Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting 10% of females, causing irregular menstrual cycles and symptoms of hyperandrogenism. Diagnosis is often delayed, and patients are more likely to be overweight or obese, with higher BMI associated with more severe symptoms. PCOS is linked to adverse reproductive, cardiovascular, psychological, metabolic, and neoplastic outcomes. Early diagnosis allows for the identification and treatment of associated conditions such as hypertension, diabetes, obstructive sleep apnea, depression, and anxiety. The pathophysiology of PCOS is complex, involving hyperandrogenism and hyperinsulinemia. Two main theories explain hyperandrogenism: altered gonadotropin secretion and functional ovarian or adrenal hyperandrogenism. Hyperandrogenism leads to follicular recruitment and atresia, resulting in polycystic ovaries on ultrasound. Diagnosis of PCOS is based on the Rotterdam criteria, which include irregular cycles, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology. Treatment options include weight loss, combined hormonal contraceptives (CHCs), metformin, inositol, and anti-androgen agents. CHCs are first-line for cycle regulation and hirsutism, while metformin can improve metabolic markers. Anti-androgen agents are considered for patients unresponsive to CHCs or with contraindications. Fertility and pregnancy considerations for PCOS patients include the need for contraception if pregnancy is not desired, and the increased risk of complications such as hypertension, gestational diabetes, and cardiovascular disease. Long-term health complications, including hypertension, metabolic disorders, depression, anxiety, and cardiovascular disease, are common and require ongoing monitoring. Early diagnosis and management of PCOS are crucial for improving symptoms and mitigating long-term health risks.Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting 10% of females, causing irregular menstrual cycles and symptoms of hyperandrogenism. Diagnosis is often delayed, and patients are more likely to be overweight or obese, with higher BMI associated with more severe symptoms. PCOS is linked to adverse reproductive, cardiovascular, psychological, metabolic, and neoplastic outcomes. Early diagnosis allows for the identification and treatment of associated conditions such as hypertension, diabetes, obstructive sleep apnea, depression, and anxiety. The pathophysiology of PCOS is complex, involving hyperandrogenism and hyperinsulinemia. Two main theories explain hyperandrogenism: altered gonadotropin secretion and functional ovarian or adrenal hyperandrogenism. Hyperandrogenism leads to follicular recruitment and atresia, resulting in polycystic ovaries on ultrasound. Diagnosis of PCOS is based on the Rotterdam criteria, which include irregular cycles, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology. Treatment options include weight loss, combined hormonal contraceptives (CHCs), metformin, inositol, and anti-androgen agents. CHCs are first-line for cycle regulation and hirsutism, while metformin can improve metabolic markers. Anti-androgen agents are considered for patients unresponsive to CHCs or with contraindications. Fertility and pregnancy considerations for PCOS patients include the need for contraception if pregnancy is not desired, and the increased risk of complications such as hypertension, gestational diabetes, and cardiovascular disease. Long-term health complications, including hypertension, metabolic disorders, depression, anxiety, and cardiovascular disease, are common and require ongoing monitoring. Early diagnosis and management of PCOS are crucial for improving symptoms and mitigating long-term health risks.