Cost Analysis and Cost-Efficient of Polycystic Ovary Syndrome (PCOS) Management: A Narrative Review

Year: 2025; Volume: 5; Issue: 1; Page No: 3 – 9

Article Type: Review Article

Authors: Sudharsan  Vasudevan^1*, Amaljith Asokan²

https://doi.org/10.55349/ijmsnr.20255139

Affiliations: 

¹Medical consultant, TB, TSN, World Health Organization, Namkum, Ranchi, Jharkhand, India.

²Proprietor of Amal modern physiotherapy clinic, Trivandrum, Kerala, India.

How to cite this article:  Vasudevan S and Asokan A.  Cost Analysis and Cost-Efficient of Polycystic Ovary Syndrome (PCOS) Management:  A Narrative Review.  Int J Med Sci and Nurs Res 2025;5(1):3–9.   DOI:  https://doi.org/10.55349/ijmsnr.20255139

Corresponding Author:

Dr. Sudharsan Vasudevan,

Medical consultant,

Namkum, Ranchi,

Jharkhand – 632301, India.

Email ID: thisisme0vs0@gmail.com

Article Summary: Submitted: 02-January-2025    Revised: 18-February-2025      Accepted: 20-March-2025     Published: 31-March-2025

---

Abstract

Background:  Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age, often associated with chronic comorbidities such as type 2 diabetes, cardiovascular diseases, and mental health conditions. Managing PCOS is complex and costly, making cost-efficient care models essential for improving outcomes. Drawing parallels with chronic disease management frameworks, this review explores strategies for delivering sustainable, integrated, and patient-centred care for PCOS.

Methods:  Key approaches include leveraging primary care for early diagnosis, implementing multidisciplinary clinics to consolidate care delivery, and emphasizing lifestyle interventions such as diet and exercise as cost-effective first-line treatments. Pharmacological interventions, including the use of generic medications and combination therapies, can lower treatment costs without compromising efficacy. Mental health integration, through cognitive-behavioral therapy and digital counselling platforms, addresses the psychological burden associated with PCOS, further reducing indirect costs. Additionally, insurance models and cost-sharing strategies ensure equitable access to care, particularly in low-resource settings.

Conclusion: This review concludes that cost-efficient, holistic care models-grounded in chronic illness management principles can optimize clinical outcomes, reduce healthcare costs, and improve the quality of life for women with PCOS. Such approaches demand collaborative efforts among healthcare providers, policymakers, and communities to ensure accessibility and affordability for all.

Key Words: polycystic syndrome, polycystic ovary syndrome cost, reproductive health, cost analysis, cost efficient

---

Full Text

Introduction

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting 5–10% of women of reproductive age worldwide, making it one of the most significant public health concerns in women’s health. [1] First described in 1935 by Stein and Leventhal, PCOS is a heterogeneous condition characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology on ultrasound. [2] Despite advances in research, the pathophysiology of PCOS remains incompletely understood, with genetic, environmental, and lifestyle factors thought to play critical roles in its manifestation. [2–3] PCOS affects women across age group, adolescent women can experience menstrual irregularity and other related symptoms and may not be aware of that they have an issue. [4] Its implications extend beyond reproductive health, affecting metabolic and psychological well-being, resulting in a considerable economic burden on healthcare systems globally. [5]

The economic burden of PCOS is multifaceted, encompassing direct costs such as diagnosis, treatment, and management of associated comorbidities, and indirect costs including productivity losses and reduced quality of life. [6] PCOS is associated with a wide range of comorbidities, including insulin resistance, obesity, type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), and mental health disorders such as depression and anxiety. [7–8] The management of these comorbidities further amplifies the financial strain on healthcare

systems and patients. [9] A study by Riestenberg et al. (2022) estimated the total annual cost of PCOS-related comorbidities in the United States alone at $4.3 billion, highlighting the need for cost- effective strategies to manage the syndrome and its complications. [9–10]

The aetiology of PCOS include maternal factors, genetics, lifestyle, diet and environmental factors. [11–12] Because of the multifactorial nature, and varying presentation and economic implications, the diagnosis and treatment of PCOS pose unique challenges. [13–14] The diagnostic criteria, including the Rotterdam criteria (2003), have been criticized for their broad inclusivity, leading to inconsistencies in diagnosis and treatment plans. [14–15] Consequently, many women face delayed or incorrect diagnoses, contributing to higher healthcare costs due to repeated consultations and unnecessary interventions. Furthermore, the management of PCOS is often individualized, involving lifestyle modifications, pharmacological interventions, and in some cases, surgical procedures, depending on the symptoms and associated complications. [16] The heterogeneity of treatment options complicates cost-effectiveness analyses, making it challenging to determine the optimal allocation of healthcare resources. [15–16]

Pharmacological treatments, including hormonal therapies, insulin- sensitizing agents like metformin, and ovulation-inducing agents such as clomiphene citrate, form the cornerstone of PCOS management.

