testosterone levels increases the oil production within the sebaceous glands and clogs pores.<a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a> For many women, the emotional impact is great and quality of life can be significantly reduced.<a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a></li> <li><a href="/facts/Androgenic_alopecia/VzqlyjF9">Androgenic alopecia</a>: Estimates suggest that androgenic alopecia affects 22% of PCOS sufferers.<a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a></li> <li><a href="/facts/Acanthosis_nigricans/yRSED4vd">Acanthosis nigricans</a> (AN): A skin condition where dark, thick, and "velvety" patches can form.<a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a> Often forms under the arms, in the groin area, on the back of the neck.<a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a></li> <li>Polycystic ovaries: There are small cysts on one or both ovaries. <a href="/facts/Ovary/z2hG6bNy">Ovaries</a> might enlarge and compress follicles surrounding the eggs. As a result, ovaries might fail to function regularly. This disease is related to the number of follicles per ovary each month, growing from the average range of 6–8 to double, triple, or more.</li></ul> <p>Women with PCOS tend to have central obesity. Still, studies are conflicting as to whether visceral and subcutaneous abdominal fat is increased, unchanged, or decreased in women with PCOS relative to non-PCOS women with the same <a href="/facts/Body_mass_index/UX4YrUTx">body mass index</a>.<a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a> In any case, androgens, such as <a href="/facts/Testosterone_(medication)/sqLR44L3">testosterone</a>, <a href="/facts/Androstanolone/fuPpQYqC">androstanolone</a> (dihydrotestosterone), and <a href="/facts/Nandrolone_decanoate/ezrNGa2U">nandrolone decanoate</a> have been found to increase visceral fat deposition in both female animals and women.<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a> </p><p>Although 80% of PCOS presents in women with obesity, 20% of women diagnosed with the disease are non-obese or "lean" women.<a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a> However, obese women who have PCOS have a higher risk of adverse outcomes, such as <a href="/facts/Hypertension/wlAvBfcf">hypertension</a>, <a href="/facts/Insulin_resistance/cz6oFqke">insulin resistance</a>, <a href="/facts/Metabolic_syndrome/jI70tRBv">metabolic syndrome</a>, and <a href="/facts/Endometrial_hyperplasia/NAnKxrYs">endometrial hyperplasia</a>.<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a> </p><p>Even though most women with PCOS are overweight or obese, non-overweight women can also be diagnosed with PCOS. Up to 30% of women diagnosed with PCOS maintain a normal weight before and after diagnosis. "Lean" women still face the various symptoms of PCOS with the added challenges of having their symptoms properly addressed and recognized. Lean women often go undiagnosed for years and are usually diagnosed after struggles to conceive.<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> Lean women are likely to have a missed diagnosis of diabetes and cardiovascular disease. These women also have an increased risk of developing insulin resistance, despite not being overweight. Lean women are often taken less seriously with their diagnosis of PCOS and also face challenges finding appropriate treatment options. This is because most treatment options are limited to approaches for losing weight and healthy dieting.<a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a> </p> <h3>Hormone levels</h3> <p><a href="/facts/Testosterone/uUumdhAz">Testosterone</a> levels are usually elevated in women with PCOS.<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a><a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a> In a 2020 <a href="/facts/Systematic_review/dGvq3BGx">systematic review</a> and <a href="/facts/Meta-analysis/IcfChd8z">meta-analysis</a> of sexual dysfunction related to PCOS which included 5,366 women with PCOS from 21 studies, testosterone levels were analyzed and were found to be 2.34 nmol/L (67 ng/dL) in women with PCOS and 1.57 nmol/L (45 ng/dL) in women without PCOS.<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a> If testosterone levels are above 100 to 200 ng/dL, per different sources, other possible causes of <a href="/facts/Hyperandrogenism/ATvFXbXX">hyperandrogenism</a>, such as <a href="/facts/Congenital_adrenal_hyperplasia/HTXWkLl8">congenital adrenal hyperplasia</a> or an <a href="/facts/Androgen/Rxey0HxX">androgen</a>-secreting <a href="/facts/Tumor/K0ytzmPz">tumor</a>, may be present and should be excluded.<a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a><a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a><a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> </p> <h3>Associated conditions</h3> <p>Warning signs may include a change in appearance. But there are also manifestations of mental health problems, such as anxiety, depression, and eating disorders.<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a>[<i>medical citation needed</i>] </p><p>A diagnosis of PCOS suggests an increased risk of the following: </p> <ul><li><a href="/facts/Endometrial_hyperplasia/NAnKxrYs">Endometrial hyperplasia</a> and <a href="/facts/Endometrial_cancer/rh605tHh">endometrial cancer</a> (cancer of the uterine lining) are possible, due to overaccumulation of the uterine lining, and also lack of <a href="/facts/Progesterone/WEj2TGRm">progesterone</a>, resulting in prolonged stimulation of uterine cells by estrogen.<a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a><a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a> It is not clear whether this risk is directly due to the syndrome or from the associated obesity, <a href="/facts/Hyperinsulinemia/bRNuEMDW">hyperinsulinemia</a>, and <a href="/facts/Hyperandrogenism/ATvFXbXX">hyperandrogenism</a>.<a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a><a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a><a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a></li> <li><a href="/facts/Insulin_resistance/cz6oFqke">Insulin resistance</a>/<a href="/facts/Type_2_diabetes/zCMXksmt">type 2 diabetes</a>. A review published in 2010 concluded that women with PCOS have an elevated prevalence of insulin resistance and type 2 diabetes, even when controlling for <a href="/facts/Body_mass_index/UX4YrUTx">body mass index</a> (BMI).<a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a><a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a> PCOS is also associated with higher risk for diabetes.<a class="footnote-ref" id="fnref:45" href="#fn:45"><sup>45</sup></a></li> <li><a href="/facts/High_blood_pressure/wlAvBfcf">High blood pressure</a>, in particular if obese or during pregnancy<a class="footnote-ref" id="fnref:46" href="#fn:46"><sup>46</sup></a></li> <li><a href="/facts/Depression_(mood)/GDNFWm1L">Depression</a> and <a href="/facts/Anxiety_(mood)/Geekl883">anxiety</a><a class="footnote-ref" id="fnref:47" href="#fn:47"><sup>47</sup></a><a class="footnote-ref" id="fnref:48" href="#fn:48"><sup>48</sup></a></li> <li><a href="/facts/Dyslipidemia/ty4sC76X">Dyslipidemia</a> – disorders of lipid metabolism – cholesterol and triglycerides. Women with PCOS show a decreased removal of <a href="/facts/Atherosclerosis/WIS8QQ6v">atherosclerosis</a>-inducing remnants, seemingly independent of insulin resistance/type 2 diabetes.<a class="footnote-ref" id="fnref:49" href="#fn:49"><sup>49</sup></a></li> <li><a href="/facts/Cardiovascular_disease/HD420nMv">Cardiovascular disease</a>,<a class="footnote-ref" id="fnref:50" href="#fn:50"><sup>50</sup></a> with a meta-analysis estimating a 2-fold risk of arterial disease for women with PCOS relative to women without PCOS, independent of BMI.<a class="footnote-ref" id="fnref:51" href="#fn:51"><sup>51</sup></a></li> <li><a href="/facts/Stroke/DwpjdzY0">Strokes</a><a class="footnote-ref" id="fnref:52" href="#fn:52"><sup>52</sup></a></li> <li><a href="/facts/Weight_gain/jVbY8Eao">Weight gain</a></li> <li><a href="/facts/Miscarriage/sFq0vdnU">Miscarriage</a><a class="footnote-ref" id="fnref:53" href="#fn:53"><sup>53</sup></a><a class="footnote-ref" id="fnref:54" href="#fn:54"><sup>54</sup></a></li> <li><a href="/facts/Sleep_apnea/mstY43ok">Sleep apnea</a>, particularly if obesity is present<a class="footnote-ref" id="fnref:55" href="#fn:55"><sup>55</sup></a></li> <li><a href="/facts/Non-alcoholic_fatty_liver_disease/WoAmAUmV">Non-alcoholic fatty liver disease</a>, particularly if obesity is present<a class="footnote-ref" id="fnref:56" href="#fn:56"><sup>56</sup></a></li></ul> <p>The risk of <a href="/facts/Ovarian_cancer/fsWbh3Tn">ovarian cancer</a> and <a href="/facts/Breast_cancer/6hME580v">breast cancer</a> is not significantly increased overall, but women with PCOS were about three times more likely to develop <a href="/facts/Endometrial_cancer/rh605tHh">endometrial cancer</a> than other women.<a class="footnote-ref" id="fnref:57" href="#fn:57"><sup>57</sup></a> </p><p>Some medical providers and groups consider PCOS to be an <a href="/facts/Intersex/r8JC6taq">intersex</a> condition because some sex hormones are outside the typical range.<a class="footnote-ref" id="fnref:58" href="#fn:58"><sup>58</sup></a> However, medical consensus, including the Endocrine Society and NIH, defines PCOS as an endocrine/metabolic disorder, not intersex, as it lacks congenital sex characteristic variations.<a class="footnote-ref" id="fnref:59" href="#fn:59"><sup>59</sup></a><a class="footnote-ref" id="fnref:60" href="#fn:60"><sup>60</sup></a> A 2023 study notes two transmasculine individuals self-identified as intersex without medical diagnosis, tying it to identity, not biology.<a class="footnote-ref" id="fnref:61" href="#fn:61"><sup>61</sup></a> </p> <h2 id="cause">Cause</h2> <p>PCOS is a <a href="/facts/Heterogeneous_disorder/Bl7orLcn">heterogeneous disorder</a> of uncertain cause.<a class="footnote-ref" id="fnref:62" href="#fn:62"><sup>62</sup></a><a class="footnote-ref" id="fnref:63" href="#fn:63"><sup>63</sup></a> There is some evidence that it is a <a href="/facts/Genetic_disease/hFqt2NLn">genetic disease</a>. Such evidence includes the familial clustering of cases, greater <a href="/facts/Concordance_(genetics)/yg11FFB8">concordance</a> in <a href="/facts/Monozygotic_twin/9QSssff4">monozygotic</a> compared with <a href="/facts/Dizygotic/9QSssff4">dizygotic</a> twins and heritability of endocrine and metabolic features of PCOS.<a class="footnote-ref" id="fnref:64" href="#fn:64"><sup>64</sup></a><a class="footnote-ref" id="fnref:65" href="#fn:65"><sup>65</sup></a><a class="footnote-ref" id="fnref:66" href="#fn:66"><sup>66</sup></a> There is some evidence that exposure to higher than typical levels of <a href="/facts/Androgens/Rxey0HxX">androgens</a> and the <a href="/facts/Anti-M%25C3%25BCllerian_hormone/P4zTofK4">anti-Müllerian hormone</a> (AMH) <i>in utero</i> increases the risk of developing PCOS in later life.<a class="footnote-ref" id="fnref:67" href="#fn:67"><sup>67</sup></a> </p><p>It may be caused by a combination of genetic and environmental factors.<a class="footnote-ref" id="fnref:68" href="#fn:68"><sup>68</sup></a><a class="footnote-ref" id="fnref:69" href="#fn:69"><sup>69</sup></a><a class="footnote-ref" id="fnref:70" href="#fn:70"><sup>70</sup></a> Risk factors include <a href="/facts/Obesity/RBF9y5Vl">obesity</a>, a lack of physical exercise, and a family history of someone with the condition.<a class="footnote-ref" id="fnref:71" href="#fn:71"><sup>71</sup></a> Diagnosis is based on two of the following three findings: <a href="/facts/Anovulation/nbg5Speh">anovulation</a>, high androgen levels, and <a href="/facts/Ovarian_cysts/Gf7dK4U6">ovarian cysts</a>.<a class="footnote-ref" id="fnref:72" href="#fn:72"><sup>72</sup></a> Other conditions that produce similar symptoms include <a href="/facts/Adrenal_hyperplasia/HTXWkLl8">adrenal hyperplasia</a>, <a href="/facts/Hypothyroidism/oqtQDu2F">hypothyroidism</a>, and <a href="/facts/Hyperprolactinemia/cTdwMNlP">high blood levels of prolactin</a>.<a class="footnote-ref" id="fnref:73" href="#fn:73"><sup>73</sup></a> </p> <h3>Genetics</h3> <p>The genetic component appears to be inherited in an <a href="/facts/Autosomal_dominant/DsvtPyQU">autosomal dominant</a> fashion with high <a href="/facts/Genetic_penetrance/dwTN9Wyb">genetic penetrance</a> but variable <a href="/facts/Expressivity_(genetics)/rC0roKbX">expressivity</a> in females; this means that each child has a 50% chance of inheriting the predisposing genetic variant(s) from a parent, and, if a daughter receives the variant(s), the daughter will have the disease to some extent.<a class="footnote-ref" id="fnref:74" href="#fn:74"><sup>74</sup></a><a class="footnote-ref" id="fnref:75" href="#fn:75"><sup>75</sup></a><a class="footnote-ref" id="fnref:76" href="#fn:76"><sup>76</sup></a><a class="footnote-ref" id="fnref:77" href="#fn:77"><sup>77</sup></a> The genetic variant(s) can be inherited from either the father or the mother, and can be passed along to both sons (who may be asymptomatic carriers or may have symptoms such as early <a href="/facts/Baldness/uEPKUafl">baldness</a> and/or excessive hair) and daughters, who will show signs of PCOS.<a class="footnote-ref" id="fnref:78" href="#fn:78"><sup>78</sup></a><a class="footnote-ref" id="fnref:79" href="#fn:79"><sup>79</sup></a> The <a href="/facts/Phenotype/vxWXKGLj">phenotype</a> appears to manifest itself at least partially via heightened androgen levels secreted by <a href="/facts/Theca_of_follicle/UaclmFyV">ovarian follicle theca</a> cells from women with the allele.<a class="footnote-ref" id="fnref:80" href="#fn:80"><sup>80</sup></a> The exact gene affected has not yet been identified.<a class="footnote-ref" id="fnref:81" href="#fn:81"><sup>81</sup></a><a class="footnote-ref" id="fnref:82" href="#fn:82"><sup>82</sup></a><a class="footnote-ref" id="fnref:83" href="#fn:83"><sup>83</sup></a> In rare instances, single-gene mutations can give rise to the syndrome phenotype.<a class="footnote-ref" id="fnref:84" href="#fn:84"><sup>84</sup></a> Current understanding of the pathogenesis of the syndrome suggests, however, that it is a complex multigenic disorder.<a class="footnote-ref" id="fnref:85" href="#fn:85"><sup>85</sup></a> </p><p>The severity of PCOS symptoms appears to be largely determined by factors such as obesity.<a class="footnote-ref" id="fnref:86" href="#fn:86"><sup>86</sup></a><a class="footnote-ref" id="fnref:87" href="#fn:87"><sup>87</sup></a><a class="footnote-ref" id="fnref:88" href="#fn:88"><sup>88</sup></a> PCOS has some aspects of a <a href="/facts/Metabolic_disorder/mXnwRURT">metabolic disorder</a>, since its symptoms are partly reversible. Even though considered as a <a href="/facts/Gynaecology/KKAAAcnb">gynecological</a> problem, PCOS consists of 28 clinical symptoms.<a class="footnote-ref" id="fnref:89" href="#fn:89"><sup>89</sup></a> </p><p>Even though the name suggests that the ovaries are central to disease pathology, cysts are a symptom instead of the cause of the disease. Some symptoms of PCOS will persist even if both ovaries are removed; the disease can appear even if cysts are absent. Since its first description by Stein and Leventhal in 1935, the criteria of diagnosis, symptoms, and causative factors have been subject to debate. Gynecologists often see it as a gynecological problem, with the ovaries being the primary organ affected. However, recent insights show a multisystem disorder, with the primary problem lying in hormonal regulation in the <a href="/facts/Hypothalamus/lCkNt1bM">hypothalamus</a>, with the involvement of many organs. The term PCOS is used because there is a wide spectrum of symptoms possible. It is common to have polycystic ovaries without having PCOS; approximately 20% of European women have polycystic ovaries, but most of those women do not have PCOS.<a class="footnote-ref" id="fnref:90" href="#fn:90"><sup>90</sup></a> </p> <h3>Environment</h3> <p>PCOS may be related to or worsened by exposures during the <a href="/facts/Pregnancy/vEKYGpep">prenatal period</a>,<a class="footnote-ref" id="fnref:91" href="#fn:91"><sup>91</sup></a><a class="footnote-ref" id="fnref:92" href="#fn:92"><sup>92</sup></a><a class="footnote-ref" id="fnref:93" href="#fn:93"><sup>93</sup></a> <a href="/facts/Epigenetic/UfAAERcn">epigenetic</a> factors, environmental impacts (especially industrial endocrine disruptors, such as <a href="/facts/Bisphenol_A/8AAPhAh0">bisphenol A</a> and certain drugs)<a class="footnote-ref" id="fnref:94" href="#fn:94"><sup>94</sup></a><a class="footnote-ref" id="fnref:95" href="#fn:95"><sup>95</sup></a><a class="footnote-ref" id="fnref:96" href="#fn:96"><sup>96</sup></a> and the increasing rates of obesity.<a class="footnote-ref" id="fnref:97" href="#fn:97"><sup>97</sup></a> </p><p><a href="/facts/Endocrine_disruptor/Yk2hfnTj">Endocrine disruptors</a> are defined as chemicals that can interfere with the <a href="/facts/Endocrine_system/PDvN5cpj">endocrine system</a> by mimicking hormones such as <a href="/facts/Estrogen/dPEewnDV">estrogen</a>. According to the <a href="/facts/National_Institutes_of_Health/G3Eytfcc">NIH (National Institute of Health)</a>, examples of endocrine disruptors can include <a href="/facts/Dioxins/rnbBvjGp">dioxins</a> and <a href="/facts/Triclosan/76PWh6tX">triclosan</a>. Endocrine disruptors can cause adverse health impacts in animals.<a class="footnote-ref" id="fnref:98" href="#fn:98"><sup>98</sup></a> Additional research is needed to assess the role that endocrine disruptors may play in disrupting reproductive health in women and possibly triggering or exacerbating PCOS and its related symptoms.<a class="footnote-ref" id="fnref:99" href="#fn:99"><sup>99</sup></a> </p><p>The study of epigenetic changes in PCOS in utero or after birth has become an emerging area of research. While extensive research is not currently available, some studies are looking into the connection between abnormal DNA methylation changes in various tissues and the development of PCOS.<a class="footnote-ref" id="fnref:100" href="#fn:100"><sup>100</sup></a> Environmental exposure to endocrine disruptors such as phthalates could alter DNA methylation patterns, particularly in the ovaries, granulosa cells, and adipose tissue.<a class="footnote-ref" id="fnref:101" href="#fn:101"><sup>101</sup></a> </p><p>One study observed early embryonic development of mice subjected to di--(2-ethylhexyl) phthalate (DEHP) and the results showed abnormal methylation patterns in the Stra8 gene involved in meiosis initiation.<a class="footnote-ref" id="fnref:102" href="#fn:102"><sup>102</sup></a> The gene for transcription factor Lhx8, involved in early follicular changes, was also impacted by DEHP when the neonatal mouse ovaries were analyzed. Together, these results showed DEHP induced epigenetic changes via DNA methylation to interfere with folliculogenesis, symptomatic of PCOS.<a class="footnote-ref" id="fnref:103" href="#fn:103"><sup>103</sup></a> Although DNA methylation in human embryonic development is not fully characterized, the animal model studies on epigenetic changes provide information to suggest that PCOS may have fetal origins. </p><p>Androgen excess is a central feature in the PCOS phenotype, and exposure in utero has shown PCOS-like features in adulthood. A study from 2014 induced DNA hypomethylation in the ovarian tissue of zebrafish exposed to androgens early in development.<a class="footnote-ref" id="fnref:104" href="#fn:104"><sup>104</sup></a> Glucose homeostasis alterations were also observed. Furthermore, these effects were carried into the next generation, suggesting that epigenetic changes caused by excess androgens in the fetus could be transgenerational.<a class="footnote-ref" id="fnref:105" href="#fn:105"><sup>105</sup></a> </p> <h2 id="mechanism">Mechanism</h2> <p>Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of androgenic hormones, in particular testosterone, by either one or a combination of the following (almost certainly combined with genetic susceptibility):<a class="footnote-ref" id="fnref:106" href="#fn:106"><sup>106</sup></a> </p> <ul><li>The release of excessive <a href="/facts/Luteinizing_hormone/a6znte2S">luteinizing hormone</a> (LH) by the <a href="/facts/Anterior_pituitary/uUj4jzRq">anterior pituitary</a> gland</li> <li>through high levels of insulin in the blood (<a href="/facts/Hyperinsulinaemia/bRNuEMDW">hyperinsulinaemia</a>) in women whose ovaries are sensitive to this stimulus</li></ul> <p>A majority of women with PCOS have <a href="/facts/Insulin_resistance/cz6oFqke">insulin resistance</a> and/or are <a href="/facts/Obese/RBF9y5Vl">obese</a>, which is a strong risk factor for insulin resistance, although insulin resistance is a common finding among women with PCOS in normal-weight women as well.<a class="footnote-ref" id="fnref:107" href="#fn:107"><sup>107</sup></a><a class="footnote-ref" id="fnref:108" href="#fn:108"><sup>108</sup></a><a class="footnote-ref" id="fnref:109" href="#fn:109"><sup>109</sup></a> Elevated insulin levels contribute to or cause the abnormalities seen in the <a href="/facts/Hypothalamic%25E2%2580%2593pituitary%25E2%2580%2593gonadal_axis/0G9ALlpQ">hypothalamic–pituitary–ovarian axis</a> that lead to PCOS. Hyperinsulinemia increases <a href="/facts/GnRH/hSsFPpdj">GnRH</a> pulse frequency,<a class="footnote-ref" id="fnref:110" href="#fn:110"><sup>110</sup></a> which in turn results in an increase in the LH/FSH ratio<a class="footnote-ref" id="fnref:111" href="#fn:111"><sup>111</sup></a><a class="footnote-ref" id="fnref:112" href="#fn:112"><sup>112</sup></a> increased ovarian androgen production; decreased follicular maturation; and decreased <a href="/facts/SHBG/9gVoXJMz">SHBG</a> binding.<a class="footnote-ref" id="fnref:113" href="#fn:113"><sup>113</sup></a> Furthermore, excessive insulin increases the activity of <a href="/facts/17%25CE%25B1-hydroxylase/MQcrtxpv">17α-hydroxylase</a>, which catalyzes the conversion of <a href="/facts/Progesterone/WEj2TGRm">progesterone</a> to <a href="/facts/Androstenedione/GBHxaQvQ">androstenedione</a>, which is in turn converted to testosterone. The combined effects of <a href="/facts/Hyperinsulinemia/bRNuEMDW">hyperinsulinemia</a> contribute to an increased risk of PCOS.<a class="footnote-ref" id="fnref:114" href="#fn:114"><sup>114</sup></a> </p><p><a href="/facts/Adipose_tissue/PxxedB6e">Adipose (fat) tissue</a> possesses <a href="/facts/Aromatase/MMXTK90e">aromatase</a>, an enzyme that converts androstenedione to <a href="/facts/Estrone/FDbcmBGS">estrone</a> and testosterone to <a href="/facts/Estradiol/eCg3UCgX">estradiol</a>. The excess of adipose tissue in obese women creates the paradox of having both excess androgens (which are responsible for hirsutism and <a href="/facts/Virilization/vcckVBu9">virilization</a>) and excess estrogens (which inhibit FSH via <a href="/facts/Negative_feedback/G9byVgpN">negative feedback</a>).