**4. The challenges in treatment and outcome**

As cause and pathophysiology is not clear, the treatment ranges widely from only lifestyle modification to planned use of insulin sensitizers like metformin to desperate ovarian drilling, there is also indecisiveness about the usefulness of present treatment methods in ameliorating long-term complications like endometrial carcinoma. A simple initial step of losing weight can return ovulation in patients. Losing weight alone does not cure other symptoms. For menstrual irregularity, continuous or cyclical hormonal therapy can be used. For infertility treatment, simple weight loss can return ovulation or patients have many time opt for in-vitro fertilization. Metformin as primary drug for ovulation is controversial though it improves insulin-resistant status.

The determinants for calculating the prognosis of the patient are also not clear. With different age of population presenting with different presentation and with people at increased risk for variety of problems like infertility, dysfunctional bleeding, endometrial cancer, obesity, type 2 diabetes mellitus, dyslipidemia, hypertension, and cardiovascular disease, it is difficult to frame a prognostic criteria.