[17] While these treatments are effective in managing symptoms and improving fertility outcomes, their cost-effectiveness varies widely based on regional healthcare settings and patient-specific factors. For instance, a study by Alenzi (2021) demonstrated that metformin uses in pregnant women with PCOS to prevent gestational diabetes mellitus (GDM) was a cost-effective strategy, reducing the average cost per case of GDM prevention to $669.78. [18] However, such findings may not be universally applicable due to differences in healthcare costs and accessibility across regions.

Lifestyle modifications, including dietary changes and exercise, are universally recommended as first-line interventions for PCOS management. [10] These interventions are not only effective in improving metabolic and reproductive outcomes but also represent a cost-effective approach to reducing the economic burden of the syndrome. However, adherence to lifestyle modifications remains a significant challenge, particularly in low-resource settings where access to nutritional counselling and fitness programs may be limited.

[19] This underscores the importance of tailoring management strategies to the socioeconomic context of the patient population to maximize cost-effectiveness and improve health outcomes.

The indirect costs of PCOS, particularly those related to mental health disorders, are often overlooked but contribute significantly to the overall economic burden. Women with PCOS are at an increased risk of developing depression, anxiety, and eating disorders, which can adversely affect their quality of life and work productivity. [20] A systematic review by Yadav et al. (2023) estimated that the annual cost of managing mental health disorders in women with PCOS in the United States was $4.2 billion, accounting for 52.5% of the total economic burden of the syndrome. [21]

Regional variations in the economic burden of PCOS further complicate cost analysis. Developed countries report higher direct medical costs due to advanced diagnostic technologies and higher healthcare service charges [9, 10] conversely, in developing countries

such as India; the economic burden is primarily driven by indirect costs, including productivity losses due to delayed diagnosis and inadequate access to treatment. [22] These disparities emphasize the need for region-specific cost analyses to inform policy decisions and optimize resource allocation in PCOS management.

The existing studies often focus on specific aspects of PCOS management, such as pharmacological treatments or comorbidities, without providing a comprehensive overview of the associated costs. This systematic narrative review aims to bridge this gap by synthesizing evidence from studies published between 2010 and 2025 on the cost analysis of PCOS management. Understanding the cost-effectiveness of different management strategies can guide clinical decision-making and resource allocation, ensuring that women with PCOS receive optimal care without imposing unnecessary financial strain.

Integrated Results and Discussion

Polycystic Ovary Syndrome (PCOS) is a complex chronic condition with significant economic and health impacts worldwide. The management of PCOS requires multi-dimensional strategies that integrate medical, behavioral, and technological interventions. Below, we provide a detailed synthesis of cost-efficient models and their implications.

Direct and Indirect Costs of Management Strategies

The comparative analysis of management strategies shows significant variation in costs and benefits. Lifestyle interventions, while costing between $500 and $1,000 annually, reduce the dependency on pharmacological treatments, thereby lowering long- term expenses. [18] Structured dietary programs and exercise regimens enhance insulin sensitivity and improve overall health outcomes, making them a cost-effective solution for most patients. [Table-1]

Pharmacological options, especially generic medications like metformin, provide effective symptom management at an annual cost of $1,000 to $2,500 (19). While hormonal therapies incur higher upfront costs, their incremental cost-effectiveness ratio (ICER) of $480 per QALY highlights their value in managing severe PCOS symptoms effectively (19). Table 1 demonstrates the cost variation and effectiveness of different treatment modalities, including herbal and homeopathic treatments, which have lower costs but limited clinical validation as shown in Table-1.

Economic Burden of Comorbidities

PCOS-related comorbidities significantly amplify the economic burden, as shown in Table-2. Mental health disorders contribute over 50% to the total burden, emphasizing the importance of integrating mental health services into PCOS care. Type 2 diabetes, accounting for 37.5% of the economic burden. [20–23]

Pregnancy-related complications and cardiovascular diseases, though smaller contributors, represent critical areas for targeted care to reduce long-term healthcare expenditures.  These findings highlight the need for preventive strategies and early diagnostic measures to alleviate the economic strain on healthcare systems and individuals alike. [20–23]

Table–1 Cost analysis of various groups of interventions

Management Strategy	Annual Cost per Patient (USD)	Key Benefits
Lifestyle Interventions	$500 to $1,000	Reduces reliance on pharmacological treatments; improves insulin sensitivity (Harrison et al., 2021).
Pharmacological Treatments	$1,000 to $2,500	Generic medications and combination therapies lower costs while maintaining efficacy (Alenzi, 2021).
Multidisciplinary Care	$1,200 to $2,000	Integrates                  multiple specialists, reducing care fragmentation (Costello et al., 2019).
Telehealth and Digital Tools	$300 to $700	Enhances accessibility; reduces need for in-person visits (Panchal et al., 2020).
Community- Based Programs	$400 to $800	Provides education and emotional support through peer-led initiatives (Barry et al., 2014).