<a class="footnote-ref" id="fnref:115" href="#fn:115"><sup>115</sup></a> </p><p>The syndrome acquired its most widely used name due to the common sign on ultrasound examination of multiple (poly) ovarian <a href="/facts/Cyst/N1n2ogU9">cysts</a>. These "cysts" are in fact immature <a href="/facts/Ovarian_follicles/7eKGUwb6">ovarian follicles</a>. The follicles have developed from primordial follicles, but this development has stopped ("arrested") at an early stage, due to the disturbed ovarian function. The follicles may be oriented along the ovarian periphery, appearing as a 'string of pearls' on ultrasound examination.<a class="footnote-ref" id="fnref:116" href="#fn:116"><sup>116</sup></a> </p><p>PCOS may be associated with <a href="/facts/Chronic_inflammation/QvI3Xphr">chronic inflammation</a>,<a class="footnote-ref" id="fnref:117" href="#fn:117"><sup>117</sup></a> with several investigators correlating inflammatory mediators with anovulation and other PCOS symptoms.<a class="footnote-ref" id="fnref:118" href="#fn:118"><sup>118</sup></a><a class="footnote-ref" id="fnref:119" href="#fn:119"><sup>119</sup></a> Similarly, there seems to be a relation between PCOS and an increased level of <a href="/facts/Oxidative_stress/HX7dfUUb">oxidative stress</a>.<a class="footnote-ref" id="fnref:120" href="#fn:120"><sup>120</sup></a> </p> <h2 id="diagnosis">Diagnosis</h2> <p>Not every person with PCOS has polycystic ovaries (PCO), nor does everyone with <a href="/facts/Ovarian_cyst/Gf7dK4U6">ovarian cysts</a> have PCOS; although a <a href="/facts/Pelvic_ultrasound/Ju5BFuuV">pelvic ultrasound</a> is a major diagnostic tool, it is not the only one.<a class="footnote-ref" id="fnref:121" href="#fn:121"><sup>121</sup></a> The diagnosis is fairly straightforward using the Rotterdam criteria, even when the syndrome is associated with a wide range of symptoms.<a class="footnote-ref" id="fnref:122" href="#fn:122"><sup>122</sup></a> </p> <h3>Diagnostic criteria</h3> <p>There are different criteria for PCOS; the 2023 International Evidence-based Guidelines for Assessment and Management of PCOS recommend the revised Rotterdam criteria for diagnosing PCOS. That is, PCOS is present in adults when two out of these three criteria are met:<a class="footnote-ref" id="fnref:123" href="#fn:123"><sup>123</sup></a><a class="footnote-ref" id="fnref:124" href="#fn:124"><sup>124</sup></a> </p> <ol><li>Signs of androgen excess (clinical or biochemical). Androgens are "male" hormones, which can for instance cause facial hair.<a class="footnote-ref" id="fnref:125" href="#fn:125"><sup>125</sup></a></li> <li>Ovulatory dysfunction with irregular or absent menstrual cycles</li> <li>Polycystic ovaries on ultrasound or elevated <a href="/facts/Anti-mullerian_hormone/P4zTofK4">anti-mullerian hormone</a> (AMH) levels</li></ol> <p>Other causes of these issues need to be excluded. In <a href="/facts/Adolescence/XUkTHFyd">adolescents</a>, both androgen excess and ovulatory dysfunction are required, as AMH and ultrasounds are not specific in this population.<a class="footnote-ref" id="fnref:126" href="#fn:126"><sup>126</sup></a> Adolescents that only meet one criterion are considered 'at risk', to be reassessed when they are adults.<a class="footnote-ref" id="fnref:127" href="#fn:127"><sup>127</sup></a> Older criteria are the 1990 NIH criteria and the 2006 Androgen Excess Society criteria.<a class="footnote-ref" id="fnref:128" href="#fn:128"><sup>128</sup></a> The Androgen Excess criteria were never adopted widely. The old NIH criteria are stricter than the Rotterdam criteria, as both oligoovulation and signs of androgen excess need to be present:<a class="footnote-ref" id="fnref:129" href="#fn:129"><sup>129</sup></a> </p> <ol><li>Oligoovulation</li> <li>Signs of androgen excess (clinical or biochemical)</li> <li>Exclusion of other disorders that can result in the above</li></ol> <h3>Assessment and testing</h3> <p>There is a three-step algorithm for diagnosis PCOS. In the first step, clinical androgen excess and irregular menstrual cycles are assessed. If someone has both and other causes are excluded, PCOS is diagnosed. In step 2, those with only irregular cycles undergo a laboratory test for excess androgens in the blood. If that shows excess male hormones, again excluding other causes of systems, PCOS is diagnosed. In the third step, for those with either irregular cycles or excess androgens, an ultrasound is performed or a AMH test, but not both to prevent overdiagnosis. If this test shows polycystic ovaries or elevated AMH levels, PCOS is diagnosed.<a class="footnote-ref" id="fnref:130" href="#fn:130"><sup>130</sup></a> </p><p>Clinical androgen excess in adults can result in acne, hirsutism (male pattern of hair growth, such as on the chin or chest) and in <a href="/facts/Female_pattern_hair_loss/VzqlyjF9">female pattern hair loss</a>. Hirsutism can be assessed using the standardised <a href="/facts/Ferriman%25E2%2580%2593Gallwey_score/5madWJY5">Ferriman–Gallwey visual scoring system</a>, with a score above 4 to 6 indicating clinical significance.<a class="footnote-ref" id="fnref:131" href="#fn:131"><sup>131</sup></a> The recommended cut-off score depends on ethnicity, with a lower cut-off for Asian women, and a higher cut-off for Hispanic and Middle Eastern women.<a class="footnote-ref" id="fnref:132" href="#fn:132"><sup>132</sup></a> Assessment may be complicated by self-treatment.<a class="footnote-ref" id="fnref:133" href="#fn:133"><sup>133</sup></a> Hair loss can be assessed with the <a href="/facts/Ludwig_scale/3rvB3HtQ">Ludwig visual score</a>. In adolescents, androgen excess shows as severe acne and hirsutism.<a class="footnote-ref" id="fnref:134" href="#fn:134"><sup>134</sup></a> </p><p>For individuals who had their <a href="/facts/First_menstrual_cycle/EFzGSWMk">first menstrual</a> <a href="/facts/First_menstrual_cycle/EFzGSWMk">cycle</a> more than three years ago, menstrual cycles are considered irregular if they occur less than 21 days apart or more than 35 days apart. For those whose first menstrual cycle was between one and three years ago, the cycle is considered irregular if it is less than 21 days apart or more than 45 days apart. Finally, for anyone whose first cycle was over a year ago, a single cycle lasting over 90 days is considered irregular.<a class="footnote-ref" id="fnref:135" href="#fn:135"><sup>135</sup></a> </p><p>Biochemical androgen excess in PCOS is assessed using total and <a href="/facts/Free_testosterone/uUumdhAz">free testosterone</a>. Accurate measurement requires <a href="/facts/Tandem_mass_spectrometry/otT5Q9tY">tandem mass spectometry</a> assays, as direct free testosterone tests are not reliable. Interpretation is based on laboratory reference ranges. <a href="/facts/Hormonal_contraception/xVw5DPGT">Hormonal contraception</a> can interfere with hormone levels, so a withdrawal period of at least three months with alternative contraception may be needed. Markedly elevated androgen levels may indicate other conditions.<a class="footnote-ref" id="fnref:136" href="#fn:136"><sup>136</sup></a> </p><p><a href="/facts/Gynecologic_ultrasonography/0HQbcqke">Gynecologic ultrasonography</a> first looks for small <a href="/facts/Ovarian_follicles/7eKGUwb6">ovarian follicles</a>.<a class="footnote-ref" id="fnref:137" href="#fn:137"><sup>137</sup></a> To count as polycystic ovaries, at least 20 follicles need to be present smaller than 9 mm. This used to be 12 in older diagnostic criteria.<a class="footnote-ref" id="fnref:138" href="#fn:138"><sup>138</sup></a> A less clear marker of PCOS is enlarged ovaries.<a class="footnote-ref" id="fnref:139" href="#fn:139"><sup>139</sup></a> Ovary need to be at least 10 cm3 to count.<a class="footnote-ref" id="fnref:140" href="#fn:140"><sup>140</sup></a> For sexually active individuals or those that agree, a <a href="/facts/Vaginal_ultrasonography/GsYLQNEe">transvaginal ultrasound</a> approach is preferred. Alternatively, AMH levels can be tested in the blood.<a class="footnote-ref" id="fnref:141" href="#fn:141"><sup>141</sup></a> <a href="/facts/Laparoscopic_surgery/cTMKggTn">Laparoscopic</a> examination may reveal a thickened, smooth, pearl-white outer surface of the ovary. This would usually be an incidental finding if laparoscopy were performed for some other reason, as it would not be routine to examine the ovaries in this way to confirm a diagnosis of PCOS.<a class="footnote-ref" id="fnref:142" href="#fn:142"><sup>142</sup></a> </p> <h3>Differential diagnosis</h3> <p>To diagnose PCOS, other conditions must first be ruled out. These include <a href="/facts/Thyroid_disease/51xH3TXu">thyroid disease</a> (assessed via <a href="/facts/Thyroid-stimulating_hormone/w8ettSpY">thyroid stimulating hormone</a>), <a href="/facts/Hyperprolactinaemia/cTdwMNlP">hyperprolactinemia</a> (assessed via <a href="/facts/Prolactin/NcdqrzFU">prolactin</a>), and non-classic <a href="/facts/Congenital_adrenal_hyperplasia/HTXWkLl8">congenital adrenal hyperplasia</a> (tested via <a href="/facts/17-hydroxy_progesterone/RzVgaTaK">17-hydroxy progesterone</a>). For those <a href="/facts/Amenorrhea/axu8sS38">without any periods</a> whatsoever or more severe signs or symptoms, further tests are recommended to exclude <a href="/facts/Hypogonadotropic_hypogonadism/MWzcDv9V">hypogonadotropic hypogonadism</a>, any androgen producing <a href="/facts/Neoplasm/K0ytzmPz">tumors</a> or <a href="/facts/Cushing%2527s_disease/HqfLkI5J">Cushing's disease</a>. Overt <a href="/facts/Virilization/vcckVBu9">virilisation</a> (development of male sex characteristics) is not characteristic of PCOS and indicates that another underlying condition may be responsible.<a class="footnote-ref" id="fnref:143" href="#fn:143"><sup>143</sup></a> </p> <h2 id="management">Management</h2> <p>PCOS has no cure.<a class="footnote-ref" id="fnref:144" href="#fn:144"><sup>144</sup></a> Treatment may involve lifestyle changes such as weight loss and exercise.<a class="footnote-ref" id="fnref:145" href="#fn:145"><sup>145</sup></a><a class="footnote-ref" id="fnref:146" href="#fn:146"><sup>146</sup></a> Recent research suggests that daily exercise including both aerobic and strength activities can improve hormone imbalances.<a class="footnote-ref" id="fnref:147" href="#fn:147"><sup>147</sup></a> </p><p><a href="/facts/Birth_control_pills/QfDgVrGA">Birth control pills</a> may help with improving the regularity of periods, excess hair growth, and acne.<a class="footnote-ref" id="fnref:148" href="#fn:148"><sup>148</sup></a> Combined oral contraceptives are especially effective and used as the first line of treatment to reduce acne and hirsutism and regulate the menstrual cycle. This is especially the case in adolescents.<a class="footnote-ref" id="fnref:149" href="#fn:149"><sup>149</sup></a> </p><p><a href="/facts/Metformin/ScXHFaPT">Metformin</a>, <a href="/facts/GLP-1/BAzQx5pJ">GLP-1</a>, and <a href="/facts/Anti-androgen/AfyGmnAs">anti-androgens</a> may also help.<a class="footnote-ref" id="fnref:150" href="#fn:150"><sup>150</sup></a> Other typical acne treatments and hair removal techniques may be used.<a class="footnote-ref" id="fnref:151" href="#fn:151"><sup>151</sup></a> Efforts to improve fertility include weight loss, <a href="/facts/Metformin/ScXHFaPT">metformin</a>, and <a href="/facts/Ovulation_induction/PKB21JVx">ovulation induction</a> using <a href="/facts/Clomiphene/DHUn89Vt">clomiphene</a> or <a href="/facts/Letrozole/23LLQw13">letrozole</a>.<a class="footnote-ref" id="fnref:152" href="#fn:152"><sup>152</sup></a> <a href="/facts/In_vitro_fertilization/kQNMtaBu">In vitro fertilization</a> is used by some in whom other measures are not effective.<a class="footnote-ref" id="fnref:153" href="#fn:153"><sup>153</sup></a> </p><p>Certain cosmetic procedures may also help alleviate symptoms in some cases. For example, the use of laser hair removal, electrolysis, or general waxing, plucking, and shaving are all effective methods for reducing hirsutism.<a class="footnote-ref" id="fnref:154" href="#fn:154"><sup>154</sup></a> The primary treatments for PCOS include lifestyle changes and the use of medications.<a class="footnote-ref" id="fnref:155" href="#fn:155"><sup>155</sup></a> </p><p>Goals of treatment may be considered under these categories: </p> <ul><li>Lowering of insulin resistance</li> <li>Reducing androgen and testosterone levels</li> <li>Restoration of fertility</li> <li>Treatment of <a href="/facts/Hirsutism/k8o1X8xP">hirsutism</a> or acne</li> <li>Restoration of regular menstruation, and prevention of <a href="/facts/Endometrial_hyperplasia/NAnKxrYs">endometrial hyperplasia</a> and <a href="/facts/Endometrial_cancer/rh605tHh">endometrial cancer</a></li></ul> <p>In each of these areas, there is considerable debate as to the optimal treatment. One of the major factors underlying the debate is the lack of large-scale clinical trials comparing different treatments. <a href="/facts/Sample_(statistics)/URCwKNge">Smaller trials</a> tend to be <a href="/facts/Sampling_error/3k8Fjlb3">less reliable</a> and hence may produce conflicting results. General interventions that help to reduce weight or insulin resistance can be beneficial for all these aims because they address what is believed to be the underlying cause.<a class="footnote-ref" id="fnref:156" href="#fn:156"><sup>156</sup></a> As PCOS appears to cause significant emotional distress, appropriate support may also be useful.<a class="footnote-ref" id="fnref:157" href="#fn:157"><sup>157</sup></a> </p> <h3>Diet</h3> <p>Where PCOS is associated with being overweight or obese, successful weight loss is the most effective method of restoring normal ovulation/menstruation. The <a href="/facts/American_Association_of_Clinical_Endocrinologists/qSIFFwNx">American Association of Clinical Endocrinologists</a> guidelines recommend a goal of achieving 10–15% weight loss or more, which improves <a href="/facts/Insulin_resistance/cz6oFqke">insulin resistance</a> and all <a href="/facts/Hormonal_disorders/nDuNHkJY">hormonal disorders</a>.<a class="footnote-ref" id="fnref:158" href="#fn:158"><sup>158</sup></a> Still, many women find it very difficult to achieve and sustain significant weight loss. Insulin resistance itself can cause increased food cravings and lower energy levels, which can make it difficult to lose weight on a regular weight-loss diet. A <a href="/facts/Scientific_review/zJb444sS">scientific review</a> in 2013 found similar improvements in weight, body composition and <a href="/facts/Pregnancy_rate/hEDdgYMo">pregnancy rate</a>, menstrual regularity, ovulation, hyperandrogenism, insulin resistance, lipids, and quality of life to occur with weight loss, independent of diet composition.<a class="footnote-ref" id="fnref:159" href="#fn:159"><sup>159</sup></a> Still, a <a href="/facts/Low_GI_diet/0gfJgD2J">low GI diet</a>, in which a significant portion of total carbohydrates is obtained from fruit, vegetables, and whole-grain sources, has resulted in greater menstrual regularity than a <a href="/facts/Macronutrient/34bn4skK">macronutrient</a>-matched healthy diet.<a class="footnote-ref" id="fnref:160" href="#fn:160"><sup>160</sup></a> </p><p>Reducing the intake of food groups that cause inflammation, such as dairy, sugars, and simple carbohydrates, can be beneficial.<a class="footnote-ref" id="fnref:161" href="#fn:161"><sup>161</sup></a> </p><p>A <a href="/facts/Mediterranean_diet/YrsjyyEH">mediterranean diet</a> is often very effective due to its anti-inflammatory and anti-oxidative properties.<a class="footnote-ref" id="fnref:162" href="#fn:162"><sup>162</sup></a> </p><p>It has been suggested that <a href="/facts/Vitamin_D_deficiency/lWMkWjEm">vitamin D deficiency</a> may play some undetermined role in the development of the <a href="/facts/Metabolic_syndrome/jI70tRBv">metabolic syndrome</a>, and that treatment might be beneficial.<a class="footnote-ref" id="fnref:163" href="#fn:163"><sup>163</sup></a><a class="footnote-ref" id="fnref:164" href="#fn:164"><sup>164</sup></a> However, a systematic review of 2015 found no evidence that vitamin D supplementation reduced or mitigated metabolic and hormonal dysregulations in PCOS.<a class="footnote-ref" id="fnref:165" href="#fn:165"><sup>165</sup></a> As of 2012, interventions using <a href="/facts/Dietary_supplements/SHXNNxaS">dietary supplements</a> to correct metabolic deficiencies in people with PCOS had been tested in small, uncontrolled and nonrandomized clinical trials; the resulting data are insufficient to recommend their use.<a class="footnote-ref" id="fnref:166" href="#fn:166"><sup>166</sup></a> </p> <h3>Medications</h3> <p>Medications for PCOS include <a href="/facts/Oral_contraceptives/QfDgVrGA">oral contraceptives</a> and <a href="/facts/Metformin/ScXHFaPT">metformin</a>. The oral contraceptives increase <a href="/facts/Sex_hormone_binding_globulin/9gVoXJMz">sex hormone binding globulin</a> production, which increases the binding of free testosterone. This reduces the symptoms of <a href="/facts/Hirsutism/k8o1X8xP">hirsutism</a> caused by high testosterone and regulates return to normal <a href="/facts/Menstrual_periods/AY6Y9xxM">menstrual periods</a>.<a class="footnote-ref" id="fnref:167" href="#fn:167"><sup>167</sup></a> <a href="/facts/Anti-androgens/AfyGmnAs">Anti-androgens</a> such as <a href="/facts/Finasteride/1LeCGr3h">finasteride</a>, <a href="/facts/Flutamide/nsGBQSdG">flutamide</a>, <a href="/facts/Spironolactone/uauzo7MM">spironolactone</a>, and <a href="/facts/Bicalutamide/GVPLWejY">bicalutamide</a> do not show advantages over oral contraceptives, but could be an option for people who do not tolerate them.<a class="footnote-ref" id="fnref:168" href="#fn:168"><sup>168</sup></a> <a href="/facts/Finasteride/1LeCGr3h">Finasteride</a> is the only oral medication for the treatment of <a href="/facts/Pattern_hair_loss/VzqlyjF9">androgenic alopecia</a>, that is <a href="/facts/Food_and_Drug_Administration/rCEnh9WB">FDA</a> approved.<a class="footnote-ref" id="fnref:169" href="#fn:169"><sup>169</sup></a> </p><p>Metformin is a medication commonly used in <a href="/facts/Type_2_diabetes_mellitus/zCMXksmt">type 2 diabetes mellitus</a> to reduce insulin resistance and is used <a href="/facts/Off-label_use/0PDs5VWS">off label</a> (in the UK, US, AU, and EU) to treat insulin resistance seen in PCOS. In many cases, metformin also supports ovarian function and a return to normal ovulation.<a class="footnote-ref" id="fnref:170" href="#fn:170"><sup>170</sup></a><a class="footnote-ref" id="fnref:171" href="#fn:171"><sup>171</sup></a> A newer insulin resistance medication class, the <a href="/facts/Thiazolidinedione/QM0mmfTY">thiazolidinediones</a> (glitazones), have shown equivalent efficacy to metformin, but metformin has a more favorable side effect profile.<a class="footnote-ref" id="fnref:172" href="#fn:172"><sup>172</sup></a><a class="footnote-ref" id="fnref:173" href="#fn:173"><sup>173</sup></a> The United Kingdom's <a href="/facts/National_Institute_for_Health_and_Clinical_Excellence/83vtP8Lk">National Institute for Health and Clinical Excellence</a> recommended in 2004 that women with PCOS and a <a href="/facts/Body_mass_index/UX4YrUTx">body mass index</a> above 25 be given metformin when other therapy has failed to produce results.<a class="footnote-ref" id="fnref:174" href="#fn:174"><sup>174</sup></a><a class="footnote-ref" id="fnref:175" href="#fn:175"><sup>175</sup></a> Metformin may not be effective in every type of PCOS, and therefore there is some disagreement about whether it should be used as a general first-line therapy.<a class="footnote-ref" id="fnref:176" href="#fn:176"><sup>176</sup></a> In addition to this, metformin is associated with several unpleasant side effects: including abdominal pain, metallic taste in the mouth, diarrhoea and vomiting.<a class="footnote-ref" id="fnref:177" href="#fn:177"><sup>177</sup></a> Metformin is thought to be safe to use during pregnancy (<a href="/facts/Pregnancy_category/v7xjF2pH">pregnancy category</a> B in the US).<a class="footnote-ref" id="fnref:178" href="#fn:178"><sup>178</sup></a> A review in 2014 concluded that the use of metformin does not increase the risk of major <a href="/facts/Birth_defect/ESfzQhTx">birth defects</a> in women treated with metformin during the first trimester.<a class="footnote-ref" id="fnref:179" href="#fn:179"><sup>179</sup></a> Liraglutide may reduce weight and waist circumference in people with PCOS more than other medications.<a class="footnote-ref" id="fnref:180" href="#fn:180"><sup>180</sup></a> The use of <a href="/facts/Statins/ba4mes9W">statins</a> in the management of underlying metabolic syndrome remains unclear.<a class="footnote-ref" id="fnref:181" href="#fn:181"><sup>181</sup></a> </p> <h3>Infertility</h3> <p class="note">Main article: <a href="/facts/Infertility_in_polycystic_ovary_syndrome/un0NpLr5">Infertility in polycystic ovary syndrome</a></p> <p>It can be difficult to become pregnant with PCOS because it causes irregular <a href="/facts/Ovulation/0K3MLdAv">ovulation</a>. Medications to induce fertility when trying to conceive include the ovulation inducer <a href="/facts/Clomiphene/DHUn89Vt">clomiphene</a> or pulsatile <a href="/facts/Leuprorelin/I064jbK6">leuprorelin</a>. Evidence from randomised controlled trials suggests that in terms of live birth, metformin may be better than placebo, and metformin plus clomiphene may be better than clomiphene alone, but that in both cases women may be more likely to experience gastrointestinal side effects with metformin.<a class="footnote-ref" id="fnref:182" href="#fn:182"><sup>182</sup></a> </p><p>For women who do, <a href="/facts/Anovulation/nbg5Speh">anovulation</a> or infrequent ovulation is a common cause and PCOS is the main cause of anovulatory infertility.<a class="footnote-ref" id="fnref:183" href="#fn:183"><sup>183</sup></a> Other factors include changed levels of <a href="/facts/Gonadotropin/Jo53mSXC">gonadotropins</a>, <a href="/facts/Hyperandrogenemia/ATvFXbXX">hyperandrogenemia</a>, and <a href="/facts/Hyperinsulinemia/bRNuEMDW">hyperinsulinemia</a>.<a class="footnote-ref" id="fnref:184" href="#fn:184"><sup>184</sup></a> Like women without PCOS, women with PCOS that are ovulating may be infertile due to other causes, such as tubal blockages due to a history of sexually transmitted diseases.<a class="footnote-ref" id="fnref:185" href="#fn:185"><sup>185</sup></a> </p><p>For overweight anovulatory women with PCOS, <a href="/facts/Weight_loss/DQE4cXw0">weight loss</a> and diet adjustments, especially to reduce the intake of simple carbohydrates, are associated with the resumption of natural ovulation.<a class="footnote-ref" id="fnref:186" href="#fn:186"><sup>186</sup></a> Digital health interventions are particularly effective in providing combined therapy to manage PCOS through both lifestyle changes and medication.