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Metabolic Mediation of the Association Between Hyperandrogenism and Paratubal Cysts in Polycystic Ovary Syndrome: A Structural Equation Modeling Approach
 
 
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Volume 14
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10.3390/jcm14165642
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Review

Obesity as a Part of Polycysric Ovary Syndrome (PCOS)—A Review of Pathophysiology and Comprehensive Therapeutic Strategies

by
Jovan Bila
1,2,
Jelena Dotlic
1,2,*,
Mladen Andjic
1,
Katarina Ivanovic
1,
Jelena Micic
1,2,
Lidija Tulic
1,2,
Miljan Pupovac
1,
Jelena Stojnic
1,2,
Ivana Vukovic
1,2 and
Stefan Ivanovic
3
1
Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
2
Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
3
The Obstetrics and Gynecology Clinic Narodni Front, 11000 Belgrade, Serbia
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(16), 5642; https://doi.org/10.3390/jcm14165642 (registering DOI)
Submission received: 4 July 2025 / Revised: 30 July 2025 / Accepted: 4 August 2025 / Published: 9 August 2025
(This article belongs to the Special Issue Clinical Perspectives on Women’s Reproductive Health: Challenges and Management Strategies)
Versions Notes

Abstract

Background/Objectives: Polycystic Ovary Syndrome (PCOS), as a multifactorial chronic disease, can cause heterogeneous metabolic, physical, and psychological disorders as well as infertility in both obese and non-obese patients. Therefore, this review aimed to present differences in pathophysiology, clinical presentation, and therapy in obese and non-obese patients with PCOS. Methods: A non-systematic review was conducted by searching papers published in English from 2010 to 2024 in MEDLINE. Results: Obesity in PCOS significantly contributes to IR and worsens metabolic dysfunction. Lifestyle modifications, including a balanced diet and regular exercise, are the first line of treatment. Pharmacological therapies, such as metformin, GLP-1 receptor agonists, myoinositol, and resveratrol, are used to improve insulin sensitivity, regulate the hormonal milieu, and reduce hyperandrogenism. Metformin is widely used to improve glucose metabolism and reduce androgen levels, while myoinositol is effective in promoting ovarian function. GLP-1 receptor agonists and resveratrol improve metabolic and reproductive outcomes. For patients with severe obesity, bariatric surgery offers substantial improvements in body composition, metabolic function, and fertility. Combination therapies, such as metformin and GLP-1 receptor agonists, provide comprehensive treatment for both reproductive and metabolic aspects of PCOS. Conclusions: The first-line treatment for PCOS is a lifestyle-modifying strategy. PCOS patients with insulin resistance and obesity would mostly benefit from combination therapy with metformin and GLP-1 receptor agonists.
Keywords: PCOS; obesity; insulin resistance; GLP-1 agonists; inositols PCOS; obesity; insulin resistance; GLP-1 agonists; inositols

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MDPI and ACS Style

Bila, J.; Dotlic, J.; Andjic, M.; Ivanovic, K.; Micic, J.; Tulic, L.; Pupovac, M.; Stojnic, J.; Vukovic, I.; Ivanovic, S. Obesity as a Part of Polycysric Ovary Syndrome (PCOS)—A Review of Pathophysiology and Comprehensive Therapeutic Strategies. J. Clin. Med. 2025, 14, 5642. https://doi.org/10.3390/jcm14165642

AMA Style

Bila J, Dotlic J, Andjic M, Ivanovic K, Micic J, Tulic L, Pupovac M, Stojnic J, Vukovic I, Ivanovic S. Obesity as a Part of Polycysric Ovary Syndrome (PCOS)—A Review of Pathophysiology and Comprehensive Therapeutic Strategies. Journal of Clinical Medicine. 2025; 14(16):5642. https://doi.org/10.3390/jcm14165642

Chicago/Turabian Style

Bila, Jovan, Jelena Dotlic, Mladen Andjic, Katarina Ivanovic, Jelena Micic, Lidija Tulic, Miljan Pupovac, Jelena Stojnic, Ivana Vukovic, and Stefan Ivanovic. 2025. "Obesity as a Part of Polycysric Ovary Syndrome (PCOS)—A Review of Pathophysiology and Comprehensive Therapeutic Strategies" Journal of Clinical Medicine 14, no. 16: 5642. https://doi.org/10.3390/jcm14165642

APA Style

Bila, J., Dotlic, J., Andjic, M., Ivanovic, K., Micic, J., Tulic, L., Pupovac, M., Stojnic, J., Vukovic, I., & Ivanovic, S. (2025). Obesity as a Part of Polycysric Ovary Syndrome (PCOS)—A Review of Pathophysiology and Comprehensive Therapeutic Strategies. Journal of Clinical Medicine, 14(16), 5642. https://doi.org/10.3390/jcm14165642

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