Women’s Health
Reframing Polycystic Ovary Syndrome as a Lifelong Disease Beyond Reproductive Endocrinology: Implications Across the Female Lifespan Anoosha Keshav* Anoosha Keshav Medical University of the Americas
Polycystic ovary syndrome (PCOS) is among the most common endocrine disorders worldwide, yet it continues to be primarily defined and managed as a reproductive condition centered on menstrual irregularity and infertility, limiting recognition of its broader and long-term health consequences. Increasing evidence indicates that PCOS is a chronic, multisystem condition with clinical and public health implications that extend across the female lifespan. This narrative review synthesizes epidemiologic and clinical evidence from adolescence through postmenopause to examine how PCOS-related risk evolves over time. The literature demonstrates that PCOS often emerges during adolescence, when early metabolic and psychological features may be overlooked or attributed to normal pubertal development, resulting in delayed diagnosis and missed preventive opportunities. During the reproductive years, clinical management frequently remains fertility-focused despite consistent associations with adverse pregnancy outcomes and early cardiometabolic dysfunction. With advancing age, reproductive manifestations may diminish; however, underlying metabolic risk persists or progresses, with insulin resistance, metabolic syndrome, type 2 diabetes, and cardiovascular disease commonly extending into midlife and later adulthood. Prolonged exposure to unopposed estrogen further increases lifetime risk of endometrial hyperplasia and endometrial cancer, underscoring the relevance of PCOS beyond reproductive endocrinology. Across all life stages, gaps in longitudinal follow-up and surveillance contribute to preventable morbidity. Collectively, these findings support reframing PCOS as a lifelong condition and highlight the importance of a life-course approach to improve early recognition, continuity of care, and prevention of chronic disease in women with PCOS.