<a class="footnote-ref" id="fnref:187" href="#fn:187"><sup>187</sup></a> </p><p>For those women that, after weight loss, are still anovulatory, or for anovulatory lean women, <a href="/facts/Ovulation_induction/PKB21JVx">ovulation induction</a> using the medications <a href="/facts/Letrozole/23LLQw13">letrozole</a> (Femara) or <a href="/facts/Clomiphene_citrate/DHUn89Vt">clomiphene citrate</a> are the principal treatments used to promote ovulation.<a class="footnote-ref" id="fnref:188" href="#fn:188"><sup>188</sup></a><a class="footnote-ref" id="fnref:189" href="#fn:189"><sup>189</sup></a><a class="footnote-ref" id="fnref:190" href="#fn:190"><sup>190</sup></a> Clomiphene can cause mood swings and abdominal cramping for some.<a class="footnote-ref" id="fnref:191" href="#fn:191"><sup>191</sup></a> </p><p>Previously, the anti-diabetes medication <a href="/facts/Metformin/ScXHFaPT">metformin</a> was a recommended treatment for anovulation, but it appears less effective than letrozole or clomiphene.<a class="footnote-ref" id="fnref:192" href="#fn:192"><sup>192</sup></a><a class="footnote-ref" id="fnref:193" href="#fn:193"><sup>193</sup></a> </p><p>For women not responsive to letrozole or clomiphene and diet and lifestyle modification, there are options available including <a href="/facts/Assisted_reproductive_technology/f3qpbE3X">assisted reproductive technology</a> procedures such as <a href="/facts/Controlled_ovarian_hyperstimulation/AVCwAznG">controlled ovarian hyperstimulation</a> with <a href="/facts/Follicle-stimulating_hormone/n6CwdebD">follicle-stimulating hormone</a> (FSH) injections followed by <a href="/facts/In_vitro_fertilisation/kQNMtaBu">in vitro fertilisation</a> (IVF).<a class="footnote-ref" id="fnref:194" href="#fn:194"><sup>194</sup></a> </p><p>Though surgery is not commonly performed, the polycystic ovaries can be treated with a laparoscopic procedure called "<a href="/facts/Ovarian_drilling/VMezqwHV">ovarian drilling</a>" (puncture of 4–10 small follicles with electrocautery, laser, or biopsy needles),<a class="footnote-ref" id="fnref:195" href="#fn:195"><sup>195</sup></a> which often results in either resumption of spontaneous ovulations<a class="footnote-ref" id="fnref:196" href="#fn:196"><sup>196</sup></a> or ovulations after adjuvant treatment with clomiphene or FSH.<a class="footnote-ref" id="fnref:197" href="#fn:197"><sup>197</sup></a> (Ovarian wedge resection is no longer used as much due to complications such as <a href="/facts/Adhesions/thLyEqrT">adhesions</a> and the presence of frequently effective medications.) There are, however, concerns about the long-term effects of ovarian drilling on ovarian function.<a class="footnote-ref" id="fnref:198" href="#fn:198"><sup>198</sup></a> </p> <h3>Mental health</h3> <p>Women with PCOS are far more likely to have depression than women without. Symptoms of depression might be heightened by certain physiological manifestations of this disease such as hirsutism or obesity that can lead to low self-esteem or poor body image.<a class="footnote-ref" id="fnref:199" href="#fn:199"><sup>199</sup></a> Researchers suggest that there be mental health screenings performed in tandem with PCOS assessment to identify these complications early and treat them accordingly.<a class="footnote-ref" id="fnref:200" href="#fn:200"><sup>200</sup></a> </p><p>PCOS is associated with other mental health-related conditions besides depression such as <a href="/facts/Anxiety/Geekl883">anxiety</a>, <a href="/facts/Bipolar_disorder/aMDwXbV0">bipolar disorder</a>, and <a href="/facts/Obsessive%25E2%2580%2593compulsive_disorder/bIhDh4dz">obsessive–compulsive disorder</a>.<a class="footnote-ref" id="fnref:201" href="#fn:201"><sup>201</sup></a> Additionally, it has been found to significantly increase the risk of eating disorders.<a class="footnote-ref" id="fnref:202" href="#fn:202"><sup>202</sup></a> Screening for these mental health conditions will also be helpful in the treatment of PCOS. </p><p>Lifestyle changes for people with PCOS have been proven to be difficult due to a lack of intrinsic motivation, altered risk perception, or other PCOS-related barriers. However, self-management techniques and behavior change can be taught in a multidisciplinary approach to support women with PCOS in managing their symptoms.<a class="footnote-ref" id="fnref:203" href="#fn:203"><sup>203</sup></a> </p> <h3>Hirsutism and acne</h3> <p class="note">Further information: <a href="/facts/Hirsutism/k8o1X8xP">Hirsutism</a></p> <p>A standard contraceptive pill is frequently effective in reducing hirsutism.<a class="footnote-ref" id="fnref:204" href="#fn:204"><sup>204</sup></a> Progestogens such as norgestrel and levonorgestrel should be avoided due to their androgenic effects.<a class="footnote-ref" id="fnref:205" href="#fn:205"><sup>205</sup></a> Metformin combined with an oral contraceptive may be more effective than either metformin or the oral contraceptive on its own.<a class="footnote-ref" id="fnref:206" href="#fn:206"><sup>206</sup></a> </p><p>In the case of taking medication for acne, Kelly Morrow-Baez PHD, in her exposition titled <i>Thriving with PCOS,</i> informs that it "takes time for medications to adjust hormone levels, and once those hormone levels are adjusted, it takes more time still for pores to be unclogged of overproduced oil and for any bacterial infections under the skin to clear up before you will see discernible results." (p. 138) <a class="footnote-ref" id="fnref:207" href="#fn:207"><sup>207</sup></a> </p><p>Other medications with anti-androgen effects include <a href="/facts/Flutamide/nsGBQSdG">flutamide</a>,<a class="footnote-ref" id="fnref:208" href="#fn:208"><sup>208</sup></a> and <a href="/facts/Spironolactone/uauzo7MM">spironolactone</a>,<a class="footnote-ref" id="fnref:209" href="#fn:209"><sup>209</sup></a> which can improve hirsutism. Metformin can reduce hirsutism, perhaps by reducing insulin resistance, and is often used if there are other features such as insulin resistance, diabetes, or obesity that are likely to respond to metformin. <a href="/facts/Eflornithine/wK3NEv5w">Eflornithine</a> (Vaniqa) is a medication that is applied to the skin in cream form, and acts directly on the hair follicles to inhibit hair growth. It is usually applied to the face.<a class="footnote-ref" id="fnref:210" href="#fn:210"><sup>210</sup></a> <a href="/facts/5-alpha_reductase_inhibitor/kKSEtb4w">5-alpha reductase inhibitors</a> (such as <a href="/facts/Finasteride/1LeCGr3h">finasteride</a> and <a href="/facts/Dutasteride/pMAr7K3G">dutasteride</a>) may also be used;<a class="footnote-ref" id="fnref:211" href="#fn:211"><sup>211</sup></a> they work by blocking the conversion of <a href="/facts/Testosterone/uUumdhAz">testosterone</a> to <a href="/facts/Dihydrotestosterone/fQpDuzcL">dihydrotestosterone</a> (the latter of which is responsible for most hair growth alterations and <a href="/facts/Acne_vulgaris/TKJxhHSd">androgenic acne</a>). </p><p>Although these agents have shown significant efficacy in clinical trials (for oral contraceptives, in 60–100% of individuals<a class="footnote-ref" id="fnref:212" href="#fn:212"><sup>212</sup></a>), the reduction in hair growth may not be enough to eliminate the social embarrassment of hirsutism or the inconvenience of plucking or shaving. Individuals vary in their response to different therapies. It is usually worth trying other medications if one does not work, but medications do not work well for all individuals.<a class="footnote-ref" id="fnref:213" href="#fn:213"><sup>213</sup></a> </p> <h3>Menstrual irregularity</h3> <p>If fertility is not the primary aim, then <a href="/facts/Menstruation/7cv4HzLe">menstruation</a> can usually be regulated with a contraceptive pill.<a class="footnote-ref" id="fnref:214" href="#fn:214"><sup>214</sup></a> The purpose of regulating menstruation, in essence, is for the patient's convenience, and perhaps their sense of well-being; there is no medical requirement for regular periods, as long as they occur sufficiently often.<a class="footnote-ref" id="fnref:215" href="#fn:215"><sup>215</sup></a> </p><p>If a regular menstrual cycle is not desired, then therapy for an irregular cycle is not necessarily required. Most experts say that, if a menstrual bleed occurs at least every three months, then the endometrium (womb lining) is being shed sufficiently often to prevent an increased risk of endometrial abnormalities or cancer.<a class="footnote-ref" id="fnref:216" href="#fn:216"><sup>216</sup></a> If menstruation occurs less often or not at all, some form of progestogen replacement is recommended.<a class="footnote-ref" id="fnref:217" href="#fn:217"><sup>217</sup></a> </p> <h3>Screening for cardiometabolic risks</h3> <p>Given the higher risk of cardiometabolic conditions, monitoring is recommended.<a class="footnote-ref" id="fnref:218" href="#fn:218"><sup>218</sup></a> Two-hour oral <a href="/facts/Glucose_tolerance_test/3XQrFJuf">glucose tolerance test</a> (GTT) in women with risk factors (obesity, family history, history of gestational diabetes)<a class="footnote-ref" id="fnref:219" href="#fn:219"><sup>219</sup></a> may indicate impaired glucose tolerance (insulin resistance) in 15–33% of women with PCOS.<a class="footnote-ref" id="fnref:220" href="#fn:220"><sup>220</sup></a> Frank diabetes can be seen in 65–68% of women with this condition.<a class="footnote-ref" id="fnref:221" href="#fn:221"><sup>221</sup></a> Insulin resistance can be observed in both normal weight and overweight people, although it is more common in the latter (and in those matching the stricter NIH criteria for diagnosis); 50–80% of people with PCOS may have insulin resistance at some level.<a class="footnote-ref" id="fnref:222" href="#fn:222"><sup>222</sup></a> </p> <h3>Alternative medicine</h3> <p>A 2017 review concluded that while both myo-inositol and D-chiro-inositols may regulate menstrual cycles and improve ovulation, there is a lack of evidence regarding effects on the probability of pregnancy.<a class="footnote-ref" id="fnref:223" href="#fn:223"><sup>223</sup></a><a class="footnote-ref" id="fnref:224" href="#fn:224"><sup>224</sup></a> A 2012 and 2017 review have found <a href="/facts/Myo-inositol/FVon023Q">myo-inositol</a> supplementation appears to be effective in improving several of the hormonal disturbances of PCOS.<a class="footnote-ref" id="fnref:225" href="#fn:225"><sup>225</sup></a><a class="footnote-ref" id="fnref:226" href="#fn:226"><sup>226</sup></a> Myo-inositol reduces the amount of gonadotropins and the length of controlled ovarian hyperstimulation in women undergoing in vitro fertilization.<a class="footnote-ref" id="fnref:227" href="#fn:227"><sup>227</sup></a> A 2011 review found not enough evidence to conclude any beneficial effect from <a href="/facts/D-chiro-inositol/DXr6QSsz">D-chiro-inositol</a>.<a class="footnote-ref" id="fnref:228" href="#fn:228"><sup>228</sup></a> There is insufficient evidence to support the use of <a href="/facts/Acupuncture/7wxdsmUL">acupuncture</a>, current studies are inconclusive and there's a need for additional <a href="/facts/Randomized_controlled_trial/LG9lkyVx">randomized controlled trials</a>.<a class="footnote-ref" id="fnref:229" href="#fn:229"><sup>229</sup></a><a class="footnote-ref" id="fnref:230" href="#fn:230"><sup>230</sup></a> </p> <h2 id="epidemiology">Epidemiology</h2> <p>PCOS is the most common <a href="/facts/Endocrine_disorder/nDuNHkJY">endocrine disorder</a> among women between the ages of 18 and 44.<a class="footnote-ref" id="fnref:231" href="#fn:231"><sup>231</sup></a> According to the <a href="/facts/World_Health_Organization/YNN3bgug">World Health Organization</a> (WHO), PCOS affects over 6 to 13% of reproductive-aged women.<a class="footnote-ref" id="fnref:232" href="#fn:232"><sup>232</sup></a> A 2022 review noted a prevalence between 5% to 18%.<a class="footnote-ref" id="fnref:233" href="#fn:233"><sup>233</sup></a> When someone is infertile due to lack of ovulation, PCOS is the most common cause and could guide to patients' diagnosis.<a class="footnote-ref" id="fnref:234" href="#fn:234"><sup>234</sup></a> </p><p>The prevalence of PCOS depends on the choice of diagnostic criteria.<a class="footnote-ref" id="fnref:235" href="#fn:235"><sup>235</sup></a> Using the Rotterdam criteria, around 10–13% of women have PCOS.<a class="footnote-ref" id="fnref:236" href="#fn:236"><sup>236</sup></a> Based on the NIH criteria, the global prevalence was 5.5%, increasing to approximately 7.1% when using the Androgen Excess Society criteria. Irrespective of criteria, the prevalance of PCOS is increasing, likely due to an aging population, more awareness and increasing obesity rates.<a class="footnote-ref" id="fnref:237" href="#fn:237"><sup>237</sup></a> </p><p>Prevalance seems fairly even among people with different ethnicities, but is perhaps higher in people from South East Asia and the Eastern Mediterranean.<a class="footnote-ref" id="fnref:238" href="#fn:238"><sup>238</sup></a> PCOS may express differently however. For instance, in African and Hispanic American people with PCOS, there is more insulance resistance compared to other ethnic groups.<a class="footnote-ref" id="fnref:239" href="#fn:239"><sup>239</sup></a> The same is true for South Asian people with PCOS, who also have more metabolic symptoms and higher BMIs. East Asian women typically have less hirsutism and lower BMI compared to other groups.<a class="footnote-ref" id="fnref:240" href="#fn:240"><sup>240</sup></a> </p><p>Ultrasonographic findings of polycystic ovaries are found in 8–25% of women non-affected by the syndrome.<a class="footnote-ref" id="fnref:241" href="#fn:241"><sup>241</sup></a><a class="footnote-ref" id="fnref:242" href="#fn:242"><sup>242</sup></a><a class="footnote-ref" id="fnref:243" href="#fn:243"><sup>243</sup></a><a class="footnote-ref" id="fnref:244" href="#fn:244"><sup>244</sup></a> 14% women on oral contraceptives are found to have polycystic ovaries.<a class="footnote-ref" id="fnref:245" href="#fn:245"><sup>245</sup></a> Ovarian cysts are also a common side effect of levonorgestrel-releasing <a href="/facts/Intrauterine_device/DSbzljJo">intrauterine devices</a> (IUDs).<a class="footnote-ref" id="fnref:246" href="#fn:246"><sup>246</sup></a> </p> <h2 id="history">History</h2> <p>Historical descriptions of possible PCOS symptoms date back to ancient Greece, where Hippocrates described women with "thick, oily skin and absence of menstruation."<a class="footnote-ref" id="fnref:247" href="#fn:247"><sup>247</sup></a> The earliest known description of what is now recognized as PCOS dates from 1721 in Italy.<a class="footnote-ref" id="fnref:248" href="#fn:248"><sup>248</sup></a> Cyst-related changes to the ovaries were described in 1844.<a class="footnote-ref" id="fnref:249" href="#fn:249"><sup>249</sup></a> </p><p>In modern times, the condition was first described in 1935 by American gynecologists Irving F. Stein Sr. and Michael L. Leventhal, from whom its original name of <i>Stein–Leventhal syndrome</i> is taken.<a class="footnote-ref" id="fnref:250" href="#fn:250"><sup>250</sup></a><a class="footnote-ref" id="fnref:251" href="#fn:251"><sup>251</sup></a> Stein and Leventhal first described PCOS as an endocrine disorder in the United States, and since then, it has become recognized as one of the most common causes of oligo-ovulatory infertility among women.<a class="footnote-ref" id="fnref:252" href="#fn:252"><sup>252</sup></a> </p> <h2 id="etymology">Etymology</h2> <p>Other names for this syndrome include polycystic ovarian syndrome, polycystic ovary disease, functional ovarian hyperandrogenism, ovarian <a href="/facts/Hyperthecosis/ApbzANPv">hyperthecosis</a>, sclerocystic ovary syndrome, and Stein–Leventhal syndrome. The <a href="/facts/Medical_eponyms/RCDxNfer">eponymous</a> last option is the original name; it is now used, if at all, only for the subset of women with all the symptoms of amenorrhea with infertility, <a href="/facts/Hirsutism/k8o1X8xP">hirsutism</a>, and enlarged polycystic ovaries.<a class="footnote-ref" id="fnref:253" href="#fn:253"><sup>253</sup></a> </p><p>Most common names for this disease derive from a typical finding on medical images, called a polycystic ovary. A polycystic ovary has an abnormally large number of developing eggs visible near its surface, looking like many small <a href="/facts/Cyst/N1n2ogU9">cysts</a>.<a class="footnote-ref" id="fnref:254" href="#fn:254"><sup>254</sup></a> </p> <h2 id="research">Research</h2> <h3>Stem cell models</h3> <p><a href="/facts/Human_embryonic_stem_cell/P1n1eS1p">Human embryonic stem cells</a> (hESCs) derived from the inner cell mass of blastocyst-stage embryos of women with PCOS have shown abnormal lipid metabolism, consistent with the pathophysiology of the disease.<a class="footnote-ref" id="fnref:255" href="#fn:255"><sup>255</sup></a> When the hESCs are differentiated into adipocytes, gene expression data from these fat cells reveal a downregulation or a decrease in genes linked to glucose, lipid, and steroid metabolism.<a class="footnote-ref" id="fnref:256" href="#fn:256"><sup>256</sup></a> </p><p>As of 2024 studies have successfully developed in vitro PCOS disease models through <a href="/facts/Induced_pluripotent_stem_cell/bGItax29">Induced pluripotent stem cell</a> technology (iPSC).<a class="footnote-ref" id="fnref:257" href="#fn:257"><sup>257</sup></a> Similar to hESCs, iPSC cells can be derived from patients and can differentiate into various cell types. Using adult somatic cells, iPSCs can reprogram the cells into a pluripotent state, which can then be specified to replicate PCOS-like traits. Furthermore, 3D “organoid” models of female reproductive tissue, such as the uterus and ovaries, produced from iPSCs, present a powerful way to stimulate the development of reproductive disorders such as PCOS in vitro.<a class="footnote-ref" id="fnref:258" href="#fn:258"><sup>258</sup></a> </p> <p>Although not widely used, some researchers have explored the use of this biotechnology to model PCOS. One study that characterized the link between obesity and PCOS reprogrammed PCOS-derived urine epithelial cells into adipocytes and found that iPSC lines had greater glucose consumption along with lower insulin response compared to controls.<a class="footnote-ref" id="fnref:259" href="#fn:259"><sup>259</sup></a> These are results consistent with symptoms of the disease. Studies on iPSCs have also contributed significantly to understanding the behavior of ovarian <a href="/facts/Granulosa_cell/8KhMa9I3">granulosa cells</a>, which maintain follicular development and secrete steroid hormones.<a class="footnote-ref" id="fnref:260" href="#fn:260"><sup>260</sup></a> The transcriptome data from the PCOS-derived iPSCs indicate dysfunctions in folliculogenesis and disruptions in the oocyte microenvironment. </p><p>Current growing data shows a strong association between mitochondrial malfunction and PCOS. iPSCs from PCOS patients have provided some evidence of impairments in glycolytic and mitochondrial functions.<a class="footnote-ref" id="fnref:261" href="#fn:261"><sup>261</sup></a> These cells exhibited a higher number of copies of mitochondrial DNA compared to the control. This may support the idea that mitochondrial biosynthesis is elevated in these patients as a compensatory response to the aberrations seen in the metabolic processes.<a class="footnote-ref" id="fnref:262" href="#fn:262"><sup>262</sup></a> </p> <h2 id="society-and-culture">Society and culture</h2> <p>In 2005, 4 million cases of PCOS were reported in the US, costing $4.36 billion in healthcare costs.<a class="footnote-ref" id="fnref:263" href="#fn:263"><sup>263</sup></a> In 2016 out of the National Institute of Health's research budget of $32.3 billion for that year, 0.1% was spent on PCOS research.<a class="footnote-ref" id="fnref:264" href="#fn:264"><sup>264</sup></a> Among women aged between 14 and 44, PCOS is conservatively estimated to cost $4.37 billion per year.<a class="footnote-ref" id="fnref:265" href="#fn:265"><sup>265</sup></a> </p><p>As opposed to women in the general population, women with PCOS experience higher rates of depression and anxiety. International guidelines and Indian guidelines suggest psychosocial factors should be considered in women with PCOS, as well as screenings for depression and anxiety.<a class="footnote-ref" id="fnref:266" href="#fn:266"><sup>266</sup></a> Globally, this aspect has been increasingly focused on because it reflects the true impact of PCOS on the lives of patients. Research shows that PCOS adversely impacts a patient's quality of life.<a class="footnote-ref" id="fnref:267" href="#fn:267"><sup>267</sup></a><a class="footnote-ref" id="fnref:268" href="#fn:268"><sup>268</sup></a> </p> <h3>Public figures</h3> <p>Several celebrities and public figures have spoken about their experiences with PCOS, including: </p> <ul><li><a href="/facts/Victoria_Beckham/UYoCRp0f">Victoria Beckham</a><a class="footnote-ref" id="fnref:269" href="#fn:269"><sup>269</sup></a></li> <li><a href="/facts/Maci_Bookout/56KXGvt8">Maci Bookout</a><a class="footnote-ref" id="fnref:270" href="#fn:270"><sup>270</sup></a></li> <li><a href="/facts/Frankie_Bridge/pDLbspgo">Frankie Bridge</a><a class="footnote-ref" id="fnref:271" href="#fn:271"><sup>271</sup></a></li> <li><a href="/facts/Harnaam_Kaur/64rDSGeo">Harnaam Kaur</a><a class="footnote-ref" id="fnref:272" href="#fn:272"><sup>272</sup></a></li> <li><a href="/facts/Jaime_King/EbDdW4AE">Jaime King</a><a class="footnote-ref" id="fnref:273" href="#fn:273"><sup>273</sup></a></li> <li><a href="/facts/Chrisette_Michele/acoxSEgC">Chrisette Michele</a><a class="footnote-ref" id="fnref:274" href="#fn:274"><sup>274</sup></a></li> <li><a href="/facts/Lea_Michele/qLlGxkLS">Lea Michele</a><a class="footnote-ref" id="fnref:275" href="#fn:275"><sup>275</sup></a></li> <li><a href="/facts/Keke_Palmer/PC3gudUk">Keke Palmer</a><a class="footnote-ref" id="fnref:276" href="#fn:276"><sup>276</sup></a></li> <li><a href="/facts/Sasha_Pieterse/Vb39U2NC">Sasha Pieterse</a><a class="footnote-ref" id="fnref:277" href="#fn:277"><sup>277</sup></a><a class="footnote-ref" id="fnref:278" href="#fn:278"><sup>278</sup></a></li> <li><a href="/facts/Florence_Pugh/5kANVppF">Florence Pugh</a><a class="footnote-ref" id="fnref:279" href="#fn:279"><sup>279</sup></a></li> <li><a href="/facts/Daisy_Ridley/a1fLY9Nu">Daisy Ridley</a><a class="footnote-ref" id="fnref:280" href="#fn:280"><sup>280</sup></a></li> <li><a href="/facts/Romee_Strijd/YPTPvrBv">Romee Strijd</a><a class="footnote-ref" id="fnref:281" href="#fn:281"><sup>281</sup></a></li> <li><a href="/facts/Lee_Tilghman/rNMHpCTC">Lee Tilghman</a><a class="footnote-ref" id="fnref:282" href="#fn:282"><sup>282</sup></a></li></ul> <h2 id="see-also">See also</h2> <ul> <li>Medicine portal</li></ul> <ul><li><a href="/facts/Androgen-dependent_syndromes/SXYY0pIs">Androgen-dependent syndromes</a></li></ul> <h3>Cited sources</h3> <ul><li>Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). <i>International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023</i>. Melbourne, Australia: <a href="/facts/Monash_University/1wcLcSGe">Monash University</a>. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-0-6458209-0-4.</li> <li>Goodarzi MO (2024). <a href="https://bestpractice.bmj.com/topics/en-gb/141/pdf/141/Polycystic%20ovary%20syndrome.pdf"><i>BMJ Best Practice: Polycystic ovary syndrome</i></a> (PDF). BMJ Publishing Group. Retrieved 29 June 2025.</li></ul> <h2 id="further-reading">Further reading</h2> <ul><li><a href="https://www.nichd.nih.gov/health/topics/pcos">"Polycystic Ovary Syndrome (PCOS)"</a>. <a href="/facts/Eunice_Kennedy_Shriver_National_Institute_of_Child_Health_and_Human_Development/xgIGrpWm">Eunice Kennedy Shriver National Institute of Child Health and Human Development</a>. 31 January 2017. <a href="https://web.archive.org/web/20181022214043/https://www.nichd.nih.gov/health/topics/pcos">Archived</a> from the original on 22 October 2018. Retrieved 19 November 2018.</li></ul> <h2 id="external-links">External links</h2> <ul><li> Media related to Polycystic ovary syndrome at Wikimedia Commons</li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E (November 2015). "American Association of Clinical Endocrinologists, American College of Endocrinology, and androgen excess and PCOS society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome-part 1". Endocrine Practice. 21 (11): 1291–1300. doi:10.4158/EP15748.DSC. PMID 26509855. <a href="https://doi.org/10.4158%2FEP15748.DSC" target="_blank">https://doi.org/10.4158%2FEP15748.DSC</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>Dunaif A, Fauser BC (November 2013). "Renaming PCOS--a two-state solution". The Journal of Clinical Endocrinology and Metabolism. 98 (11): 4325–8. doi:10.1210/jc.2013-2040. PMC 3816269. PMID 24009134. Around 20% of European women have polycystic ovaries (the prevalence is even higher in some other populations) but approximately two-thirds of these women do not have PCOS <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816269" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816269</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>Khan MJ, Ullah A, Basit S (2019). "Genetic Basis of Polycystic Ovary Syndrome (PCOS): Current Perspectives". Appl Clin Genet. 12: 249–260. doi:10.2147/TACG.S200341. PMC 6935309. PMID 31920361. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935309" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935309</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>Crespo RP, Bachega TA, Mendonça BB, Gomes LG (June 2018). "An update of genetic basis of PCOS pathogenesis". Archives of Endocrinology and Metabolism. 62 (3): 352–361. doi:10.20945/2359-3997000000049. PMC 10118782. PMID 29972435. S2CID 49681196. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10118782" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10118782</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>"What are the symptoms of PCOS?". Eunice Kennedy Shriver National Institute of Child Health and Human Development. 21 August 2024. Archived from the original on 20 May 2025. Retrieved 28 June 2025. <a href="https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/symptoms" target="_blank">https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/symptoms</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>CDC (15 May 2024). "Diabetes and Polycystic Ovary Syndrome (PCOS)". Diabetes and Polycystic Ovary Syndrome (PCOS). Retrieved 20 September 2024. <a href="https://www.cdc.gov/diabetes/risk-factors/pcos-polycystic-ovary-syndrome.html" target="_blank">https://www.cdc.gov/diabetes/risk-factors/pcos-polycystic-ovary-syndrome.html</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>Lentscher JA, Slocum B, Torrealday S (March 2021). "Polycystic Ovarian Syndrome and Fertility". Clinical Obstetrics and Gynecology. 64 (1): 65–75. doi:10.1097/GRF.0000000000000595. PMID 33337743. S2CID 229323594. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ, et al. (1 September 2022). "Polycystic ovary syndrome". The Lancet Diabetes & Endocrinology. 10 (9): 668–680. doi:10.1016/S2213-8587(22)00163-2. ISSN 2213-8587. PMID 35934017. <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00163-2/abstract" target="_blank">https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00163-2/abstract</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>"What are the symptoms of PCOS?". Eunice Kennedy Shriver National Institute of Child Health and Human Development. 21 August 2024. Archived from the original on 20 May 2025. Retrieved 28 June 2025. <a href="https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/symptoms" target="_blank">https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/symptoms</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>"What We Talk About When We Talk About PCOS". Vice.com. 23 January 2019. Archived from the original on 19 January 2022. Retrieved 19 January 2022. <a href="https://www.vice.com/en/article/what-we-talk-about-when-we-talk-about-pcos/" target="_blank">https://www.vice.com/en/article/what-we-talk-about-when-we-talk-about-pcos/</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>"Polycystic Ovary Syndrome (PCOS)". www.hopkinsmedicine.org. 28 February 2022. Archived from the original on 10 February 2023. Retrieved 9 February 2023. <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos" target="_blank">https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>"Polycystic Ovary Syndrome (PCOS): Condition Information". National Institute of Child Health and Human Development. 31 January 2017. Archived from the original on 22 October 2018. Retrieved 19 November 2018. <a href="https://www.nichd.nih.gov/health/topics/pcos/conditioninfo" target="_blank">https://www.nichd.nih.gov/health/topics/pcos/conditioninfo</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> <li id="fn:13"><p>Teede H, Deeks A, Moran L (June 2010). "Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan". BMC Medicine. 8 (1): 41. doi:10.1186/1741-7015-8-41. PMC 2909929. PMID 20591140. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>Teede H, Deeks A, Moran L (June 2010). "Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan". BMC Medicine. 8 (1): 41. doi:10.1186/1741-7015-8-41. PMC 2909929. PMID 20591140. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>Teede H, Deeks A, Moran L (June 2010). "Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan". BMC Medicine. 8 (1): 41. doi:10.1186/1741-7015-8-41. PMC 2909929. PMID 20591140. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>Cortet-Rudelli C, Dewailly D (21 September 2006). "Diagnosis of Hyperandrogenism in Female Adolescents". Hyperandrogenism in Adolescent Girls. Armenian Health Network, Health.am. Archived from the original on 30 September 2007. Retrieved 21 November 2006. <a href="http://www.health.am/gyneco/more/diagnosis-of-hyperandrogenism-in-female/" target="_blank">http://www.health.am/gyneco/more/diagnosis-of-hyperandrogenism-in-female/</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></p></li> <li id="fn:17"><p>Huang A, Brennan K, Azziz R (April 2010). "Prevalence of hyperandrogenemia in the polycystic ovary syndrome diagnosed by the National Institutes of Health 1990 criteria". Fertility and Sterility. 93 (6): 1938–41. doi:10.1016/j.fertnstert.2008.12.138. PMC 2859983. PMID 19249030. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859983" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859983</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></p></li> <li id="fn:18"><p>Teede H, Deeks A, Moran L (June 2010). "Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan". BMC Medicine. 8 (1): 41. doi:10.1186/1741-7015-8-41. PMC 2909929. PMID 20591140. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929</a> <a href="#fnref:18" class="footnote-back-ref">↩</a></p></li> <li id="fn:19"><p>Nafiye Y, Sevtap K, Muammer D, Emre O, Senol K, Leyla M (April 2010). "The effect of serum and intrafollicular insulin resistance parameters and homocysteine levels of nonobese, nonhyperandrogenemic polycystic ovary syndrome patients on in vitro fertilization outcome". Fertility and Sterility. 93 (6): 1864–9. doi:10.1016/j.fertnstert.2008.12.024. PMID 19171332. <a href="https://doi.org/10.1016%2Fj.fertnstert.2008.12.024" target="_blank">https://doi.org/10.1016%2Fj.fertnstert.2008.12.024</a> <a href="#fnref:19" class="footnote-back-ref">↩</a></p></li> <li id="fn:20"><p>Pasquali R (2018). "Lifestyle Interventions and Natural and Assisted Reproduction in Patients with PCOS". Infertility in Women with Polycystic Ovary Syndrome. Cham: Springer International Publishing. pp. 169–180. doi:10.1007/978-3-319-45534-1_13. ISBN 978-3-319-45533-4. <a href="978-3-319-45533-4" target="_blank">978-3-319-45533-4</a> <a href="#fnref:20" class="footnote-back-ref">↩</a></p></li> <li id="fn:21"><p>Brutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A (November 2018). "Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis". Endocrine. 62 (2): 318–325. doi:10.1007/s12020-018-1692-3. PMID 30066285. S2CID 51889051. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:21" class="footnote-back-ref">↩</a></p></li> <li id="fn:22"><p>Pasquali R (2018). "Lifestyle Interventions and Natural and Assisted Reproduction in Patients with PCOS". Infertility in Women with Polycystic Ovary Syndrome. Cham: Springer International Publishing. pp. 169–180. doi:10.1007/978-3-319-45534-1_13. ISBN 978-3-319-45533-4. <a href="978-3-319-45533-4" target="_blank">978-3-319-45533-4</a> <a href="#fnref:22" class="footnote-back-ref">↩</a></p></li> <li id="fn:23"><p>Morrow-Baez K (2018). Thriving with PCOS: Lifestyle Strategies to Successfully Manage Polycystic Ovary Syndrome. Rowman & Littlefield Publishers. <a href="#fnref:23" class="footnote-back-ref">↩</a></p></li> <li id="fn:24"><p>Polycystic Ovarian Syndrome at eMedicine <a href="https://emedicine.medscape.com/article/256806-overview" target="_blank">https://emedicine.medscape.com/article/256806-overview</a> <a href="#fnref:24" class="footnote-back-ref">↩</a></p></li> <li id="fn:25"><p>Sam S (February 2015). "Adiposity and metabolic dysfunction in polycystic ovary syndrome". Hormone Molecular Biology and Clinical Investigation. 21 (2): 107–116. doi:10.1515/hmbci-2015-0008. PMID 25781555. S2CID 23592351. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:25" class="footnote-back-ref">↩</a></p></li> <li id="fn:26"><p>Corbould A (October 2008). "Effects of androgens on insulin action in women: is androgen excess a component of female metabolic syndrome?". Diabetes/Metabolism Research and Reviews. 24 (7): 520–532. doi:10.1002/dmrr.872. PMID 18615851. S2CID 24630977. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:26" class="footnote-back-ref">↩</a></p></li> <li id="fn:27"><p>Goyal M, Dawood AS (2017). "Debates Regarding Lean Patients with Polycystic Ovary Syndrome: A Narrative Review". Journal of Human Reproductive Sciences. 10 (3): 154–161. doi:10.4103/jhrs.JHRS_77_17. PMC 5672719. PMID 29142442. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672719" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672719</a> <a href="#fnref:27" class="footnote-back-ref">↩</a></p></li> <li id="fn:28"><p>Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S (2019). "Obese and Non-obese Polycystic Ovarian Syndrome: Comparison of Clinical, Metabolic, Hormonal Parameters, and their Differential Response to Clomiphene". Indian Journal of Endocrinology and Metabolism. 23 (2): 257–262. doi:10.4103/ijem.IJEM_637_18. PMC 6540884. PMID 31161114. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540884" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540884</a> <a href="#fnref:28" class="footnote-back-ref">↩</a></p></li> <li id="fn:29"><p>Johnstone E, Cannon-Albright L, Peterson CM, Allen-Brady K (July 2018). "Lean PCOS may be a genetically distinct from obese PCOS: lean women with polycystic ovary syndrome and their relatives have no increased risk of T2DM". Human Reproduction. 33. Oxford, England: Oxford Univ Press: 454. doi:10.26226/morressier.5af300b3738ab10027aa99cd. S2CID 242055977. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:29" class="footnote-back-ref">↩</a></p></li> <li id="fn:30"><p>Goyal M, Dawood AS (2017). "Debates Regarding Lean Patients with Polycystic Ovary Syndrome: A Narrative Review". Journal of Human Reproductive Sciences. 10 (3): 154–161. doi:10.4103/jhrs.jhrs_77_17. PMC 5672719. PMID 29142442. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672719" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672719</a> <a href="#fnref:30" class="footnote-back-ref">↩</a></p></li> <li id="fn:31"><p>Mazze R, Strock ES, Simonson GD, Bergenstal RM (11 January 2007). "Type 2 Diabetes and Metabolic Syndrome in Children and Adolescents". Staged Diabetes Management: A Systematic Approach (2nd ed.). John Wiley & Sons. pp. 213–. ISBN 978-0-470-06171-8. OCLC 1039172275. Archived from the original on 29 May 2024. Retrieved 18 September 2022. Diagnosis and treatment. The first diagnostic test [of PCOS] is a measurement of total testosterone and free testosterone by radioimmunoassay. If total testosterone is between 50 ng/dL and 200 ng/dL above normal (<2.5 ng/dL), PCOS is present. If >200 ng/dL, then serum DHEA-S should be measured. If total testosterone or DHEA-S >700 μg/dL, then rule out an ovarian or adrenal tumor. These tests should be followed by tests for hypothyroidism, hyperprolactinemia, and adrenal hyperplasia. <a href="978-0-470-06171-8" target="_blank">978-0-470-06171-8</a> <a href="#fnref:31" class="footnote-back-ref">↩</a></p></li> <li id="fn:32"><p>Loh HH, Yee A, Loh HS, Kanagasundram S, Francis B, Lim LL (September 2020). "Sexual dysfunction in polycystic ovary syndrome: a systematic review and meta-analysis". Hormones (Athens). 19 (3): 413–423. doi:10.1007/s42000-020-00210-0. PMID 32462512. S2CID 218898082. A total of 5366 women with PCOS from 21 studies were included. [...] Women with PCOS [...] [had higher] serum total testosterone level (2.34 ± 0.58 nmol/L vs 1.57 ± 0.60 nmol/L, p < 0.001) compared with women without PCOS. [...] PCOS is characterized by high levels of androgens (dehydroepiandrosterone, androstenedione, and testosterone) and luteinizing hormone (LH), and increased LH/follicle-stimulating hormone (FSH) ratio [52]. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:32" class="footnote-back-ref">↩</a></p></li> <li id="fn:33"><p>Loh HH, Yee A, Loh HS, Kanagasundram S, Francis B, Lim LL (September 2020). "Sexual dysfunction in polycystic ovary syndrome: a systematic review and meta-analysis". Hormones (Athens). 19 (3): 413–423. doi:10.1007/s42000-020-00210-0. PMID 32462512. S2CID 218898082. A total of 5366 women with PCOS from 21 studies were included. [...] Women with PCOS [...] [had higher] serum total testosterone level (2.34 ± 0.58 nmol/L vs 1.57 ± 0.60 nmol/L, p < 0.001) compared with women without PCOS. [...] PCOS is characterized by high levels of androgens (dehydroepiandrosterone, androstenedione, and testosterone) and luteinizing hormone (LH), and increased LH/follicle-stimulating hormone (FSH) ratio [52]. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:33" class="footnote-back-ref">↩</a></p></li> <li id="fn:34"><p>Balen AH, Conway GS, Kaltsas G, Techatrasak K, Manning PJ, West C, et al. (August 1995). "Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients". Hum Reprod. 10 (8): 2107–11. doi:10.1093/oxfordjournals.humrep.a136243. PMID 8567849. The criteria for the diagnosis of the polycystic ovary syndrome (PCOS) have still not been agreed universally. A population of 1741 women with PCOS were studied, all of whom had polycystic ovaries seen by ultrasound scan. The frequency distributions of the serum concentrations of [...] testosterone [...] were determined and compared with the symptoms and signs of PCOS. [...] A rising serum concentration of testosterone [mean and 95th percentiles 2.6 (1.1-4.8) nmol/1] was associated with an increased risk of hirsutism, infertility, and cycle disturbance. [...] If the serum testosterone concentration is >4.8 nmol/1, other causes of hyperandrogenism should be excluded. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:34" class="footnote-back-ref">↩</a></p></li> <li id="fn:35"><p>Carmina E, Stanczyk FZ, Lobo RA (2019). "Evaluation of Hormonal Status". In Strauss JF, Barbieri RL (eds.). Yen and Jaffe's Reproductive Endocrinology: Physiology, Pathophysiology, and Clinical Management (8th ed.). Elsevier. pp. 887–915.e4. doi:10.1016/B978-0-323-47912-7.00034-2. ISBN 978-0-323-47912-7. S2CID 56977185. <a href="978-0-323-47912-7" target="_blank">978-0-323-47912-7</a> <a href="#fnref:35" class="footnote-back-ref">↩</a></p></li> <li id="fn:36"><p>Mazze R, Strock ES, Simonson GD, Bergenstal RM (11 January 2007). "Type 2 Diabetes and Metabolic Syndrome in Children and Adolescents". Staged Diabetes Management: A Systematic Approach (2nd ed.). John Wiley & Sons. pp. 213–. ISBN 978-0-470-06171-8. OCLC 1039172275. Archived from the original on 29 May 2024. Retrieved 18 September 2022. Diagnosis and treatment. The first diagnostic test [of PCOS] is a measurement of total testosterone and free testosterone by radioimmunoassay. If total testosterone is between 50 ng/dL and 200 ng/dL above normal (<2.5 ng/dL), PCOS is present. If >200 ng/dL, then serum DHEA-S should be measured. If total testosterone or DHEA-S >700 μg/dL, then rule out an ovarian or adrenal tumor. These tests should be followed by tests for hypothyroidism, hyperprolactinemia, and adrenal hyperplasia. <a href="978-0-470-06171-8" target="_blank">978-0-470-06171-8</a> <a href="#fnref:36" class="footnote-back-ref">↩</a></p></li> <li id="fn:37"><p>"What We Talk About When We Talk About PCOS". Vice.com. 23 January 2019. Archived from the original on 19 January 2022. Retrieved 19 January 2022. <a href="https://www.vice.com/en/article/what-we-talk-about-when-we-talk-about-pcos/" target="_blank">https://www.vice.com/en/article/what-we-talk-about-when-we-talk-about-pcos/</a> <a href="#fnref:37" class="footnote-back-ref">↩</a></p></li> <li id="fn:38"><p>Polycystic Ovarian Syndrome at eMedicine <a href="https://emedicine.medscape.com/article/256806-overview" target="_blank">https://emedicine.medscape.com/article/256806-overview</a> <a href="#fnref:38" class="footnote-back-ref">↩</a></p></li> <li id="fn:39"><p>Barry JA, Azizia MM, Hardiman PJ (1 September 2014). "Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis". Human Reproduction Update. 20 (5): 748–758. doi:10.1093/humupd/dmu012. PMC 4326303. PMID 24688118. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326303" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326303</a> <a href="#fnref:39" class="footnote-back-ref">↩</a></p></li> <li id="fn:40"><p>New MI (May 1993). "Nonclassical congenital adrenal hyperplasia and the polycystic ovarian syndrome". Annals of the New York Academy of Sciences. 687 (1): 193–205. Bibcode:1993NYASA.687..193N. doi:10.1111/j.1749-6632.1993.tb43866.x. PMID 8323173. S2CID 30161989. <a href="/wiki/Bibcode_(identifier)" target="_blank">/wiki/Bibcode_(identifier)</a> <a href="#fnref:40" class="footnote-back-ref">↩</a></p></li> <li id="fn:41"><p>Hardiman P, Pillay OC, Atiomo W (May 2003). "Polycystic ovary syndrome and endometrial carcinoma". Lancet. 361 (9371): 1810–2. doi:10.1016/S0140-6736(03)13409-5. PMID 12781553. S2CID 27453081. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:41" class="footnote-back-ref">↩</a></p></li> <li id="fn:42"><p>Mather KJ, Kwan F, Corenblum B (January 2000). "Hyperinsulinemia in polycystic ovary syndrome correlates with increased cardiovascular risk independent of obesity". Fertility and Sterility. 73 (1): 150–6. doi:10.1016/S0015-0282(99)00468-9. PMID 10632431. <a href="https://doi.org/10.1016%2FS0015-0282%2899%2900468-9" target="_blank">https://doi.org/10.1016%2FS0015-0282%2899%2900468-9</a> <a href="#fnref:42" class="footnote-back-ref">↩</a></p></li> <li id="fn:43"><p>Polycystic Ovarian Syndrome at eMedicine <a href="https://emedicine.medscape.com/article/256806-overview" target="_blank">https://emedicine.medscape.com/article/256806-overview</a> <a href="#fnref:43" class="footnote-back-ref">↩</a></p></li> <li id="fn:44"><p>Moran LJ, Misso ML, Wild RA, Norman RJ (2010). "Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis". Human Reproduction Update. 16 (4): 347–363. doi:10.1093/humupd/dmq001. PMID 20159883. <a href="https://doi.org/10.1093%2Fhumupd%2Fdmq001" target="_blank">https://doi.org/10.1093%2Fhumupd%2Fdmq001</a> <a href="#fnref:44" class="footnote-back-ref">↩</a></p></li> <li id="fn:45"><p>Falcone T, Hurd RW (2007). Clinical Reproductive Medicine and Surgery. Elsevier Health Sciences. p. 223. ISBN 978-0-323-03309-1. Archived from the original on 14 January 2023. Retrieved 24 May 2020. <a href="978-0-323-03309-1" target="_blank">978-0-323-03309-1</a> <a href="#fnref:45" class="footnote-back-ref">↩</a></p></li> <li id="fn:46"><p>"Polycystic ovary syndrome (PCOS) - Symptoms and causes". Mayo Clinic. Archived from the original on 21 November 2021. Retrieved 26 June 2021. <a href="https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439" target="_blank">https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439</a> <a href="#fnref:46" class="footnote-back-ref">↩</a></p></li> <li id="fn:47"><p>Teede H, Deeks A, Moran L (June 2010). "Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan". BMC Medicine. 8 (1): 41. doi:10.1186/1741-7015-8-41. PMC 2909929. PMID 20591140. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929</a> <a href="#fnref:47" class="footnote-back-ref">↩</a></p></li> <li id="fn:48"><p>Barry JA, Kuczmierczyk AR, Hardiman PJ (September 2011). "Anxiety and depression in polycystic ovary syndrome: a systematic review and meta-analysis". Human Reproduction. 26 (9): 2442–51. doi:10.1093/humrep/der197. PMID 21725075. <a href="https://doi.org/10.1093%2Fhumrep%2Fder197" target="_blank">https://doi.org/10.1093%2Fhumrep%2Fder197</a> <a href="#fnref:48" class="footnote-back-ref">↩</a></p></li> <li id="fn:49"><p>Ovalle F, Azziz R (June 2002). "Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus". Fertility and Sterility. 77 (6): 1095–1105. doi:10.1016/s0015-0282(02)03111-4. PMID 12057712. <a href="https://doi.org/10.1016%2Fs0015-0282%2802%2903111-4" target="_blank">https://doi.org/10.1016%2Fs0015-0282%2802%2903111-4</a> <a href="#fnref:49" class="footnote-back-ref">↩</a></p></li> <li id="fn:50"><p>Polycystic Ovarian Syndrome at eMedicine <a href="https://emedicine.medscape.com/article/256806-overview" target="_blank">https://emedicine.medscape.com/article/256806-overview</a> <a href="#fnref:50" class="footnote-back-ref">↩</a></p></li> <li id="fn:51"><p>de Groot PC, Dekkers OM, Romijn JA, Dieben SW, Helmerhorst FM (1 July 2011). "PCOS, coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis". Human Reproduction Update. 