A Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age, affecting approximately 8% to 13% of this population, depending on the diagnostic criteria used. Although it is frequently associated with menstrual irregularities, acne, and difficulty conceiving, PCOS is now considered a complex metabolic and inflammatory condition with repercussions that extend far beyond gynecological symptoms.

In recent decades, advances in research have broadened our understanding of the mechanisms involved in the syndrome, highlighting the interaction between hormonal, metabolic, inflammatory, and even gut-related factors. This more integrated view allows healthcare professionals to develop therapeutic strategies aimed not only at symptom management but also at promoting long-term women's health.

What is Polycystic Ovary Syndrome?

PCOS is a multifactorial disorder characterized by changes in ovarian function and androgen production. In most cases, the diagnosis is based on the Rotterdam Criteria, which consider the presence of at least two of the following factors:

• irregular or absent ovulation;  

• clinical and/or biochemical hyperandrogenism;  

• polycystic ovaries on ultrasound examination.  

Although the diagnosis is based on reproductive criteria, the syndrome is also associated with metabolic changes that can affect the patient throughout her life.

Far beyond the ovaries: a systemic condition

It is now understood that PCOS involves different body systems. Among the main pathophysiological mechanisms are:

Insulin resistance

Insulin resistance is present in a large proportion of women with PCOS, including those at a healthy weight. The compensatory increase in insulin secretion stimulates ovarian androgen production, promoting manifestations such as acne, hirsutism, and menstrual irregularities.

Chronic low-grade inflammation

Several studies show that women with PCOS exhibit higher systemic inflammatory activity, characterized by an increase in pro-inflammatory cytokines and inflammatory markers. This environment can contribute to metabolic changes and a higher cardiovascular risk.

Oxidative stress

The imbalance between the production of reactive oxygen species and antioxidant mechanisms has also been linked to PCOS. Oxidative stress can influence insulin resistance, oocyte quality, and ovarian function.

Gut microbiota alterations

Recent research suggests that changes in the composition of the gut microbiota can influence inflammatory processes, energy metabolism, and insulin sensitivity, reinforcing the concept of the gut-metabolism axis in the syndrome's pathophysiology.

What are the impacts of PCOS on women's health?

Beyond gynecological manifestations, PCOS can increase the risk for several conditions throughout life, including:

• insulin resistance and type 2 diabetes mellitus;  

• metabolic syndrome;  

• dyslipidemia;  

• hypertension;  

• metabolic dysfunction-associated steatotic liver disease (MASLD);  

• infertility related to anovulation;  

• emotional changes, such as anxiety and depression.  

These aspects reinforce the importance of a preventive and multidisciplinary approach from the moment of diagnosis.

Clinical assessment: what to consider?

Care for women with PCOS should go beyond the assessment of reproductive symptoms. Parameters frequently considered in clinical practice include:

• menstrual and reproductive history;  

• body composition and waist circumference;  

• fasting glucose and insulin;  

• glycated hemoglobin;  

• lipid profile;  

• blood pressure;  

• inflammatory markers, when indicated;  

• assessment of dietary habits, sleep, and physical activity.  

Investigation should be individualized, considering the patient's life stage and therapeutic goals.

Nutritional strategies in the management of PCOS

Nutritional therapy is considered a cornerstone of syndrome management and can contribute to the improvement of metabolic, hormonal, and reproductive parameters.

Modulation of insulin resistance

Dietary strategies that promote glycemic control and reduce insulin spikes can help improve insulin sensitivity and support hormonal balance.

Control of the inflammatory process

Adopting a dietary pattern rich in fruits, vegetables, whole grains, legumes, nuts, and sources of unsaturated fats is associated with a reduction in inflammatory markers and support for metabolic health.

Gut health

Consuming adequate dietary fiber and foods that promote gut microbiota diversity can help maintain the integrity of the intestinal barrier and modulate inflammatory processes associated with PCOS.

Protein intake

Adequate intake of high-quality protein helps maintain muscle mass and satiety, both of which are important factors for metabolic control and body composition.

Nutritional supplementation: when should it be considered?

When based on an individualized clinical assessment, supplementation can be part of a therapeutic plan for women with PCOS.

Nutrients and bioactive compounds with evidence in various clinical contexts include vitamins, minerals, omega-3 fatty acids, myo-inositol, and antioxidants, always taking into account individual needs, laboratory results, and treatment goals.

Furthermore, high-quality proteins can contribute to strategies aimed at preserving lean mass and providing metabolic support, especially in patients undergoing weight management interventions. In this context, specific nutritional solutions can be part of individualized protocols, in accordance with the healthcare professional's prescription.

Care for every stage of life

Although PCOS is most often diagnosed during adolescence or the reproductive years, its impact can span decades.

A modern approach to the syndrome seeks to reduce the risk of future complications, preserve metabolic health, promote hormonal balance, and improve patients' quality of life, considering physical, emotional, and reproductive aspects.

Conclusion

Polycystic Ovary Syndrome is a complex condition that goes far beyond menstrual irregularities or the presence of ovarian cysts. Current scientific evidence shows that PCOS involves an interaction between hormonal, metabolic, inflammatory, and gut-related factors, requiring an integrated and individualized approach.

For healthcare professionals, understanding these mechanisms expands the possibilities for early intervention and contributes to more comprehensive care for women at every stage of life. The combination of lifestyle changes, nutritional therapy, and evidence-based strategies represents one of the most promising paths to promoting health, functionality, and quality of life.

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