Pathogenesis and treatment of obesity-related polycystic ovary syndrome

Abstract Polycystic ovary syndrome (PCOS) is a gynecological endocrine disorder affecting 5%–18% of women of reproductive age worldwide. It is characterized by hyperandrogenemia (HA), anovulation, and polycystic ovarian morphology (PCOM), severely impacting women’s reproductive and metabolic health. Obesity has become increasingly common among PCOS patients in recent years. Obesity can further exacerbate the metabolic and reproductive dysfunctions of PCOS through mechanisms such as insulin resistance (IR) and chronic low-grade inflammation. It may even have adverse effects on mental health. However, the specific pathogenesis and effective therapeutic targets of PCOS with obesity remain incompletely understood. This review presents a narrative review of recent research, focusing on the molecular mechanisms that drive autophagy in the context of obesity associated with polycystic ovary syndrome (PCOS), endoplasmic reticulum stress (ERS), gut microbiota imbalances, and disruptions in the hypothalamic-pituitary-ovarian (HPO) axis. It also explores corresponding therapeutic strategies. The aim is to provide fresh perspectives and insights for future mechanistic research and clinical interventions in this field.