17 (4): 495–500. doi:10.1093/humupd/dmr001. PMID 21335359. <a href="https://doi.org/10.1093%2Fhumupd%2Fdmr001" target="_blank">https://doi.org/10.1093%2Fhumupd%2Fdmr001</a> <a href="#fnref:51" class="footnote-back-ref">↩</a></p></li> <li id="fn:52"><p>Polycystic Ovarian Syndrome at eMedicine <a href="https://emedicine.medscape.com/article/256806-overview" target="_blank">https://emedicine.medscape.com/article/256806-overview</a> <a href="#fnref:52" class="footnote-back-ref">↩</a></p></li> <li id="fn:53"><p>Goldenberg N, Glueck C (February 2008). "Medical therapy in women with polycystic ovarian syndrome before and during pregnancy and lactation". Minerva Ginecologica. 60 (1): 63–75. PMID 18277353. Archived from the original on 2 November 2021. Retrieved 13 October 2021. <a href="https://www.minervamedica.it/en/journals/minerva-obstetrics-gynecology/article.php?cod=R09Y2008N01A0063" target="_blank">https://www.minervamedica.it/en/journals/minerva-obstetrics-gynecology/article.php?cod=R09Y2008N01A0063</a> <a href="#fnref:53" class="footnote-back-ref">↩</a></p></li> <li id="fn:54"><p>Boomsma CM, Fauser BC, Macklon NS (January 2008). "Pregnancy complications in women with polycystic ovary syndrome". Seminars in Reproductive Medicine. 26 (1): 72–84. doi:10.1055/s-2007-992927. PMID 18181085. S2CID 260316768. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:54" class="footnote-back-ref">↩</a></p></li> <li id="fn:55"><p>Helvaci N, Karabulut E, Demir AU, Yildiz BO (24 July 2017). "Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature". Endocrine Connections. 6 (7): 437–445. doi:10.1530/EC-17-0129. PMC 5574283. PMID 28739562. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574283" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574283</a> <a href="#fnref:55" class="footnote-back-ref">↩</a></p></li> <li id="fn:56"><p>Vassilatou E (14 July 2014). "Nonalcoholic fatty liver disease and polycystic ovary syndrome". World Journal of Gastroenterology. 20 (26): 8351–8363. doi:10.3748/wjg.v20.i26.8351. PMC 4093689. PMID 25024594. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4093689" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4093689</a> <a href="#fnref:56" class="footnote-back-ref">↩</a></p></li> <li id="fn:57"><p>Barry JA, Azizia MM, Hardiman PJ (1 September 2014). "Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis". Human Reproduction Update. 20 (5): 748–758. doi:10.1093/humupd/dmu012. PMC 4326303. PMID 24688118. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326303" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326303</a> <a href="#fnref:57" class="footnote-back-ref">↩</a></p></li> <li id="fn:58"><p>Tara Becker, Marshall Chin, and Nancy Bates (9 Mar 2022). "Measuring Sex, Gender Identity, and Sexual Orientation". National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Washington DC: National Academies Press (US). 7, Measuring Intersex/DSD Populations. Archived from the original on 1 February 2025. Retrieved 12 February 2025. <a href="http://www.ncbi.nlm.nih.gov/books/NBK581039/" target="_blank">http://www.ncbi.nlm.nih.gov/books/NBK581039/</a> <a href="#fnref:58" class="footnote-back-ref">↩</a></p></li> <li id="fn:59"><p>Singh S, Pal N, Shubham S, Sarma DK, Verma V, Marotta F, et al. (11 February 2023). "Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics". Journal of Clinical Medicine. 12 (4): 1454. doi:10.3390/jcm12041454. ISSN 2077-0383. PMC 9964744. PMID 36835989. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9964744" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9964744</a> <a href="#fnref:59" class="footnote-back-ref">↩</a></p></li> <li id="fn:60"><p>"Polycystic Ovary Syndrome". www.endocrine.org. 24 January 2022. Retrieved 7 March 2025. <a href="https://www.endocrine.org/patient-engagement/endocrine-library/pcos" target="_blank">https://www.endocrine.org/patient-engagement/endocrine-library/pcos</a> <a href="#fnref:60" class="footnote-back-ref">↩</a></p></li> <li id="fn:61"><p>Wugalter K, Perovic M, Karkaby L, Einstein G (2 April 2024). "The double-edged sword of PCOS and gender: exploring gender-diverse experiences of polycystic ovary syndrome". International Journal of Transgender Health. 25 (2): 251–267. doi:10.1080/26895269.2023.2183448. ISSN 2689-5269. PMC 11044764. PMID 38681493. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11044764" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11044764</a> <a href="#fnref:61" class="footnote-back-ref">↩</a></p></li> <li id="fn:62"><p>Page 836 (Section:Polycystic ovary syndrome) in: Fauser BC, Diedrich K, Bouchard P, Domínguez F, Matzuk M, Franks S, et al. (2011). "Contemporary genetic technologies and female reproduction". Human Reproduction Update. 17 (6): 829–847. doi:10.1093/humupd/dmr033. PMC 3191938. PMID 21896560. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191938" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191938</a> <a href="#fnref:62" class="footnote-back-ref">↩</a></p></li> <li id="fn:63"><p>Legro RS, Strauss JF (September 2002). "Molecular progress in infertility: polycystic ovary syndrome". Fertility and Sterility. 78 (3): 569–576. doi:10.1016/S0015-0282(02)03275-2. PMID 12215335. <a href="https://doi.org/10.1016%2FS0015-0282%2802%2903275-2" target="_blank">https://doi.org/10.1016%2FS0015-0282%2802%2903275-2</a> <a href="#fnref:63" class="footnote-back-ref">↩</a></p></li> <li id="fn:64"><p>Diamanti-Kandarakis E, Kandarakis H, Legro RS (August 2006). "The role of genes and environment in the etiology of PCOS". Endocrine. 30 (1): 19–26. doi:10.1385/ENDO:30:1:19. PMID 17185788. S2CID 21220430. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:64" class="footnote-back-ref">↩</a></p></li> <li id="fn:65"><p>Page 836 (Section:Polycystic ovary syndrome) in: Fauser BC, Diedrich K, Bouchard P, Domínguez F, Matzuk M, Franks S, et al. (2011). "Contemporary genetic technologies and female reproduction". Human Reproduction Update. 17 (6): 829–847. doi:10.1093/humupd/dmr033. PMC 3191938. PMID 21896560. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191938" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191938</a> <a href="#fnref:65" class="footnote-back-ref">↩</a></p></li> <li id="fn:66"><p>Legro RS, Strauss JF (September 2002). "Molecular progress in infertility: polycystic ovary syndrome". Fertility and Sterility. 78 (3): 569–576. doi:10.1016/S0015-0282(02)03275-2. PMID 12215335. <a href="https://doi.org/10.1016%2FS0015-0282%2802%2903275-2" target="_blank">https://doi.org/10.1016%2FS0015-0282%2802%2903275-2</a> <a href="#fnref:66" class="footnote-back-ref">↩</a></p></li> <li id="fn:67"><p>Filippou P, Homburg R (July 2017). "Is foetal hyperexposure to androgens a cause of PCOS?". Human Reproduction Update. 23 (4): 421–432. doi:10.1093/humupd/dmx013. PMID 28531286. <a href="https://doi.org/10.1093%2Fhumupd%2Fdmx013" target="_blank">https://doi.org/10.1093%2Fhumupd%2Fdmx013</a> <a href="#fnref:67" class="footnote-back-ref">↩</a></p></li> <li id="fn:68"><p>De Leo V, Musacchio MC, Cappelli V, Massaro MG, Morgante G, Petraglia F (July 2016). "Genetic, hormonal and metabolic aspects of PCOS: an update". Reproductive Biology and Endocrinology (Review). 14 (1): 38. doi:10.1186/s12958-016-0173-x. PMC 4947298. PMID 27423183. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947298" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947298</a> <a href="#fnref:68" class="footnote-back-ref">↩</a></p></li> <li id="fn:69"><p>Diamanti-Kandarakis E, Kandarakis H, Legro RS (August 2006). "The role of genes and environment in the etiology of PCOS". Endocrine. 30 (1): 19–26. doi:10.1385/ENDO:30:1:19. PMID 17185788. S2CID 21220430. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:69" class="footnote-back-ref">↩</a></p></li> <li id="fn:70"><p>Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS (October 2015). "Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome". Endocrine Reviews (Review). 36 (5): 487–525. doi:10.1210/er.2015-1018. PMC 4591526. PMID 26426951. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591526" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591526</a> <a href="#fnref:70" class="footnote-back-ref">↩</a></p></li> <li id="fn:71"><p>"What causes PCOS?". Eunice Kennedy Shriver National Institute of Child Health and Human Development. 29 September 2022. Archived from the original on 9 October 2021. Retrieved 13 October 2021. <a href="https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/causes" target="_blank">https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/causes</a> <a href="#fnref:71" class="footnote-back-ref">↩</a></p></li> <li id="fn:72"><p>"Polycystic Ovary Syndrome (PCOS): Condition Information". National Institute of Child Health and Human Development. 31 January 2017. Archived from the original on 22 October 2018. Retrieved 19 November 2018. <a href="https://www.nichd.nih.gov/health/topics/pcos/conditioninfo" target="_blank">https://www.nichd.nih.gov/health/topics/pcos/conditioninfo</a> <a href="#fnref:72" class="footnote-back-ref">↩</a></p></li> <li id="fn:73"><p>"How do health care providers diagnose PCOS?". Eunice Kennedy Shriver National Institute of Child Health and Human Development. 29 September 2022. Archived from the original on 9 October 2021. Retrieved 13 October 2021. <a href="https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/diagnose" target="_blank">https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/diagnose</a> <a href="#fnref:73" class="footnote-back-ref">↩</a></p></li> <li id="fn:74"><p>Legro RS, Strauss JF (September 2002). "Molecular progress in infertility: polycystic ovary syndrome". Fertility and Sterility. 78 (3): 569–576. doi:10.1016/S0015-0282(02)03275-2. PMID 12215335. <a href="https://doi.org/10.1016%2FS0015-0282%2802%2903275-2" target="_blank">https://doi.org/10.1016%2FS0015-0282%2802%2903275-2</a> <a href="#fnref:74" class="footnote-back-ref">↩</a></p></li> <li id="fn:75"><p>Crosignani PG, Nicolosi AE (2001). "Polycystic ovarian disease: heritability and heterogeneity". Human Reproduction Update. 7 (1): 3–7. doi:10.1093/humupd/7.1.3. PMID 11212071. <a href="https://doi.org/10.1093%2Fhumupd%2F7.1.3" target="_blank">https://doi.org/10.1093%2Fhumupd%2F7.1.3</a> <a href="#fnref:75" class="footnote-back-ref">↩</a></p></li> <li id="fn:76"><p>Strauss JF (November 2003). "Some new thoughts on the pathophysiology and genetics of polycystic ovary syndrome". Annals of the New York Academy of Sciences. 997 (1): 42–48. Bibcode:2003NYASA.997...42S. doi:10.1196/annals.1290.005. PMID 14644808. S2CID 23559461. <a href="/wiki/Bibcode_(identifier)" target="_blank">/wiki/Bibcode_(identifier)</a> <a href="#fnref:76" class="footnote-back-ref">↩</a></p></li> <li id="fn:77"><p>Hamosh A (12 September 2011). "POLYCYSTIC OVARY SYNDROME 1; PCOS1". OMIM. McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine. Archived from the original on 16 July 2015. Retrieved 15 November 2011. <a href="http://omim.org/entry/184700" target="_blank">http://omim.org/entry/184700</a> <a href="#fnref:77" class="footnote-back-ref">↩</a></p></li> <li id="fn:78"><p>Crosignani PG, Nicolosi AE (2001). "Polycystic ovarian disease: heritability and heterogeneity". Human Reproduction Update. 7 (1): 3–7. doi:10.1093/humupd/7.1.3. PMID 11212071. <a href="https://doi.org/10.1093%2Fhumupd%2F7.1.3" target="_blank">https://doi.org/10.1093%2Fhumupd%2F7.1.3</a> <a href="#fnref:78" class="footnote-back-ref">↩</a></p></li> <li id="fn:79"><p>Hamosh A (12 September 2011). "POLYCYSTIC OVARY SYNDROME 1; PCOS1". OMIM. McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine. Archived from the original on 16 July 2015. Retrieved 15 November 2011. <a href="http://omim.org/entry/184700" target="_blank">http://omim.org/entry/184700</a> <a href="#fnref:79" class="footnote-back-ref">↩</a></p></li> <li id="fn:80"><p>Strauss JF (November 2003). "Some new thoughts on the pathophysiology and genetics of polycystic ovary syndrome". Annals of the New York Academy of Sciences. 997 (1): 42–48. Bibcode:2003NYASA.997...42S. doi:10.1196/annals.1290.005. PMID 14644808. S2CID 23559461. <a href="/wiki/Bibcode_(identifier)" target="_blank">/wiki/Bibcode_(identifier)</a> <a href="#fnref:80" class="footnote-back-ref">↩</a></p></li> <li id="fn:81"><p>Diamanti-Kandarakis E, Kandarakis H, Legro RS (August 2006). "The role of genes and environment in the etiology of PCOS". Endocrine. 30 (1): 19–26. doi:10.1385/ENDO:30:1:19. PMID 17185788. S2CID 21220430. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:81" class="footnote-back-ref">↩</a></p></li> <li id="fn:82"><p>Legro RS, Strauss JF (September 2002). "Molecular progress in infertility: polycystic ovary syndrome". Fertility and Sterility. 78 (3): 569–576. doi:10.1016/S0015-0282(02)03275-2. PMID 12215335. <a href="https://doi.org/10.1016%2FS0015-0282%2802%2903275-2" target="_blank">https://doi.org/10.1016%2FS0015-0282%2802%2903275-2</a> <a href="#fnref:82" class="footnote-back-ref">↩</a></p></li> <li id="fn:83"><p>Amato P, Simpson JL (October 2004). "The genetics of polycystic ovary syndrome". Best Practice & Research. Clinical Obstetrics & Gynaecology. 18 (5): 707–718. doi:10.1016/j.bpobgyn.2004.05.002. PMID 15380142. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:83" class="footnote-back-ref">↩</a></p></li> <li id="fn:84"><p>Draper N, Walker EA, Bujalska IJ, Tomlinson JW, Chalder SM, Arlt W, et al. (August 2003). "Mutations in the genes encoding 11beta-hydroxysteroid dehydrogenase type 1 and hexose-6-phosphate dehydrogenase interact to cause cortisone reductase deficiency". Nature Genetics. 34 (4): 434–9. doi:10.1038/ng1214. PMID 12858176. S2CID 22772927. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:84" class="footnote-back-ref">↩</a></p></li> <li id="fn:85"><p>Ehrmann DA (March 2005). "Polycystic ovary syndrome". The New England Journal of Medicine. 352 (12): 1223–36. doi:10.1056/NEJMra041536. PMID 15788499. S2CID 79796961. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:85" class="footnote-back-ref">↩</a></p></li> <li id="fn:86"><p>Diamanti-Kandarakis E, Kandarakis H, Legro RS (August 2006). "The role of genes and environment in the etiology of PCOS". Endocrine. 30 (1): 19–26. doi:10.1385/ENDO:30:1:19. PMID 17185788. S2CID 21220430. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:86" class="footnote-back-ref">↩</a></p></li> <li id="fn:87"><p>Teede H, Deeks A, Moran L (June 2010). "Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan". BMC Medicine. 8 (1): 41. doi:10.1186/1741-7015-8-41. PMC 2909929. PMID 20591140. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929</a> <a href="#fnref:87" class="footnote-back-ref">↩</a></p></li> <li id="fn:88"><p>Faghfoori Z, Fazelian S, Shadnoush M, Goodarzi R (November 2017). "Nutritional management in women with polycystic ovary syndrome: A review study". Diabetes & Metabolic Syndrome (Review). 11 (Suppl 1): S429 – S432. doi:10.1016/j.dsx.2017.03.030. PMID 28416368. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:88" class="footnote-back-ref">↩</a></p></li> <li id="fn:89"><p>Witchel SF, Oberfield SE, Peña AS (August 2019). "Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls". Journal of the Endocrine Society. 3 (8): 1545–73. doi:10.1210/js.2019-00078. PMC 6676075. PMID 31384717. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676075" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676075</a> <a href="#fnref:89" class="footnote-back-ref">↩</a></p></li> <li id="fn:90"><p>Dunaif A, Fauser BC (November 2013). "Renaming PCOS--a two-state solution". The Journal of Clinical Endocrinology and Metabolism. 98 (11): 4325–8. doi:10.1210/jc.2013-2040. PMC 3816269. PMID 24009134. Around 20% of European women have polycystic ovaries (the prevalence is even higher in some other populations) but approximately two-thirds of these women do not have PCOS <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816269" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816269</a> <a href="#fnref:90" class="footnote-back-ref">↩</a></p></li> <li id="fn:91"><p>Hoeger KM (May 2014). "Developmental origins and future fate in PCOS". Seminars in Reproductive Medicine. 32 (3): 157–8. doi:10.1055/s-0034-1371086. PMID 24715509. S2CID 32069697. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:91" class="footnote-back-ref">↩</a></p></li> <li id="fn:92"><p>Abbott DH, Barnett DK, Bruns CM, Dumesic DA (2005). "Androgen excess fetal programming of female reproduction: a developmental aetiology for polycystic ovary syndrome?". Human Reproduction Update. 11 (4): 357–374. doi:10.1093/humupd/dmi013. PMID 15941725. <a href="https://doi.org/10.1093%2Fhumupd%2Fdmi013" target="_blank">https://doi.org/10.1093%2Fhumupd%2Fdmi013</a> <a href="#fnref:92" class="footnote-back-ref">↩</a></p></li> <li id="fn:93"><p>Rasgon N (June 2004). "The relationship between polycystic ovary syndrome and antiepileptic drugs: a review of the evidence". Journal of Clinical Psychopharmacology. 24 (3): 322–334. doi:10.1097/01.jcp.0000125745.60149.c6. PMID 15118487. S2CID 24603227. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:93" class="footnote-back-ref">↩</a></p></li> <li id="fn:94"><p>Rutkowska A, Rachoń D (April 2014). "Bisphenol A (BPA) and its potential role in the pathogenesis of the polycystic ovary syndrome (PCOS)". Gynecological Endocrinology. 30 (4): 260–5. doi:10.3109/09513590.2013.871517. PMID 24397396. S2CID 5828672. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:94" class="footnote-back-ref">↩</a></p></li> <li id="fn:95"><p>Palioura E, Diamanti-Kandarakis E (December 2013). "Industrial endocrine disruptors and polycystic ovary syndrome". Journal of Endocrinological Investigation. 36 (11): 1105–11. doi:10.1007/bf03346762. PMID 24445124. S2CID 27141519. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:95" class="footnote-back-ref">↩</a></p></li> <li id="fn:96"><p>Hu X, Wang J, Dong W, Fang Q, Hu L, Liu C (November 2011). "A meta-analysis of polycystic ovary syndrome in women taking valproate for epilepsy". Epilepsy Research. 97 (1–2): 73–82. doi:10.1016/j.eplepsyres.2011.07.006. PMID 21820873. S2CID 26422134. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:96" class="footnote-back-ref">↩</a></p></li> <li id="fn:97"><p>Palioura E, Diamanti-Kandarakis E (December 2013). "Industrial endocrine disruptors and polycystic ovary syndrome". Journal of Endocrinological Investigation. 36 (11): 1105–11. doi:10.1007/bf03346762. PMID 24445124. S2CID 27141519. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:97" class="footnote-back-ref">↩</a></p></li> <li id="fn:98"><p>"Endocrine Disruptors". National Institute of Environmental Health Sciences. Archived from the original on 11 June 2020. Retrieved 10 November 2022. <a href="https://www.niehs.nih.gov/health/topics/agents/endocrine/index.cfm" target="_blank">https://www.niehs.nih.gov/health/topics/agents/endocrine/index.cfm</a> <a href="#fnref:98" class="footnote-back-ref">↩</a></p></li> <li id="fn:99"><p>Merkin SS, Phy JL, Sites CK, Yang D (July 2016). "Environmental determinants of polycystic ovary syndrome". Fertility and Sterility. 106 (1): 16–24. doi:10.1016/j.fertnstert.2016.05.011. PMID 27240194. <a href="https://doi.org/10.1016%2Fj.fertnstert.2016.05.011" target="_blank">https://doi.org/10.1016%2Fj.fertnstert.2016.05.011</a> <a href="#fnref:99" class="footnote-back-ref">↩</a></p></li> <li id="fn:100"><p>Liu YN, Qin Y, Wu B, Peng H, Li M, Luo H, et al. (August 2022). "DNA methylation in polycystic ovary syndrome: Emerging evidence and challenges". Reproductive Toxicology. 111: 11–19. Bibcode:2022RepTx.111...11L. doi:10.1016/j.reprotox.2022.04.010. PMID 35562068. <a href="https://doi.org/10.1016%2Fj.reprotox.2022.04.010" target="_blank">https://doi.org/10.1016%2Fj.reprotox.2022.04.010</a> <a href="#fnref:100" class="footnote-back-ref">↩</a></p></li> <li id="fn:101"><p>Liu YN, Qin Y, Wu B, Peng H, Li M, Luo H, et al. (August 2022). "DNA methylation in polycystic ovary syndrome: Emerging evidence and challenges". Reproductive Toxicology. 111: 11–19. Bibcode:2022RepTx.111...11L. doi:10.1016/j.reprotox.2022.04.010. PMID 35562068. <a href="https://doi.org/10.1016%2Fj.reprotox.2022.04.010" target="_blank">https://doi.org/10.1016%2Fj.reprotox.2022.04.010</a> <a href="#fnref:101" class="footnote-back-ref">↩</a></p></li> <li id="fn:102"><p>Zhang T, Li L, Qin XS, Zhou Y, Zhang XF, Wang LQ, et al. (May 2014). "Di-(2-ethylhexyl) phthalate and bisphenol A exposure impairs mouse primordial follicle assembly in vitro". Environmental and Molecular Mutagenesis. 55 (4): 343–353. Bibcode:2014EnvMM..55..343Z. doi:10.1002/em.21847. ISSN 0893-6692. PMID 24458533. <a href="https://onlinelibrary.wiley.com/doi/10.1002/em.21847" target="_blank">https://onlinelibrary.wiley.com/doi/10.1002/em.21847</a> <a href="#fnref:102" class="footnote-back-ref">↩</a></p></li> <li id="fn:103"><p>Zhang T, Li L, Qin XS, Zhou Y, Zhang XF, Wang LQ, et al. (May 2014). "Di-(2-ethylhexyl) phthalate and bisphenol A exposure impairs mouse primordial follicle assembly in vitro". Environmental and Molecular Mutagenesis. 55 (4): 343–353. Bibcode:2014EnvMM..55..343Z. doi:10.1002/em.21847. ISSN 0893-6692. PMID 24458533. <a href="https://onlinelibrary.wiley.com/doi/10.1002/em.21847" target="_blank">https://onlinelibrary.wiley.com/doi/10.1002/em.21847</a> <a href="#fnref:103" class="footnote-back-ref">↩</a></p></li> <li id="fn:104"><p>Xu N, Chua AK, Jiang H, Liu NA, Goodarzi MO (1 August 2014). "Early Embryonic Androgen Exposure Induces Transgenerational Epigenetic and Metabolic Changes". Molecular Endocrinology. 28 (8): 1329–1336. doi:10.1210/me.2014-1042. ISSN 0888-8809. PMC 5414805. PMID 24992182. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414805" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414805</a> <a href="#fnref:104" class="footnote-back-ref">↩</a></p></li> <li id="fn:105"><p>Xu N, Chua AK, Jiang H, Liu NA, Goodarzi MO (1 August 2014). "Early Embryonic Androgen Exposure Induces Transgenerational Epigenetic and Metabolic Changes". Molecular Endocrinology. 28 (8): 1329–1336. doi:10.1210/me.2014-1042. ISSN 0888-8809. PMC 5414805. PMID 24992182. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414805" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414805</a> <a href="#fnref:105" class="footnote-back-ref">↩</a></p></li> <li id="fn:106"><p>Strauss JF (November 2003). "Some new thoughts on the pathophysiology and genetics of polycystic ovary syndrome". Annals of the New York Academy of Sciences. 997 (1): 42–48. Bibcode:2003NYASA.997...42S. doi:10.1196/annals.1290.005. PMID 14644808. S2CID 23559461. <a href="/wiki/Bibcode_(identifier)" target="_blank">/wiki/Bibcode_(identifier)</a> <a href="#fnref:106" class="footnote-back-ref">↩</a></p></li> <li id="fn:107"><p>Mortada R, Williams T (August 2015). "Metabolic Syndrome: Polycystic Ovary Syndrome". FP Essentials (Review). 435: 30–42. PMID 26280343. <a href="/wiki/PMID_(identifier)" target="_blank">/wiki/PMID_(identifier)</a> <a href="#fnref:107" class="footnote-back-ref">↩</a></p></li> <li id="fn:108"><p>Teede H, Deeks A, Moran L (June 2010). "Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan". BMC Medicine. 8 (1): 41. doi:10.1186/1741-7015-8-41. PMC 2909929. PMID 20591140. