The Endocrine Society has published clinical practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS). The guidelines recommend using the Rotterdam criteria for PCOS diagnosis, which requires two of three criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries. Diagnosis in adolescents and menopausal women is more challenging, as symptoms may be normal for their developmental stage. Hyperandrogenism is central to PCOS in adolescents, while postmenopausal women may not show consistent symptoms. Women with PCOS should be evaluated for alternate androgen-excess disorders and risk factors such as endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease. Hormonal contraceptives are first-line treatment for menstrual irregularities and hirsutism/acne. Clomiphene is first-line for infertility, while metformin is beneficial for metabolic issues but not for hirsutism or acne. Hormonal contraceptives and metformin are recommended for adolescents with PCOS. Weight loss is beneficial for overweight/obese individuals but not for normal-weight women. Thiazolidinediones have an unfavorable risk-benefit ratio, and statins require further study. Screening for cardiovascular risk factors, including BMI, blood pressure, and glucose tolerance, is recommended for women with PCOS. The guidelines emphasize the importance of screening for depression, anxiety, and sleep-disordered breathing in women with PCOS. Awareness of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) is recommended, but routine screening is not advised. The guidelines also highlight the need to exclude other conditions that mimic PCOS, such as thyroid disease, hyperprolactinemia, and nonclassic congenital adrenal hyperplasia. The Endocrine Society's guidelines are based on the GRADE system, which assesses the quality of evidence and strength of recommendations. The guidelines were developed through a consensus process involving experts, a methodologist, and a medical writer. The guidelines aim to provide a comprehensive approach to the diagnosis and treatment of PCOS, emphasizing the importance of individualized care and considering the patient's values and preferences.The Endocrine Society has published clinical practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS). The guidelines recommend using the Rotterdam criteria for PCOS diagnosis, which requires two of three criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries. Diagnosis in adolescents and menopausal women is more challenging, as symptoms may be normal for their developmental stage. Hyperandrogenism is central to PCOS in adolescents, while postmenopausal women may not show consistent symptoms. Women with PCOS should be evaluated for alternate androgen-excess disorders and risk factors such as endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease. Hormonal contraceptives are first-line treatment for menstrual irregularities and hirsutism/acne. Clomiphene is first-line for infertility, while metformin is beneficial for metabolic issues but not for hirsutism or acne. Hormonal contraceptives and metformin are recommended for adolescents with PCOS. Weight loss is beneficial for overweight/obese individuals but not for normal-weight women. Thiazolidinediones have an unfavorable risk-benefit ratio, and statins require further study. Screening for cardiovascular risk factors, including BMI, blood pressure, and glucose tolerance, is recommended for women with PCOS. The guidelines emphasize the importance of screening for depression, anxiety, and sleep-disordered breathing in women with PCOS. Awareness of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) is recommended, but routine screening is not advised. The guidelines also highlight the need to exclude other conditions that mimic PCOS, such as thyroid disease, hyperprolactinemia, and nonclassic congenital adrenal hyperplasia. The Endocrine Society's guidelines are based on the GRADE system, which assesses the quality of evidence and strength of recommendations. The guidelines were developed through a consensus process involving experts, a methodologist, and a medical writer. The guidelines aim to provide a comprehensive approach to the diagnosis and treatment of PCOS, emphasizing the importance of individualized care and considering the patient's values and preferences.