**1. Introduction**

Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of reproductiveage. It was described for the first time by Stein and Leventhal in 1935 [1].

The PCOS Consensus Workshop Group has proposed a review of diagnostic criteria, defining PCOS as the presence of at least two of the following criteria together [2]:

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In order to establish the diagnosis of PCOS, it is important to exclude other disorders with a similar clinical presentation, such as congenital adrenal hyperplasia, Cushing's syndrome, and androgen-secreting tumors.

the cutoff choice can be discussed and modified on the basis of geographical and socioeconomic considerations. The presence of obesity in women with PCOS results in worsening in

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Obese women with PCOS compared to women with normal weight with PCOS have increased prevalence of glucose intolerance and type 2 diabetes mellitus [10], higher prevalence of hirsutism [11], greater risk of metabolic syndrome, and therefore cardiovascular disease [12, 13]. Obesity increases the prevalence of obstructive sleep apnea in patients with PCOS [14].

A lipolysis dysregulation in PCOS patients has been documented [15], as an increased lipolysis of visceral fat resulting in an increase in free fatty acids released directly into the portal circulation. The free fatty acid levels in the hepatic portal circulation are the major modulators of hepatic gluconeogenesis [16]. This increased visceral fat lipolysis may be one of the mecha-

In obese women with PCOS, physical activity and low-calorie diet intake lead to an improvement in ovarian function and reduction of the risk of type 2 diabetes mellitus [18]. Exercise and weight control are highly recommended because of their direct effect not only on the metabolic framework but also on ovarian function and restoration of fertility [19]. Success in treating obesity requires a multidisciplinary approach involving the dietician, the psychologist, and the physician.

The perception of hirsutism as a problem depends on cultural and ethnic factors. The commonly used Ferriman-Gallwey score for clinical evaluation and score above 8 is considered

The incidence of hirsutism in Caucasian women is 60–70%, while in Japanese women is

In PCOS patients, hyperinsulinism also contributes to increased adrenal androgen secretion in part by increasing adrenal sensitivity to adrenocorticotropic hormone (ACTH) action [22].

It is a polymorphic dermatitis sustained by a chronic inflammatory process of the hair follicle. In the genesis of acne, four pathological events are distinguished: follicular channel hyper-

Chronic hyperandrogenism causes an increase in sebaceous secretion, thus forming a cystic collection resulting in bacterial overlap and thereby stimulating the inflammatory process. It

The main cause of infertility in PCOS women is chronic anovulation. However, subfertility may be related to the increase of plasma LH levels in the follicular phase of the cycle, causing a resumption of the second meiotic division of the oocyte and the release of premature

diagnostic [20]. The fact remains that it is an extremely subjective assessment.

keratosis, sebaceous hypersecretion, bacterial proliferation, and inflammation.

has been estimated roughly that one-third of PCOS patients have acne [23, 24].

the metabolic and reproductive outcomes [9].

nisms for increased risk of glucose intolerance [17].

**4. Hirsutism**

30% [21].

**4.1. Acne**

**4.2. Infertility**