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929</a> <a href="#fnref:108" class="footnote-back-ref">↩</a></p></li> <li id="fn:109"><p>Nafiye Y, Sevtap K, Muammer D, Emre O, Senol K, Leyla M (April 2010). "The effect of serum and intrafollicular insulin resistance parameters and homocysteine levels of nonobese, nonhyperandrogenemic polycystic ovary syndrome patients on in vitro fertilization outcome". Fertility and Sterility. 93 (6): 1864–9. doi:10.1016/j.fertnstert.2008.12.024. PMID 19171332. <a href="https://doi.org/10.1016%2Fj.fertnstert.2008.12.024" target="_blank">https://doi.org/10.1016%2Fj.fertnstert.2008.12.024</a> <a href="#fnref:109" class="footnote-back-ref">↩</a></p></li> <li id="fn:110"><p>Diamanti-Kandarakis E, Dunaif A (December 2012). "Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications". Endocrine Reviews. 33 (6): 981–1030. doi:10.1210/er.2011-1034. PMC 5393155. PMID 23065822. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393155" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393155</a> <a href="#fnref:110" class="footnote-back-ref">↩</a></p></li> <li id="fn:111"><p>Diamanti-Kandarakis E, Dunaif A (December 2012). "Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications". Endocrine Reviews. 33 (6): 981–1030. doi:10.1210/er.2011-1034. PMC 5393155. PMID 23065822. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393155" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393155</a> <a href="#fnref:111" class="footnote-back-ref">↩</a></p></li> <li id="fn:112"><p>Lewandowski KC, Cajdler-Łuba A, Salata I, Bieńkiewicz M, Lewiński A (2011). "The utility of the gonadotrophin-releasing hormone (GnRH) test in the diagnosis of polycystic ovary syndrome (PCOS)". Endokrynologia Polska. 62 (2): 120–8. PMID 21528473. ProQuest 2464206947. Archived from the original on 27 October 2021. Retrieved 13 October 2021. <a href="https://journals.viamedica.pl/endokrynologia_polska/article/view/25282" target="_blank">https://journals.viamedica.pl/endokrynologia_polska/article/view/25282</a> <a href="#fnref:112" class="footnote-back-ref">↩</a></p></li> <li id="fn:113"><p>Diamanti-Kandarakis E, Dunaif A (December 2012). "Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications". Endocrine Reviews. 33 (6): 981–1030. doi:10.1210/er.2011-1034. PMC 5393155. PMID 23065822. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393155" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393155</a> <a href="#fnref:113" class="footnote-back-ref">↩</a></p></li> <li id="fn:114"><p>Diamanti-Kandarakis E, Dunaif A (December 2012). "Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications". Endocrine Reviews. 33 (6): 981–1030. doi:10.1210/er.2011-1034. PMC 5393155. PMID 23065822. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393155" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393155</a> <a href="#fnref:114" class="footnote-back-ref">↩</a></p></li> <li id="fn:115"><p>Rojas J, Chávez M, Olivar L, Rojas M, Morillo J, Mejías J, et al. (2014). "Polycystic ovary syndrome, insulin resistance, and obesity: navigating the pathophysiologic labyrinth". Int J Reprod Med. 2014: 71905. doi:10.1155/2014/719050. PMC 4334071. PMID 25763405. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334071" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334071</a> <a href="#fnref:115" class="footnote-back-ref">↩</a></p></li> <li id="fn:116"><p>Ali HI, Elsadawy ME, Khater NH (March 2016). "Ultrasound assessment of polycystic ovaries: Ovarian volume and morphology; which is more accurate in making the diagnosis?!". The Egyptian Journal of Radiology and Nuclear Medicine. 47 (1): 347–350. doi:10.1016/j.ejrnm.2015.10.002. <a href="https://doi.org/10.1016%2Fj.ejrnm.2015.10.002" target="_blank">https://doi.org/10.1016%2Fj.ejrnm.2015.10.002</a> <a href="#fnref:116" class="footnote-back-ref">↩</a></p></li> <li id="fn:117"><p>Sathyapalan T, Atkin SL (2010). "Mediators of inflammation in polycystic ovary syndrome in relation to adiposity". Mediators of Inflammation. 2010: 758656. doi:10.1155/2010/758656. PMC 2852606. PMID 20396393. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852606" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852606</a> <a href="#fnref:117" class="footnote-back-ref">↩</a></p></li> <li id="fn:118"><p>Fukuoka M, Yasuda K, Fujiwara H, Kanzaki H, Mori T (November 1992). "Interactions between interferon gamma, tumour necrosis factor alpha, and interleukin-1 in modulating progesterone and oestradiol production by human luteinized granulosa cells in culture". Human Reproduction. 7 (10): 1361–64. doi:10.1093/oxfordjournals.humrep.a137574. PMID 1291559. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:118" class="footnote-back-ref">↩</a></p></li> <li id="fn:119"><p>González F, Rote NS, Minium J, Kirwan JP (January 2006). "Reactive oxygen species-induced oxidative stress in the development of insulin resistance and hyperandrogenism in polycystic ovary syndrome". The Journal of Clinical Endocrinology and Metabolism. 91 (1): 336–340. doi:10.1210/jc.2005-1696. PMID 16249279. <a href="https://doi.org/10.1210%2Fjc.2005-1696" target="_blank">https://doi.org/10.1210%2Fjc.2005-1696</a> <a href="#fnref:119" class="footnote-back-ref">↩</a></p></li> <li id="fn:120"><p>Murri M, Luque-Ramírez M, Insenser M, Ojeda-Ojeda M, Escobar-Morreale HF (2013). "Circulating markers of oxidative stress and polycystic ovary syndrome (PCOS): a systematic review and meta-analysis". Human Reproduction Update. 19 (3): 268–288. doi:10.1093/humupd/dms059. PMID 23303572. <a href="https://doi.org/10.1093%2Fhumupd%2Fdms059" target="_blank">https://doi.org/10.1093%2Fhumupd%2Fdms059</a> <a href="#fnref:120" class="footnote-back-ref">↩</a></p></li> <li id="fn:121"><p>Imaging in Polycystic Ovary Disease at eMedicine <a href="https://emedicine.medscape.com/article/404754-overview" target="_blank">https://emedicine.medscape.com/article/404754-overview</a> <a href="#fnref:121" class="footnote-back-ref">↩</a></p></li> <li id="fn:122"><p>Lujan ME, Chizen DR, Pierson RA (August 2008). "Diagnostic criteria for polycystic ovary syndrome: pitfalls and controversies". Journal of Obstetrics and Gynaecology Canada. 30 (8): 671–9. doi:10.1016/S1701-2163(16)32915-2. PMC 2893212. PMID 18786289. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2893212" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2893212</a> <a href="#fnref:122" class="footnote-back-ref">↩</a></p></li> <li id="fn:123"><p>Teede et al. 2023, p. 5. - Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Melbourne, Australia: Monash University. ISBN 978-0-6458209-0-4. <a href="#fnref:123" class="footnote-back-ref">↩</a></p></li> <li id="fn:124"><p>Stener-Victorin E, Teede H, Norman RJ, Legro R, Goodarzi MO, Dokras A, et al. (18 April 2024). "Polycystic ovary syndrome". Nature Reviews Disease Primers. 10 (1). doi:10.1038/s41572-024-00511-3. ISSN 2056-676X. <a href="https://www.nature.com/articles/s41572-024-00511-3" target="_blank">https://www.nature.com/articles/s41572-024-00511-3</a> <a href="#fnref:124" class="footnote-back-ref">↩</a></p></li> <li id="fn:125"><p>"Polycystic ovary syndrome". nhs.uk. 20 October 2017. Retrieved 27 June 2025. <a href="https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/" target="_blank">https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/</a> <a href="#fnref:125" class="footnote-back-ref">↩</a></p></li> <li id="fn:126"><p>Teede et al. 2023, p. 18. - Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Melbourne, Australia: Monash University. ISBN 978-0-6458209-0-4. <a href="#fnref:126" class="footnote-back-ref">↩</a></p></li> <li id="fn:127"><p>Stener-Victorin E, Teede H, Norman RJ, Legro R, Goodarzi MO, Dokras A, et al. (18 April 2024). "Polycystic ovary syndrome". Nature Reviews Disease Primers. 10 (1). doi:10.1038/s41572-024-00511-3. ISSN 2056-676X. <a href="https://www.nature.com/articles/s41572-024-00511-3" target="_blank">https://www.nature.com/articles/s41572-024-00511-3</a> <a href="#fnref:127" class="footnote-back-ref">↩</a></p></li> <li id="fn:128"><p>Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ, et al. (1 September 2022). "Polycystic ovary syndrome". The Lancet Diabetes & Endocrinology. 10 (9): 668–680. doi:10.1016/S2213-8587(22)00163-2. ISSN 2213-8587. PMID 35934017. <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00163-2/abstract" target="_blank">https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00163-2/abstract</a> <a href="#fnref:128" class="footnote-back-ref">↩</a></p></li> <li id="fn:129"><p>Chang S, Dunaif A (1 March 2021). "Diagnosis of Polycystic Ovary Syndrome: Which Criteria to Use and When". Endocrinology and metabolism clinics of North America. 50 (1): 11–23. doi:10.1016/j.ecl.2020.10.002. ISSN 1558-4410. PMC 7860982. PMID 33518179. <a href="https://europepmc.org/articles/PMC7860982" target="_blank">https://europepmc.org/articles/PMC7860982</a> <a href="#fnref:129" class="footnote-back-ref">↩</a></p></li> <li id="fn:130"><p>Teede et al. 2023, p. 232. - Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Melbourne, Australia: Monash University. ISBN 978-0-6458209-0-4. <a href="#fnref:130" class="footnote-back-ref">↩</a></p></li> <li id="fn:131"><p>Teede et al. 2023, p. 233. - Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Melbourne, Australia: Monash University. ISBN 978-0-6458209-0-4. <a href="#fnref:131" class="footnote-back-ref">↩</a></p></li> <li id="fn:132"><p>Ghafari A, Maftoohi M, Samarin ME, Barani S, Banimohammad M, Samie R (1 March 2025). "The last update on polycystic ovary syndrome(PCOS), diagnosis criteria, and novel treatment". Endocrine and Metabolic Science. 17: 100228. doi:10.1016/j.endmts.2025.100228. ISSN 2666-3961. <a href="https://www.sciencedirect.com/science/article/pii/S2666396125000147" target="_blank">https://www.sciencedirect.com/science/article/pii/S2666396125000147</a> <a href="#fnref:132" class="footnote-back-ref">↩</a></p></li> <li id="fn:133"><p>Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (September 2023). "Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome". J Clin Endocrinol Metab. 108 (10): 2447–69. doi:10.1210/clinem/dgad463. PMC 10505534. PMID 37580314. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10505534" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10505534</a> <a href="#fnref:133" class="footnote-back-ref">↩</a></p></li> <li id="fn:134"><p>Teede et al. 2023, p. 233. - Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Melbourne, Australia: Monash University. ISBN 978-0-6458209-0-4. <a href="#fnref:134" class="footnote-back-ref">↩</a></p></li> <li id="fn:135"><p>Teede et al. 2023, p. 232. - Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Melbourne, Australia: Monash University. ISBN 978-0-6458209-0-4. <a href="#fnref:135" class="footnote-back-ref">↩</a></p></li> <li id="fn:136"><p>Teede et al. 2023, p. 232. - Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Melbourne, Australia: Monash University. ISBN 978-0-6458209-0-4. <a href="#fnref:136" class="footnote-back-ref">↩</a></p></li> <li id="fn:137"><p>Teede et al. 2023, p. 233. - Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Melbourne, Australia: Monash University. ISBN 978-0-6458209-0-4. <a href="#fnref:137" class="footnote-back-ref">↩</a></p></li> <li id="fn:138"><p>Stener-Victorin E, Teede H, Norman RJ, Legro R, Goodarzi MO, Dokras A, et al. (18 April 2024). "Polycystic ovary syndrome". Nature Reviews Disease Primers. 10 (1). doi:10.1038/s41572-024-00511-3. ISSN 2056-676X. <a href="https://www.nature.com/articles/s41572-024-00511-3" target="_blank">https://www.nature.com/articles/s41572-024-00511-3</a> <a href="#fnref:138" class="footnote-back-ref">↩</a></p></li> <li id="fn:139"><p>Teede et al. 2023, p. 233. - Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Melbourne, Australia: Monash University. ISBN 978-0-6458209-0-4. <a href="#fnref:139" class="footnote-back-ref">↩</a></p></li> <li id="fn:140"><p>Stener-Victorin E, Teede H, Norman RJ, Legro R, Goodarzi MO, Dokras A, et al. (18 April 2024). "Polycystic ovary syndrome". Nature Reviews Disease Primers. 10 (1). doi:10.1038/s41572-024-00511-3. ISSN 2056-676X. <a href="https://www.nature.com/articles/s41572-024-00511-3" target="_blank">https://www.nature.com/articles/s41572-024-00511-3</a> <a href="#fnref:140" class="footnote-back-ref">↩</a></p></li> <li id="fn:141"><p>Teede et al. 2023, p. 233. - Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Melbourne, Australia: Monash University. ISBN 978-0-6458209-0-4. <a href="#fnref:141" class="footnote-back-ref">↩</a></p></li> <li id="fn:142"><p>Bordewijk EM, Ng KY, Rakic L, Mol BW, Brown J, Crawford TJ, et al. (February 2020). "Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome". The Cochrane Database of Systematic Reviews. 2 (2): CD001122. doi:10.1002/14651858.CD001122.pub5. PMC 7013239. PMID 32048270. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013239" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013239</a> <a href="#fnref:142" class="footnote-back-ref">↩</a></p></li> <li id="fn:143"><p>Teede et al. 2023, p. 18. - Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Melbourne, Australia: Monash University. ISBN 978-0-6458209-0-4. <a href="#fnref:143" class="footnote-back-ref">↩</a></p></li> <li id="fn:144"><p>"Is there a cure for PCOS?". Eunice Kennedy Shriver National Institute of Child Health and Human Development. 31 January 2017. Archived from the original on 9 October 2021. Retrieved 13 October 2021. <a href="https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/cure" target="_blank">https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/cure</a> <a href="#fnref:144" class="footnote-back-ref">↩</a></p></li> <li id="fn:145"><p>Mortada R, Williams T (August 2015). "Metabolic Syndrome: Polycystic Ovary Syndrome". FP Essentials (Review). 435: 30–42. PMID 26280343. <a href="/wiki/PMID_(identifier)" target="_blank">/wiki/PMID_(identifier)</a> <a href="#fnref:145" class="footnote-back-ref">↩</a></p></li> <li id="fn:146"><p>Giallauria F, Palomba S, Vigorito C, Tafuri MG, Colao A, Lombardi G, et al. (July 2009). "Androgens in polycystic ovary syndrome: the role of exercise and diet". Seminars in Reproductive Medicine (Review). 27 (4): 306–315. doi:10.1055/s-0029-1225258. PMID 19530064. S2CID 260321191. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:146" class="footnote-back-ref">↩</a></p></li> <li id="fn:147"><p>Diamanti-Kandarakis E, ed. (2022). Polycystic Ovary Syndrome. doi:10.1016/c2018-0-03276-4. ISBN 978-0-12-823045-9. S2CID 222263507. Archived from the original on 29 May 2024. Retrieved 22 August 2023. <a href="978-0-12-823045-9" target="_blank">978-0-12-823045-9</a> <a href="#fnref:147" class="footnote-back-ref">↩</a></p></li> <li id="fn:148"><p>National Institutes of Health (NIH) (14 July 2014). "Treatments to Relieve Symptoms of PCOS". Archived from the original on 2 April 2015. Retrieved 13 March 2015. <a href="/wiki/National_Institutes_of_Health" target="_blank">/wiki/National_Institutes_of_Health</a> <a href="#fnref:148" class="footnote-back-ref">↩</a></p></li> <li id="fn:149"><p>Diamanti-Kandarakis E, ed. (2022). Polycystic Ovary Syndrome. doi:10.1016/c2018-0-03276-4. ISBN 978-0-12-823045-9. S2CID 222263507. Archived from the original on 29 May 2024. Retrieved 22 August 2023. <a href="978-0-12-823045-9" target="_blank">978-0-12-823045-9</a> <a href="#fnref:149" class="footnote-back-ref">↩</a></p></li> <li id="fn:150"><p>National Institutes of Health (NIH) (14 July 2014). "Treatments to Relieve Symptoms of PCOS". Archived from the original on 2 April 2015. Retrieved 13 March 2015. <a href="/wiki/National_Institutes_of_Health" target="_blank">/wiki/National_Institutes_of_Health</a> <a href="#fnref:150" class="footnote-back-ref">↩</a></p></li> <li id="fn:151"><p>National Institutes of Health (NIH) (14 July 2014). "Treatments to Relieve Symptoms of PCOS". Archived from the original on 2 April 2015. Retrieved 13 March 2015. <a href="/wiki/National_Institutes_of_Health" target="_blank">/wiki/National_Institutes_of_Health</a> <a href="#fnref:151" class="footnote-back-ref">↩</a></p></li> <li id="fn:152"><p>National Institutes of Health (NIH) (14 July 2014). "Treatments for Infertility Resulting from PCOS". Archived from the original on 2 April 2015. Retrieved 13 March 2015. <a href="/wiki/National_Institutes_of_Health" target="_blank">/wiki/National_Institutes_of_Health</a> <a href="#fnref:152" class="footnote-back-ref">↩</a></p></li> <li id="fn:153"><p>National Institutes of Health (NIH) (14 July 2014). "Treatments for Infertility Resulting from PCOS". Archived from the original on 2 April 2015. Retrieved 13 March 2015. <a href="/wiki/National_Institutes_of_Health" target="_blank">/wiki/National_Institutes_of_Health</a> <a href="#fnref:153" class="footnote-back-ref">↩</a></p></li> <li id="fn:154"><p>Morrow-Baez K (2018). Thriving with PCOS: Lifestyle Strategies to Successfully Manage Polycystic Ovary Syndrome. Rowman & Littlefield Publishers. <a href="#fnref:154" class="footnote-back-ref">↩</a></p></li> <li id="fn:155"><p>Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. (December 2013). "Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline". The Journal of Clinical Endocrinology and Metabolism. 98 (12): 4565–92. doi:10.1210/jc.2013-2350. PMC 5399492. PMID 24151290. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399492" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399492</a> <a href="#fnref:155" class="footnote-back-ref">↩</a></p></li> <li id="fn:156"><p>Magkos F, Yannakoulia M, Chan JL, Mantzoros CS (2009). "Management of the metabolic syndrome and type 2 diabetes through lifestyle modification". Annual Review of Nutrition. 29: 223–256. doi:10.1146/annurev-nutr-080508-141200. PMC 5653262. PMID 19400751. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653262" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653262</a> <a href="#fnref:156" class="footnote-back-ref">↩</a></p></li> <li id="fn:157"><p>Veltman-Verhulst SM, Boivin J, Eijkemans MJ, Fauser BJ (2012). "Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies". Human Reproduction Update. 18 (6): 638–651. doi:10.1093/humupd/dms029. PMID 22824735. <a href="https://doi.org/10.1093%2Fhumupd%2Fdms029" target="_blank">https://doi.org/10.1093%2Fhumupd%2Fdms029</a> <a href="#fnref:157" class="footnote-back-ref">↩</a></p></li> <li id="fn:158"><p>Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. (Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines) (July 2016). "American association of clinical endocrinologists and American college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity". Endocrine Practice. 22 (Suppl 3): 1–203. doi:10.4158/EP161365.GL. PMID 27219496. <a href="https://doi.org/10.4158%2FEP161365.GL" target="_blank">https://doi.org/10.4158%2FEP161365.GL</a> <a href="#fnref:158" class="footnote-back-ref">↩</a></p></li> <li id="fn:159"><p>Moran LJ, Ko H, Misso M, Marsh K, Noakes M, Talbot M, et al. (2013). "Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines". Human Reproduction Update. 19 (5): 432. doi:10.1093/humupd/dmt015. PMID 23727939. <a href="https://doi.org/10.1093%2Fhumupd%2Fdmt015" target="_blank">https://doi.org/10.1093%2Fhumupd%2Fdmt015</a> <a href="#fnref:159" class="footnote-back-ref">↩</a></p></li> <li id="fn:160"><p>Moran LJ, Ko H, Misso M, Marsh K, Noakes M, Talbot M, et al. (2013). "Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines". Human Reproduction Update. 19 (5): 432. doi:10.1093/humupd/dmt015. PMID 23727939. <a href="https://doi.org/10.1093%2Fhumupd%2Fdmt015" target="_blank">https://doi.org/10.1093%2Fhumupd%2Fdmt015</a> <a href="#fnref:160" class="footnote-back-ref">↩</a></p></li> <li id="fn:161"><p>Morrow-Baez K (2018). Thriving with PCOS: Lifestyle Strategies to Successfully Manage Polycystic Ovary Syndrome. Rowman & Littlefield Publishers. <a href="#fnref:161" class="footnote-back-ref">↩</a></p></li> <li id="fn:162"><p>Diamanti-Kandarakis E, ed. (2022). Polycystic Ovary Syndrome. doi:10.1016/c2018-0-03276-4. ISBN 978-0-12-823045-9. S2CID 222263507. Archived from the original on 29 May 2024. Retrieved 22 August 2023. <a href="978-0-12-823045-9" target="_blank">978-0-12-823045-9</a> <a href="#fnref:162" class="footnote-back-ref">↩</a></p></li> <li id="fn:163"><p>Polycystic Ovarian Syndrome~treatment at eMedicine <a href="https://emedicine.medscape.com/article/256806-treatment" target="_blank">https://emedicine.medscape.com/article/256806-treatment</a> <a href="#fnref:163" class="footnote-back-ref">↩</a></p></li> <li id="fn:164"><p>Krul-Poel YH, Snackey C, Louwers Y, Lips P, Lambalk CB, Laven JS, et al. (December 2013). "The role of vitamin D in metabolic disturbances in polycystic ovary syndrome: a systematic review". European Journal of Endocrinology (Review). 169 (6): 853–865. doi:10.1530/EJE-13-0617. hdl:1765/71001. PMID 24044903. <a href="https://doi.org/10.1530%2FEJE-13-0617" target="_blank">https://doi.org/10.1530%2FEJE-13-0617</a> <a href="#fnref:164" class="footnote-back-ref">↩</a></p></li> <li id="fn:165"><p>He C, Lin Z, Robb SW, Ezeamama AE (2015). "Serum Vitamin D Levels and Polycystic Ovary syndrome: A Systematic Review and Meta-Analysis". Nutrients. 7 (6): 4555–77. doi:10.3390/nu7064555. PMC 4488802. PMID 26061015. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488802" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488802</a> <a href="#fnref:165" class="footnote-back-ref">↩</a></p></li> <li id="fn:166"><p>Huang G, Coviello A (December 2012). "Clinical update on screening, diagnosis and management of metabolic disorders and cardiovascular risk factors associated with polycystic ovary syndrome". Current Opinion in Endocrinology, Diabetes and Obesity. 19 (6): 512–9. doi:10.1097/med.0b013e32835a000e. PMID 23108199. S2CID 205792902. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:166" class="footnote-back-ref">↩</a></p></li> <li id="fn:167"><p>Polycystic Ovarian Syndrome~treatment at eMedicine <a href="https://emedicine.medscape.com/article/256806-treatment" target="_blank">https://emedicine.medscape.com/article/256806-treatment</a> <a href="#fnref:167" class="footnote-back-ref">↩</a></p></li> <li id="fn:168"><p>Alesi S, Forslund M, Melin J, Romualdi D, Peña A, Tay CT, et al. (September 2023). "Efficacy and safety of anti-androgens in the management of polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials". eClinicalMedicine. 63: 102162. doi:10.1016/j.eclinm.2023.102162. PMC 10424142. PMID 37583655. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10424142" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10424142</a> <a href="#fnref:168" class="footnote-back-ref">↩</a></p></li> <li id="fn:169"><p>Morrow-Baez K (2018). Thriving with PCOS: Lifestyle Strategies to Successfully Manage Polycystic Ovary Syndrome. Rowman & Littlefield Publishers. <a href="#fnref:169" class="footnote-back-ref">↩</a></p></li> <li id="fn:170"><p>Polycystic Ovarian Syndrome~treatment at eMedicine <a href="https://emedicine.medscape.com/article/256806-treatment" target="_blank">https://emedicine.medscape.com/article/256806-treatment</a> <a href="#fnref:170" class="footnote-back-ref">↩</a></p></li> <li id="fn:171"><p>Lord JM, Flight IH, Norman RJ (October 2003). "Metformin in polycystic ovary syndrome: systematic review and meta-analysis". BMJ. 327 (7421): 951–3. doi:10.1136/bmj.327.7421.951. PMC 259161. PMID 14576245. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC259161" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC259161</a> <a href="#fnref:171" class="footnote-back-ref">↩</a></p></li> <li id="fn:172"><p>Li XJ, Yu YX, Liu CQ, Zhang W, Zhang HJ, Yan B, et al. (March 2011). "Metformin vs thiazolidinediones for treatment of clinical, hormonal and metabolic characteristics of polycystic ovary syndrome: a meta-analysis". Clinical Endocrinology. 74 (3): 332–9. doi:10.1111/j.1365-2265.2010.03917.x. PMID 21050251. S2CID 19620846. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:172" class="footnote-back-ref">↩</a></p></li> <li id="fn:173"><p>Grover A, Yialamas MA (March 2011). "Metformin or thiazolidinedione therapy in PCOS?". Nature Reviews. Endocrinology. 7 (3): 128–9. doi:10.1038/nrendo.2011.16. PMID 21283123. S2CID 26162421. Gale A250471047. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:173" class="footnote-back-ref">↩</a></p></li> <li id="fn:174"><p>National Institute for Health and Clinical Excellence. 11 Clinical guideline 11 : Fertility: assessment and treatment for people with fertility problems . London, 2004. <a href="/wiki/National_Institute_for_Health_and_Clinical_Excellence" target="_blank">/wiki/National_Institute_for_Health_and_Clinical_Excellence</a> <a href="#fnref:174" class="footnote-back-ref">↩</a></p></li> <li id="fn:175"><p>Balen A (December 2008). "Metformin therapy for the management of infertility in women with polycystic ovary syndrome" (PDF). Scientific Advisory Committee Opinion Paper 13. Royal College of Obstetricians and Gynaecologists. Archived from the original (PDF) on 18 December 2009. Retrieved 13 December 2009. <a href="https://www.webcitation.org/5m73m3kuM?url=http://www.rcog.org.uk/files/rcog-corp/uploaded-files/SAC13metformin-minorrevision.pdf" target="_blank">https://www.webcitation.org/5m73m3kuM?url=http://www.rcog.org.uk/files/rcog-corp/uploaded-files/SAC13metformin-minorrevision.pdf</a> <a href="#fnref:175" class="footnote-back-ref">↩</a></p></li> <li id="fn:176"><p>Leeman L, Acharya U (August 2009). "The use of metformin in the management of polycystic ovary syndrome and associated anovulatory infertility: the current evidence". Journal of Obstetrics and Gynaecology. 29 (6): 467–472. doi:10.1080/01443610902829414. PMID 19697191. S2CID 3339588. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:176" class="footnote-back-ref">↩</a></p></li> <li id="fn:177"><p>NICE (December 2018). "Metformin Hydrochloride". National Institute for Care Excellence. NICE. Archived from the original on 10 June 2021. Retrieved 2 November 2017. <a href="https://bnf.nice.org.uk/drug/metformin-hydrochloride.html#sideEffects" target="_blank">https://bnf.nice.org.uk/drug/metformin-hydrochloride.html#sideEffects</a> <a href="#fnref:177" class="footnote-back-ref">↩</a></p></li> <li id="fn:178"><p>Feig DS, Moses RG (October 2011). "Metformin therapy during pregnancy: good for the goose and good for the gosling too?". Diabetes Care. 34 (10): 2329–30. doi:10.2337/dc11-1153. PMC 3177745. PMID 21949224. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3177745" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3177745</a> <a href="#fnref:178" class="footnote-back-ref">↩</a></p></li> <li id="fn:179"><p>Cassina M, Donà M, Di Gianantonio E, Litta P, Clementi M (1 September 2014). "First-trimester exposure to metformin and risk of birth defects: a systematic review and meta-analysis". Human Reproduction Update. 20 (5): 656–669. doi:10.1093/humupd/dmu022. PMID 24861556. <a href="https://doi.org/10.1093%2Fhumupd%2Fdmu022" target="_blank">https://doi.org/10.1093%2Fhumupd%2Fdmu022</a> <a href="#fnref:179" class="footnote-back-ref">↩</a></p></li> <li id="fn:180"><p>Wang FF, Wu Y, Zhu YH, Ding T, Batterham RL, Qu F, et al. (October 2018). "Pharmacologic therapy to induce weight loss in women who have obesity/overweight with polycystic ovary syndrome: a systematic review and network meta-analysis" (PDF). Obesity Reviews. 19 (10): 1424–45. doi:10.1111/obr.12720. PMID 30066361. S2CID 51891552. Archived (PDF) from the original on 3 December 2021. Retrieved 13 October 2021. <a href="https://discovery.ucl.ac.uk/id/eprint/10050648/1/Hardiman_revised%20MS%5B23061%5D.pdf" target="_blank">https://discovery.ucl.ac.uk/id/eprint/10050648/1/Hardiman_revised%20MS%5B23061%5D.pdf</a> <a href="#fnref:180" class="footnote-back-ref">↩</a></p></li> <li id="fn:181"><p>Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. (December 2013). "Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline". The Journal of Clinical Endocrinology and Metabolism. 98 (12): 4565–92. doi:10.1210/jc.2013-2350. PMC 5399492. PMID 24151290. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399492" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399492</a> <a href="#fnref:181" class="footnote-back-ref">↩</a></p></li> <li id="fn:182"><p>Sharpe A, Morley LC, Tang T, Norman RJ, Balen AH (December 2019). "Metformin for ovulation induction (excluding gonadotrophins) in women with polycystic ovary syndrome". The Cochrane Database of Systematic Reviews. 2019 (12): CD013505. doi:10.1002/14651858.CD013505. PMC 6915832. PMID 31845767. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915832" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915832</a> <a href="#fnref:182" class="footnote-back-ref">↩</a></p></li> <li id="fn:183"><p>Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, et al. (November 2016). "The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance". Human Reproduction Update. 22 (6): 687–708. doi:10.1093/humupd/dmw025. PMID 27511809. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:183" class="footnote-back-ref">↩</a></p></li> <li id="fn:184"><p>Qiao J, Feng HL (2010). "Extra- and intra-ovarian factors in polycystic ovary syndrome: impact on oocyte maturation and embryo developmental competence". Human Reproduction Update. 17 (1): 17–33. doi:10.1093/humupd/dmq032. PMC 3001338. PMID 20639519. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001338" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001338</a> <a href="#fnref:184" class="footnote-back-ref">↩</a></p></li> <li id="fn:185"><p>"What are some causes of female infertility?". National Institute of Child Health and Human Development, National Institutes of Health. 31 January 2017. Archived from the original on 8 August 2020. Retrieved 25 October 2019. <a href="https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/causes-female" target="_blank">https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/causes-female</a> <a href="#fnref:185" class="footnote-back-ref">↩</a></p></li> <li id="fn:186"><p>Jurczewska J, Szostak-Węgierek D (April 2022). "The Influence of Diet on Ovulation Disorders in Women-A Narrative Review". Nutrients. 14 (8): 1556. doi:10.3390/nu14081556. PMC 9029579. PMID 35458118. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9029579" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9029579</a> <a href="#fnref:186" class="footnote-back-ref">↩</a></p></li> <li id="fn:187"><p>Wang L, Liu Y, Tan H, Huang S (May 2022). "Transtheoretical model-based mobile health application for PCOS". Reproductive Health. 19 (1): 117. doi:10.1186/s12978-022-01422-w. PMC 9097413. PMID 35549736. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9097413" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9097413</a> <a href="#fnref:187" class="footnote-back-ref">↩</a></p></li> <li id="fn:188"><p>Franik S, Le QK, Kremer JA, Kiesel L, Farquhar C (September 2022). "Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome". The Cochrane Database of Systematic Reviews. 2022 (9): CD010287. doi:10.1002/14651858.CD010287.pub4. PMC 9514207. PMID 36165742. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9514207" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9514207</a> <a href="#fnref:188" class="footnote-back-ref">↩</a></p></li> <li id="fn:189"><p>Tanbo T, Mellembakken J, Bjercke S, Ring E, Åbyholm T, Fedorcsak P (October 2018). "Ovulation induction in polycystic ovary syndrome". Acta Obstetricia et Gynecologica Scandinavica. 97 (10): 1162–7. doi:10.1111/aogs.13395. hdl:10852/72989. PMID 29889977. <a href="https://doi.org/10.1111%2Faogs.13395" target="_blank">https://doi.org/10.1111%2Faogs.13395</a> <a href="#fnref:189" class="footnote-back-ref">↩</a></p></li> <li id="fn:190"><p>Hu S, Yu Q, Wang Y, Wang M, Xia W, Zhu C (May 2018). "Letrozole versus clomiphene citrate in polycystic ovary syndrome: a meta-analysis of randomized controlled trials". Archives of Gynecology and Obstetrics. 297 (5): 1081–8. doi:10.1007/s00404-018-4688-6. PMID 29392438. S2CID 4800270. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:190" class="footnote-back-ref">↩</a></p></li> <li id="fn:191"><p>Morrow-Baez K (2018). Thriving with PCOS: Lifestyle Strategies to Successfully Manage Polycystic Ovary Syndrome. Rowman & Littlefield Publishers. <a href="#fnref:191" class="footnote-back-ref">↩</a></p></li> <li id="fn:192"><p>Penzias A, Bendikson K, Butts S, Coutifaris C, Falcone T, Fossum G, et al. (September 2017). "Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome (PCOS): a guideline". Fertility and Sterility. 108 (3): 426–441. doi:10.1016/j.fertnstert.2017.06.026. PMID 28865539. <a href="https://doi.org/10.1016%2Fj.fertnstert.2017.06.026" target="_blank">https://doi.org/10.1016%2Fj.fertnstert.2017.06.026</a> <a href="#fnref:192" class="footnote-back-ref">↩</a></p></li> <li id="fn:193"><p>Legro RS, Barnhart HX, Schlaff WD, Carr BR, Diamond MP, Carson SA, et al. (February 2007). "Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome". The New England Journal of Medicine. 356 (6): 551–566. doi:10.1056/NEJMoa063971. PMID 17287476.[non-primary source needed] <a href="https://doi.org/10.1056%2FNEJMoa063971" target="_blank">https://doi.org/10.1056%2FNEJMoa063971</a> <a href="#fnref:193" class="footnote-back-ref">↩</a></p></li> <li id="fn:194"><p>Homburg R (October 2004). "Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome". Best Practice & Research. Clinical Obstetrics & Gynaecology. 18 (5): 773–788. doi:10.1016/j.bpobgyn.2004.05.006. PMID 15380146. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:194" class="footnote-back-ref">↩</a></p></li> <li id="fn:195"><p>Bordewijk EM, Ng KY, Rakic L, Mol BW, Brown J, Crawford TJ, et al. (11 February 2020). "Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome". The Cochrane Database of Systematic Reviews. 2 (2): CD001122. doi:10.1002/14651858.CD001122.pub5. ISSN 1469-493X. PMC 7013239. PMID 32048270. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013239" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013239</a> <a href="#fnref:195" class="footnote-back-ref">↩</a></p></li> <li id="fn:196"><p>Polycystic Ovarian Syndrome~treatment at eMedicine <a href="https://emedicine.medscape.com/article/256806-treatment" target="_blank">https://emedicine.medscape.com/article/256806-treatment</a> <a href="#fnref:196" class="footnote-back-ref">↩</a></p></li> <li id="fn:197"><p>Ghanem ME, Elboghdady LA, Hassan M, Helal AS, Gibreel A, Houssen M, et al. (November 2013). "Clomiphene citrate co-treatment with low dose urinary FSH versus urinary FSH for clomiphene resistant PCOS: randomized controlled trial". Journal of Assisted Reproduction and Genetics. 30 (11): 1477–85. doi:10.1007/s10815-013-0090-2. PMC 3879942. PMID 24014214. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879942" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879942</a> <a href="#fnref:197" class="footnote-back-ref">↩</a></p></li> <li id="fn:198"><p>Polycystic Ovarian Syndrome~treatment at eMedicine <a href="https://emedicine.medscape.com/article/256806-treatment" target="_blank">https://emedicine.medscape.com/article/256806-treatment</a> <a href="#fnref:198" class="footnote-back-ref">↩</a></p></li> <li id="fn:199"><p>Brutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A (November 2018). "Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis". Endocrine. 62 (2): 318–325. doi:10.1007/s12020-018-1692-3. PMID 30066285. S2CID 51889051. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:199" class="footnote-back-ref">↩</a></p></li> <li id="fn:200"><p>Berni TR, Morgan CL, Berni ER, Rees DA (June 2018). "Polycystic Ovary Syndrome Is Associated With Adverse Mental Health and Neurodevelopmental Outcomes". The Journal of Clinical Endocrinology and Metabolism. 103 (6): 2116–25. doi:10.1210/jc.2017-02667. PMID 29648599. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:200" class="footnote-back-ref">↩</a></p></li> <li id="fn:201"><p>Brutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A (November 2018). "Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis". Endocrine. 62 (2): 318–325. doi:10.1007/s12020-018-1692-3. PMID 30066285. S2CID 51889051. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:201" class="footnote-back-ref">↩</a></p></li> <li id="fn:202"><p>Berni TR, Morgan CL, Berni ER, Rees DA (June 2018). "Polycystic Ovary Syndrome Is Associated With Adverse Mental Health and Neurodevelopmental Outcomes". The Journal of Clinical Endocrinology and Metabolism. 103 (6): 2116–25. doi:10.1210/jc.2017-02667. PMID 29648599. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:202" class="footnote-back-ref">↩</a></p></li> <li id="fn:203"><p>Ee C, Pirotta S, Mousa A, Moran L, Lim S (November 2021). "Providing lifestyle advice to women with PCOS: an overview of practical issues affecting success". BMC Endocrine Disorders. 21 (1): 234. doi:10.1186/s12902-021-00890-8. PMC 8609880. PMID 34814919. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8609880" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8609880</a> <a href="#fnref:203" class="footnote-back-ref">↩</a></p></li> <li id="fn:204"><p>Polycystic Ovarian Syndrome~treatment at eMedicine <a href="https://emedicine.medscape.com/article/256806-treatment" target="_blank">https://emedicine.medscape.com/article/256806-treatment</a> <a href="#fnref:204" class="footnote-back-ref">↩</a></p></li> <li id="fn:205"><p>Polycystic Ovarian Syndrome~treatment at eMedicine <a href="https://emedicine.medscape.com/article/256806-treatment" target="_blank">https://emedicine.medscape.com/article/256806-treatment</a> <a href="#fnref:205" class="footnote-back-ref">↩</a></p></li> <li id="fn:206"><p>Fraison E, Kostova E, Moran LJ, Bilal S, Ee CC, Venetis C, et al. (August 2020). "Metformin versus the combined oral contraceptive pill for hirsutism, acne, and menstrual pattern in polycystic ovary syndrome". The Cochrane Database of Systematic Reviews. 2020 (8): CD005552. doi:10.1002/14651858.CD005552.pub3. PMC 7437400. PMID 32794179. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437400" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437400</a> <a href="#fnref:206" class="footnote-back-ref">↩</a></p></li> <li id="fn:207"><p>Morrow-Baez K (2018). Thriving with PCOS: Lifestyle Strategies to Successfully Manage Polycystic Ovary Syndrome. Rowman & Littlefield Publishers. <a href="#fnref:207" class="footnote-back-ref">↩</a></p></li> <li id="fn:208"><p>"Polycystic ovary syndrome – Treatment". United Kingdom: National Health Service. 17 October 2011. Archived from the original on 6 November 2011. Retrieved 19 November 2011. <a href="http://www.nhs.uk/Conditions/Polycystic-ovarian-syndrome/Pages/Treatment.aspx" target="_blank">http://www.nhs.uk/Conditions/Polycystic-ovarian-syndrome/Pages/Treatment.aspx</a> <a href="#fnref:208" class="footnote-back-ref">↩</a></p></li> <li id="fn:209"><p>Polycystic Ovarian Syndrome~treatment at eMedicine <a href="https://emedicine.medscape.com/article/256806-treatment" target="_blank">https://emedicine.medscape.com/article/256806-treatment</a> <a href="#fnref:209" class="footnote-back-ref">↩</a></p></li> <li id="fn:210"><p>Polycystic Ovarian Syndrome~treatment at eMedicine <a href="https://emedicine.medscape.com/article/256806-treatment" target="_blank">https://emedicine.medscape.com/article/256806-treatment</a> <a href="#fnref:210" class="footnote-back-ref">↩</a></p></li> <li id="fn:211"><p>Polycystic Ovarian Syndrome~medication at eMedicine <a href="https://emedicine.medscape.com/article/256806-medication" target="_blank">https://emedicine.medscape.com/article/256806-medication</a> <a href="#fnref:211" class="footnote-back-ref">↩</a></p></li> <li id="fn:212"><p>Polycystic Ovarian Syndrome~treatment at eMedicine <a href="https://emedicine.medscape.com/article/256806-treatment" target="_blank">https://emedicine.medscape.com/article/256806-treatment</a> <a href="#fnref:212" class="footnote-back-ref">↩</a></p></li> <li id="fn:213"><p>van Zuuren EJ, Fedorowicz Z, Carter B, Pandis N (April 2015). "Interventions for hirsutism (excluding laser and photoepilation therapy alone)". The Cochrane Database of Systematic Reviews. 2015 (4): CD010334. doi:10.1002/14651858.CD010334.pub2. PMC 6481758. PMID 25918921. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481758" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481758</a> <a href="#fnref:213" class="footnote-back-ref">↩</a></p></li> <li id="fn:214"><p>Polycystic Ovarian Syndrome~treatment at eMedicine <a href="https://emedicine.medscape.com/article/256806-treatment" target="_blank">https://emedicine.medscape.com/article/256806-treatment</a> <a href="#fnref:214" class="footnote-back-ref">↩</a></p></li> <li id="fn:215"><p>"Irregular periods - NHS". Nhs.uk. 21 October 2020. Archived from the original on 19 July 2022. Retrieved 19 July 2022. <a href="https://www.nhs.uk/conditions/irregular-periods/" target="_blank">https://www.nhs.uk/conditions/irregular-periods/</a> <a href="#fnref:215" class="footnote-back-ref">↩</a></p></li> <li id="fn:216"><p>"What are the health risks of PCOS?". Verity – PCOS Charity. Verity. 2011. Archived from the original on 25 December 2012. Retrieved 21 November 2011. <a href="https://archive.today/20121225050404/http://www.verity-pcos.org.uk/guide_to_pcos/what_is_pcos/health_risks" target="_blank">https://archive.today/20121225050404/http://www.verity-pcos.org.uk/guide_to_pcos/what_is_pcos/health_risks</a> <a href="#fnref:216" class="footnote-back-ref">↩</a></p></li> <li id="fn:217"><p>Polycystic Ovarian Syndrome~medication at eMedicine <a href="https://emedicine.medscape.com/article/256806-medication" target="_blank">https://emedicine.medscape.com/article/256806-medication</a> <a href="#fnref:217" class="footnote-back-ref">↩</a></p></li> <li id="fn:218"><p>Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ, et al. (1 September 2022). "Polycystic ovary syndrome". The Lancet Diabetes & Endocrinology. 10 (9): 668–680. doi:10.1016/S2213-8587(22)00163-2. ISSN 2213-8587. PMID 35934017. <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00163-2/abstract" target="_blank">https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00163-2/abstract</a> <a href="#fnref:218" class="footnote-back-ref">↩</a></p></li> <li id="fn:219"><p>Teede H, Deeks A, Moran L (June 2010). "Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan". BMC Medicine. 8 (1): 41. doi:10.1186/1741-7015-8-41. PMC 2909929. PMID 20591140. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929</a> <a href="#fnref:219" class="footnote-back-ref">↩</a></p></li> <li id="fn:220"><p>Polycystic Ovarian Syndrome~workup at eMedicine <a href="https://emedicine.medscape.com/article/256806-workup" target="_blank">https://emedicine.medscape.com/article/256806-workup</a> <a href="#fnref:220" class="footnote-back-ref">↩</a></p></li> <li id="fn:221"><p>Andersen M, Glintborg D (September 2018). "Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?". European Journal of Endocrinology. 179 (3): D1 – D14. doi:10.1530/EJE-18-0237. PMID 29921567. S2CID 49315075. <a href="https://doi.org/10.1530%2FEJE-18-0237" target="_blank">https://doi.org/10.1530%2FEJE-18-0237</a> <a href="#fnref:221" class="footnote-back-ref">↩</a></p></li> <li id="fn:222"><p>Teede H, Deeks A, Moran L (June 2010). "Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan". BMC Medicine. 8 (1): 41. doi:10.1186/1741-7015-8-41. PMC 2909929. PMID 20591140. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929</a> <a href="#fnref:222" class="footnote-back-ref">↩</a></p></li> <li id="fn:223"><p>Pundir J, Psaroudakis D, Savnur P, Bhide P, Sabatini L, Teede H, et al. (February 2018). "Inositol treatment of anovulation in women with polycystic ovary syndrome: a meta-analysis of randomised trials" (PDF). BJOG. 125 (3): 299–308. doi:10.1111/1471-0528.14754. PMID 28544572. S2CID 21090113. Archived (PDF) from the original on 24 October 2021. Retrieved 13 October 2021. <a href="https://pure-oai.bham.ac.uk/ws/files/41620024/Pundir_et_al_Inositol_treatment_BJOG.pdf" target="_blank">https://pure-oai.bham.ac.uk/ws/files/41620024/Pundir_et_al_Inositol_treatment_BJOG.pdf</a> <a href="#fnref:223" class="footnote-back-ref">↩</a></p></li> <li id="fn:224"><p>Amoah-Arko A, Evans M, Rees A (20 October 2017). "Effects of myoinositol and D-chiro inositol on hyperandrogenism and ovulation in women with polycystic ovary syndrome: a systematic review". Endocrine Abstracts. doi:10.1530/endoabs.50.P363. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:224" class="footnote-back-ref">↩</a></p></li> <li id="fn:225"><p>Unfer V, Carlomagno G, Dante G, Facchinetti F (July 2012). "Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials". Gynecological Endocrinology. 28 (7): 509–515. doi:10.3109/09513590.2011.650660. hdl:11380/744390. PMID 22296306. S2CID 24582338. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:225" class="footnote-back-ref">↩</a></p></li> <li id="fn:226"><p>Zeng L, Yang K (January 2018). "Effectiveness of myoinositol for polycystic ovary syndrome: a systematic review and meta-analysis". Endocrine. 59 (1): 30–38. doi:10.1007/s12020-017-1442-y. PMID 29052180. S2CID 4376339. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:226" class="footnote-back-ref">↩</a></p></li> <li id="fn:227"><p>Laganà AS, Vitagliano A, Noventa M, Ambrosini G, D'Anna R (October 2018). "Myo-inositol supplementation reduces the amount of gonadotropins and length of ovarian stimulation in women undergoing IVF: a systematic review and meta-analysis of randomized controlled trials". Archives of Gynecology and Obstetrics. 298 (4): 675–684. doi:10.1007/s00404-018-4861-y. PMID 30078122. S2CID 51921158. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:227" class="footnote-back-ref">↩</a></p></li> <li id="fn:228"><p>Galazis N, Galazi M, Atiomo W (April 2011). "D-Chiro-inositol and its significance in polycystic ovary syndrome: a systematic review". Gynecological Endocrinology. 27 (4): 256–262. doi:10.3109/09513590.2010.538099. PMID 21142777. S2CID 1989262. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:228" class="footnote-back-ref">↩</a></p></li> <li id="fn:229"><p>Lim CE, Ng RW, Cheng NC, Zhang GS, Chen H (July 2019). "Acupuncture for polycystic ovarian syndrome". The Cochrane Database of Systematic Reviews. 2019 (7): CD007689. doi:10.1002/14651858.CD007689.pub4. PMC 6603768. PMID 31264709. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603768" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603768</a> <a href="#fnref:229" class="footnote-back-ref">↩</a></p></li> <li id="fn:230"><p>Wu XK, Stener-Victorin E, Kuang HY, Ma HL, Gao JS, Xie LZ, et al. (June 2017). "Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome: A Randomized Clinical Trial". JAMA. 317 (24): 2502–14. doi:10.1001/jama.2017.7217. PMC 5815063. PMID 28655015. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815063" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815063</a> <a href="#fnref:230" class="footnote-back-ref">↩</a></p></li> <li id="fn:231"><p>Teede H, Deeks A, Moran L (June 2010). "Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan". BMC Medicine. 8 (1): 41. doi:10.1186/1741-7015-8-41. PMC 2909929. PMID 20591140. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929</a> <a href="#fnref:231" class="footnote-back-ref">↩</a></p></li> <li id="fn:232"><p>WHO (28 June 2023). "Polycystic ovary syndrome". World Health Organization- Polycystic Ovary Syndrome. Retrieved 20 September 2024. <a href="https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome" target="_blank">https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome</a> <a href="#fnref:232" class="footnote-back-ref">↩</a></p></li> <li id="fn:233"><p>Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ, et al. (1 September 2022). "Polycystic ovary syndrome". The Lancet Diabetes & Endocrinology. 10 (9): 668–680. doi:10.1016/S2213-8587(22)00163-2. ISSN 2213-8587. PMID 35934017. <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00163-2/abstract" target="_blank">https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00163-2/abstract</a> <a href="#fnref:233" class="footnote-back-ref">↩</a></p></li> <li id="fn:234"><p>"Polycystic Ovary Syndrome (PCOS): Condition Information". National Institute of Child Health and Human Development. 31 January 2017. Archived from the original on 22 October 2018. Retrieved 19 November 2018. <a href="https://www.nichd.nih.gov/health/topics/pcos/conditioninfo" target="_blank">https://www.nichd.nih.gov/health/topics/pcos/conditioninfo</a> <a href="#fnref:234" class="footnote-back-ref">↩</a></p></li> <li id="fn:235"><p>Pal L, ed. (2013). "Diagnostic Criteria and Epidemiology of PCOS". Polycystic Ovary Syndrome Current and Emerging Concepts. Dordrecht: Springer. p. 7. ISBN 978-1-4614-8394-6. Archived from the original on 10 September 2017. <a href="978-1-4614-8394-6" target="_blank">978-1-4614-8394-6</a> <a href="#fnref:235" class="footnote-back-ref">↩</a></p></li> <li id="fn:236"><p>Teede et al. 2023, p. 64. - Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Melbourne, Australia: Monash University. ISBN 978-0-6458209-0-4. <a href="#fnref:236" class="footnote-back-ref">↩</a></p></li> <li id="fn:237"><p>Salari N, Nankali A, Ghanbari A, Jafarpour S, Ghasemi H, Dokaneheifard S, et al. (2024). "Global prevalence of polycystic ovary syndrome in women worldwide: a comprehensive systematic review and meta-analysis". Archives of Gynecology and Obstetrics. 310 (3): 1303–1314. doi:10.1007/s00404-024-07607-x. ISSN 1432-0711. <a href="https://link.springer.com/10.1007/s00404-024-07607-x" target="_blank">https://link.springer.com/10.1007/s00404-024-07607-x</a> <a href="#fnref:237" class="footnote-back-ref">↩</a></p></li> <li id="fn:238"><p>Teede et al. 2023, p. 64. - Teede HJ, Tay CT, Laven JJ, Dokras A, Moran LJ, Piltonen TT, et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Melbourne, Australia: Monash University. ISBN 978-0-6458209-0-4. <a href="#fnref:238" class="footnote-back-ref">↩</a></p></li> <li id="fn:239"><p>Stener-Victorin E, Teede H, Norman RJ, Legro R, Goodarzi MO, Dokras A, et al. (18 April 2024). "Polycystic ovary syndrome". Nature Reviews Disease Primers. 10 (1). doi:10.1038/s41572-024-00511-3. ISSN 2056-676X. <a href="https://www.nature.com/articles/s41572-024-00511-3" target="_blank">https://www.nature.com/articles/s41572-024-00511-3</a> <a href="#fnref:239" class="footnote-back-ref">↩</a></p></li> <li id="fn:240"><p>Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ, et al. (1 September 2022). "Polycystic ovary syndrome". The Lancet Diabetes & Endocrinology. 10 (9): 668–680. doi:10.1016/S2213-8587(22)00163-2. ISSN 2213-8587. PMID 35934017. <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00163-2/abstract" target="_blank">https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00163-2/abstract</a> <a href="#fnref:240" class="footnote-back-ref">↩</a></p></li> <li id="fn:241"><p>Polson DW, Adams J, Wadsworth J, Franks S (April 1988). "Polycystic ovaries--a common finding in normal women". Lancet. 1 (8590): 870–2. doi:10.1016/s0140-6736(88)91612-1. PMID 2895373. S2CID 41297081. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:241" class="footnote-back-ref">↩</a></p></li> <li id="fn:242"><p>Clayton RN, Ogden V, Hodgkinson J, Worswick L, Rodin DA, Dyer S, et al. (August 1992). "How common are polycystic ovaries in normal women and what is their significance for the fertility of the population?". Clinical Endocrinology. 37 (2): 127–134. doi:10.1111/j.1365-2265.1992.tb02296.x. PMID 1395063. S2CID 12384062. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:242" class="footnote-back-ref">↩</a></p></li> <li id="fn:243"><p>Farquhar CM, Birdsall M, Manning P, Mitchell JM, France JT (February 1994). "The prevalence of polycystic ovaries on ultrasound scanning in a population of randomly selected women". The Australian & New Zealand Journal of Obstetrics & Gynaecology. 34 (1): 67–72. doi:10.1111/j.1479-828X.1994.tb01041.x. PMID 8053879. S2CID 312422. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:243" class="footnote-back-ref">↩</a></p></li> <li id="fn:244"><p>van Santbrink EJ, Hop WC, Fauser BC (March 1997). "Classification of normogonadotropic infertility: polycystic ovaries diagnosed by ultrasound versus endocrine characteristics of polycystic ovary syndrome". Fertility and Sterility. 67 (3): 452–8. doi:10.1016/S0015-0282(97)80068-4. PMID 9091329. <a href="https://doi.org/10.1016%2FS0015-0282%2897%2980068-4" target="_blank">https://doi.org/10.1016%2FS0015-0282%2897%2980068-4</a> <a href="#fnref:244" class="footnote-back-ref">↩</a></p></li> <li id="fn:245"><p>Clayton RN, Ogden V, Hodgkinson J, Worswick L, Rodin DA, Dyer S, et al. (August 1992). "How common are polycystic ovaries in normal women and what is their significance for the fertility of the population?". Clinical Endocrinology. 37 (2): 127–134. doi:10.1111/j.1365-2265.1992.tb02296.x. PMID 1395063. S2CID 12384062. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:245" class="footnote-back-ref">↩</a></p></li> <li id="fn:246"><p>Hardeman J, Weiss BD (March 2014). "Intrauterine devices: an update". American Family Physician. 89 (6): 445–450. PMID 24695563. <a href="/wiki/PMID_(identifier)" target="_blank">/wiki/PMID_(identifier)</a> <a href="#fnref:246" class="footnote-back-ref">↩</a></p></li> <li id="fn:247"><p>Hanson AE (1975). "Hippocrates: "Diseases of Women 1"". Signs: Journal of Women in Culture and Society. 1 (2): 567–584. doi:10.1086/493243. ISSN 0097-9740. PMID 21213645. <a href="https://www.journals.uchicago.edu/doi/10.1086/493243" target="_blank">https://www.journals.uchicago.edu/doi/10.1086/493243</a> <a href="#fnref:247" class="footnote-back-ref">↩</a></p></li> <li id="fn:248"><p>Kovacs GT, Norman R (22 February 2007). Polycystic Ovary Syndrome. Cambridge University Press. p. 4. ISBN 978-1-139-46203-7. Archived from the original on 16 June 2013. Retrieved 29 March 2013. <a href="978-1-139-46203-7" target="_blank">978-1-139-46203-7</a> <a href="#fnref:248" class="footnote-back-ref">↩</a></p></li> <li id="fn:249"><p>Kovacs GT, Norman R (22 February 2007). Polycystic Ovary Syndrome. Cambridge University Press. p. 4. ISBN 978-1-139-46203-7. Archived from the original on 16 June 2013. Retrieved 29 March 2013. <a href="978-1-139-46203-7" target="_blank">978-1-139-46203-7</a> <a href="#fnref:249" class="footnote-back-ref">↩</a></p></li> <li id="fn:250"><p>Imaging in Polycystic Ovary Disease at eMedicine <a href="https://emedicine.medscape.com/article/404754-overview" target="_blank">https://emedicine.medscape.com/article/404754-overview</a> <a href="#fnref:250" class="footnote-back-ref">↩</a></p></li> <li id="fn:251"><p>Polycystic Ovarian Syndrome at eMedicine <a href="https://emedicine.medscape.com/article/256806-overview" target="_blank">https://emedicine.medscape.com/article/256806-overview</a> <a href="#fnref:251" class="footnote-back-ref">↩</a></p></li> <li id="fn:252"><p>Barry JA, Azizia MM, Hardiman PJ (1 September 2014). "Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis". Human Reproduction Update. 20 (5): 748–758. doi:10.1093/humupd/dmu012. PMC 4326303. PMID 24688118. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326303" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326303</a> <a href="#fnref:252" class="footnote-back-ref">↩</a></p></li> <li id="fn:253"><p>Imaging in Polycystic Ovary Disease at eMedicine <a href="https://emedicine.medscape.com/article/404754-overview" target="_blank">https://emedicine.medscape.com/article/404754-overview</a> <a href="#fnref:253" class="footnote-back-ref">↩</a></p></li> <li id="fn:254"><p>Imaging in Polycystic Ovary Disease at eMedicine <a href="https://emedicine.medscape.com/article/404754-overview" target="_blank">https://emedicine.medscape.com/article/404754-overview</a> <a href="#fnref:254" class="footnote-back-ref">↩</a></p></li> <li id="fn:255"><p>Khatun M, Lundin K, Naillat F, Loog L, Saarela U, Tuuri T, et al. (January 2024). "Induced Pluripotent Stem Cells as a Possible Approach for Exploring the Pathophysiology of Polycystic Ovary Syndrome (PCOS)". Stem Cell Reviews and Reports. 20 (1): 67–87. doi:10.1007/s12015-023-10627-w. ISSN 2629-3269. PMC 10799779. PMID 37768523. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10799779" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10799779</a> <a href="#fnref:255" class="footnote-back-ref">↩</a></p></li> <li id="fn:256"><p>Li Pf, Wang F, Kong Hj, Zhao F, Bai Ah, Chen Xm, et al. (January 2012). "Establishment of polycystic ovary syndrome-derived human embryonic stem cell lines". Gynecological Endocrinology. 28 (1): 25–28. doi:10.3109/09513590.2011.588748. ISSN 0951-3590. PMID 21780950. <a href="http://www.tandfonline.com/doi/full/10.3109/09513590.2011.588748" target="_blank">http://www.tandfonline.com/doi/full/10.3109/09513590.2011.588748</a> <a href="#fnref:256" class="footnote-back-ref">↩</a></p></li> <li id="fn:257"><p>Khatun M, Lundin K, Naillat F, Loog L, Saarela U, Tuuri T, et al. (January 2024). "Induced Pluripotent Stem Cells as a Possible Approach for Exploring the Pathophysiology of Polycystic Ovary Syndrome (PCOS)". Stem Cell Reviews and Reports. 20 (1): 67–87. doi:10.1007/s12015-023-10627-w. ISSN 2629-3269. PMC 10799779. PMID 37768523. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10799779" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10799779</a> <a href="#fnref:257" class="footnote-back-ref">↩</a></p></li> <li id="fn:258"><p>Khatun M, Lundin K, Naillat F, Loog L, Saarela U, Tuuri T, et al. (January 2024). "Induced Pluripotent Stem Cells as a Possible Approach for Exploring the Pathophysiology of Polycystic Ovary Syndrome (PCOS)". Stem Cell Reviews and Reports. 20 (1): 67–87. doi:10.1007/s12015-023-10627-w. ISSN 2629-3269. PMC 10799779. PMID 37768523. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10799779" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10799779</a> <a href="#fnref:258" class="footnote-back-ref">↩</a></p></li> <li id="fn:259"><p>Yang S, Ding S, Jiang X, Sun B, Xu Q (June 2016). "Establishment and adipocyte differentiation of polycystic ovary syndrome-derived induced pluripotent stem cells". Cell Proliferation. 49 (3): 352–361. doi:10.1111/cpr.12258. ISSN 0960-7722. PMC 6496004. PMID 27108524. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6496004" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6496004</a> <a href="#fnref:259" class="footnote-back-ref">↩</a></p></li> <li id="fn:260"><p>Jozkowiak M, Piotrowska-Kempisty H, Kobylarek D, Gorska N, Mozdziak P, Kempisty B, et al. (31 December 2022). "Endocrine Disrupting Chemicals in Polycystic Ovary Syndrome: The Relevant Role of the Theca and Granulosa Cells in the Pathogenesis of the Ovarian Dysfunction". Cells. 12 (1): 174. doi:10.3390/cells12010174. ISSN 2073-4409. PMC 9818374. PMID 36611967. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9818374" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9818374</a> <a href="#fnref:260" class="footnote-back-ref">↩</a></p></li> <li id="fn:261"><p>Khatun M, Lundin K, Naillat F, Loog L, Saarela U, Tuuri T, et al. (January 2024). "Induced Pluripotent Stem Cells as a Possible Approach for Exploring the Pathophysiology of Polycystic Ovary Syndrome (PCOS)". Stem Cell Reviews and Reports. 20 (1): 67–87. doi:10.1007/s12015-023-10627-w. ISSN 2629-3269. PMC 10799779. PMID 37768523. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10799779" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10799779</a> <a href="#fnref:261" class="footnote-back-ref">↩</a></p></li> <li id="fn:262"><p>Khatun M, Lundin K, Naillat F, Loog L, Saarela U, Tuuri T, et al. (January 2024). "Induced Pluripotent Stem Cells as a Possible Approach for Exploring the Pathophysiology of Polycystic Ovary Syndrome (PCOS)". Stem Cell Reviews and Reports. 20 (1): 67–87. doi:10.1007/s12015-023-10627-w. ISSN 2629-3269. PMC 10799779. PMID 37768523. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10799779" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10799779</a> <a href="#fnref:262" class="footnote-back-ref">↩</a></p></li> <li id="fn:263"><p>Azziz R, Marin C, Hoq L, Badamgarav E, Song P (August 2005). "Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span". The Journal of Clinical Endocrinology and Metabolism. 90 (8): 4650–58. doi:10.1210/jc.2005-0628. PMID 15944216. <a href="https://doi.org/10.1210%2Fjc.2005-0628" target="_blank">https://doi.org/10.1210%2Fjc.2005-0628</a> <a href="#fnref:263" class="footnote-back-ref">↩</a></p></li> <li id="fn:264"><p>"RCDC Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC)". NIH. Archived from the original on 28 February 2019. Retrieved 3 December 2018. <a href="https://web.archive.org/web/20190228225730/https://report.nih.gov/categorical_spending.aspx#tab1" target="_blank">https://web.archive.org/web/20190228225730/https://report.nih.gov/categorical_spending.aspx#tab1</a> <a href="#fnref:264" class="footnote-back-ref">↩</a></p></li> <li id="fn:265"><p>Azziz R (March 2006). "Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature". The Journal of Clinical Endocrinology and Metabolism. 91 (3): 781–5. doi:10.1210/jc.2005-2153. PMID 16418211. <a href="https://doi.org/10.1210%2Fjc.2005-2153" target="_blank">https://doi.org/10.1210%2Fjc.2005-2153</a> <a href="#fnref:265" class="footnote-back-ref">↩</a></p></li> <li id="fn:266"><p>Chaudhari AP, Mazumdar K, Mehta PD (2018). "Anxiety, Depression, and Quality of Life in Women with Polycystic Ovarian Syndrome". Indian Journal of Psychological Medicine. 40 (3): 239–246. doi:10.4103/IJPSYM.IJPSYM_561_17. PMC 5968645. PMID 29875531. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968645" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968645</a> <a href="#fnref:266" class="footnote-back-ref">↩</a></p></li> <li id="fn:267"><p>Chaudhari AP, Mazumdar K, Mehta PD (2018). "Anxiety, Depression, and Quality of Life in Women with Polycystic Ovarian Syndrome". Indian Journal of Psychological Medicine. 40 (3): 239–246. doi:10.4103/IJPSYM.IJPSYM_561_17. PMC 5968645. PMID 29875531. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968645" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968645</a> <a href="#fnref:267" class="footnote-back-ref">↩</a></p></li> <li id="fn:268"><p>Zhang S, Wu Y, Mprah R, Wang M (2024). "COVID-19 and persistent symptoms: implications for polycystic ovary syndrome and its management". Front Endocrinol (Lausanne). 15: 1434331. doi:10.3389/fendo.2024.1434331. PMC 11486749. PMID 39429741. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11486749" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11486749</a> <a href="#fnref:268" class="footnote-back-ref">↩</a></p></li> <li id="fn:269"><p>"Sarah Hall investigates polycystic ovary syndrome". The Guardian. 28 February 2002. Archived from the original on 29 May 2024. Retrieved 21 January 2022. <a href="https://www.theguardian.com/lifeandstyle/2002/feb/28/healthandwellbeing.health" target="_blank">https://www.theguardian.com/lifeandstyle/2002/feb/28/healthandwellbeing.health</a> <a href="#fnref:269" class="footnote-back-ref">↩</a></p></li> <li id="fn:270"><p>Migdol E. "'Teen Mom' Star Nails the 'Lose-Lose' Side of Chronic Illness Doctors Don't Always Get". The Mighty. Archived from the original on 19 January 2022. Retrieved 14 November 2022. <a href="https://themighty.com/2018/02/maci-bookout-teen-mom-og-pcos/" target="_blank">https://themighty.com/2018/02/maci-bookout-teen-mom-og-pcos/</a> <a href="#fnref:270" class="footnote-back-ref">↩</a></p></li> <li id="fn:271"><p>"All the celebrities who've opened up about life with Polycystic Ovary Syndrome". Cosmopolitan. 26 November 2021. Archived from the original on 1 September 2022. Retrieved 1 September 2022. <a href="https://www.cosmopolitan.com/uk/body/health/g38290937/celebrities-pcos/" target="_blank">https://www.cosmopolitan.com/uk/body/health/g38290937/celebrities-pcos/</a> <a href="#fnref:271" class="footnote-back-ref">↩</a></p></li> <li id="fn:272"><p>Chowdhury J. "What Every Woman Should Know About PCOS". Refinery29.com. Archived from the original on 21 January 2022. Retrieved 21 January 2022. <a href="https://www.refinery29.com/en-us/2015/07/91099/harnaam-kaur-women-with-facial-hair-true-story-pcos" target="_blank">https://www.refinery29.com/en-us/2015/07/91099/harnaam-kaur-women-with-facial-hair-true-story-pcos</a> <a href="#fnref:272" class="footnote-back-ref">↩</a></p></li> <li id="fn:273"><p>"Actress Jaime King on her investment in Allara, a chronic care platform for women". Fortune. Archived from the original on 1 September 2022. Retrieved 1 September 2022. <a href="https://fortune.com/2022/01/23/actress-jaime-king-investment-chronic-care-allara/" target="_blank">https://fortune.com/2022/01/23/actress-jaime-king-investment-chronic-care-allara/</a> <a href="#fnref:273" class="footnote-back-ref">↩</a></p></li> <li id="fn:274"><p>"Chrisette Michele Opens Up About Living With PCOS & No Longer Being Vegan - BlackDoctor.org - Where Wellness & Culture Connect". BlackDoctor.org. 10 December 2015. Archived from the original on 22 January 2022. Retrieved 22 January 2022. <a href="https://blackdoctor.org/chrisette-michele-pcos-vegan/" target="_blank">https://blackdoctor.org/chrisette-michele-pcos-vegan/</a> <a href="#fnref:274" class="footnote-back-ref">↩</a></p></li> <li id="fn:275"><p>"Lea Michele On How PCOS Changed Her Relationship With Food: 'The Side Effects Can Be Brutal'". Health Magazine. Archived from the original on 1 September 2022. Retrieved 1 September 2022. <a href="https://web.archive.org/web/20220901164503/https://www.health.com/celebrities/lea-michele-interview" target="_blank">https://web.archive.org/web/20220901164503/https://www.health.com/celebrities/lea-michele-interview</a> <a href="#fnref:275" class="footnote-back-ref">↩</a></p></li> <li id="fn:276"><p>Natale N (17 November 2021). "Keke Palmer Says PCOS Causes Facial Hair and Adult Acne". Prevention. Archived from the original on 21 January 2022. Retrieved 21 January 2022. <a href="https://www.prevention.com/health/health-conditions/a38280615/keke-palmer-pcos-symptoms/" target="_blank">https://www.prevention.com/health/health-conditions/a38280615/keke-palmer-pcos-symptoms/</a> <a href="#fnref:276" class="footnote-back-ref">↩</a></p></li> <li id="fn:277"><p>Seemayer Z (26 September 2017). "Sasha Pieterse Tears Up Over Health Problems, Opens Up About Losing 15 Pounds Since Joining 'DWTS'". Entertainment Tonight. Archived from the original on 10 October 2017. Retrieved 27 September 2017. <a href="http://www.etonline.com/sasha-pieterse-tears-over-health-problems-opens-about-losing-15-pounds-joining-dwts-88109" target="_blank">http://www.etonline.com/sasha-pieterse-tears-over-health-problems-opens-about-losing-15-pounds-joining-dwts-88109</a> <a href="#fnref:277" class="footnote-back-ref">↩</a></p></li> <li id="fn:278"><p>Mizoguchi K, Stern AB (5 October 2017). "Sasha Pieterse Wows on People's Ones to Watch Red Carpet as She Reveals Why She's 'So Thankful to DWTS'". people.com. Archived from the original on 11 December 2021. Retrieved 11 December 2021. <a href="https://people.com/tv/sasha-pieterse-medical-condition-response-amazing-dwts/" target="_blank">https://people.com/tv/sasha-pieterse-medical-condition-response-amazing-dwts/</a> <a href="#fnref:278" class="footnote-back-ref">↩</a></p></li> <li id="fn:279"><p>Shultz CL (19 November 2024). "Florence Pugh Says It Was a 'Mind-Boggling Realization' to Learn She Had to Freeze Her Eggs at 27". People. <a href="https://people.com/florence-pugh-froze-eggs-27-pcos-endometriosis-she-md-podcast-8746962" target="_blank">https://people.com/florence-pugh-froze-eggs-27-pcos-endometriosis-she-md-podcast-8746962</a> <a href="#fnref:279" class="footnote-back-ref">↩</a></p></li> <li id="fn:280"><p>"'Star Wars: The Force Awakens' Actress Opens Up About Painful Disorder". ABC News. Archived from the original on 21 January 2022. Retrieved 21 January 2022. <a href="https://abcnews.go.com/Entertainment/star-wars-force-awakens-actress-opens-painful-disorder/story?id=39745956" target="_blank">https://abcnews.go.com/Entertainment/star-wars-force-awakens-actress-opens-painful-disorder/story?id=39745956</a> <a href="#fnref:280" class="footnote-back-ref">↩</a></p></li> <li id="fn:281"><p>"Romee Strijd's Pregnancy Announcement Comes With an Honest Message About Reproductive Health". Vogue. 29 May 2020. Archived from the original on 1 September 2022. Retrieved 1 September 2022. <a href="https://www.vogue.com/article/romee-strijd-pregnancy-announcement" target="_blank">https://www.vogue.com/article/romee-strijd-pregnancy-announcement</a> <a href="#fnref:281" class="footnote-back-ref">↩</a></p></li> <li id="fn:282"><p>Silman A (10 March 2020). "Lee's American Dream". The Cut. New York Media. Archived from the original on 12 April 2023. Retrieved 12 April 2023. <a href="https://www.thecut.com/2020/03/wellness-influencer-lee-from-americas-story.html" target="_blank">https://www.thecut.com/2020/03/wellness-influencer-lee-from-americas-story.html</a> <a href="#fnref:282" class="footnote-back-ref">↩</a></p></li> </ol>