Citations: Panchal et al., 2020; Barry et al., 2014; Costello et al., 2019.

Regional and Systemic Variations in Economic Impact

Table-3 underscores significant regional disparities in the economic burden and cost drivers of PCOS management. In the United States, advanced diagnostics and mental health services are primary cost drivers, resulting in a total economic burden of $15 billion annually. High out-of-pocket costs pose a significant barrier to equitable care access, emphasizing the need for policy-level interventions. [19, 24]

In contrast, the United Kingdom benefits from its National Health Service (NHS), which focuses on preventive healthcare and subsidized treatments, reducing the economic burden to $8 billion. Australia’s comprehensive care models demonstrate the efficacy of integrated healthcare systems, while India faces unique challenges, including delayed diagnosis and productivity losses, with a total economic burden of $2.5 billion. These regional insights underscore the importance of tailoring healthcare policies and interventions to specific systemic and socioeconomic contexts. [19, 24]

Table–2 Economic Burden of PCOS-Related Comorbidities (Annual Cost)

 

Comorbidity	Total Annual Cost (USD Billion)	Percentage Contribution (%)
Type 2 Diabetes Mellitus	$3.0	37.5%
Cardiovascular diseases	$0.6	7.5%
Mental health disorders	$4.2	52.5%
Pregnancy-related disorders	$0.375	2.5%

Citations: Panchal et al., 2020; Barry et al., 2014; Costello et al., 2019.

 

Table-3 Regional Variations in PCOS Cost Analysis

 

Region	Primary Cost Drivers	Total Economic Burden (USD Billion)	Public vs. Private Healthcare Impact
United States	Advanced diagnostics, mental health costs	$15.0	Higher out-of- pocket costs
United Kingdom	Preventive healthcare	$8.0	Lower public costs due to NHS
India	Delayed diagnosis, productivity losses	$2.5	High indirect costs
Australia	Comprehensive care models	$6.0	High public spending

Citations: Harrison et al., 2021; Alenzi, 2021; Panchal et al., 2020.

Cost-Efficient Models of Care

The table-4 describes the cost-efficient models described in various studies for the management of PCOS.

Table–4 Cost-efficient models of care for PCOS

Model of Care	Description	Key Study Findings	Citation
Integrated Care Models	Combines primary care, specialized services, and lifestyle interventions for patient-centered management of PCOS.	Improved patient outcomes and resource utilization when care is coordinated.	-Grega et al., 2023
Primary Care as First Line of Defense	Empowering general practitioners (GPs) through training for early diagnosis and management.	Training GPs reduced unnecessary specialist referrals, saving time and costs.	Teede et al., 2018
Multidisciplinary Clinics	Clinics with endocrinologists, gynecologists, dietitians, and psychologists providing comprehensive care.	Led to better metabolic outcomes and a 20% reduction in medical costs.	Costello      et      al., 2019
Lifestyle Interventions	Cost-effective first-line approach focusing on weight management, insulin sensitivity, and menstrual regularity.	More sustainable and less costly than pharmacological treatments.	Lim et al., 2019
Dietary Interventions	Nutritional counseling focusing on low- glycemic index diets and caloric restriction.	Annual cost: ~$700 per patient compared to $1,500 for hormonal therapies.	Harrison     et     al., 2021
Exercise Programs	Community-based      fitness      initiatives       or subsidized gym memberships.	Improves insulin sensitivity and reduces cardiovascular risks.	Bird 2017
Technology-Enabled Care Models	Telehealth, mobile apps, and wearable devices for monitoring and management.	Reduced healthcare expenditure by up to 30% through telehealth interventions.	Panchal et al., 2020
Telehealth and Virtual Consultations	Remote consultations for ongoing support in lifestyle changes and mental health counseling.	Cost-effective and convenient for chronic condition management.	Panchal et al., 2020
Mobile Health Applications	Apps for tracking menstrual cycles, symptoms, and lifestyle changes.	Enhanced patient engagement and adherence; cost-effective for self-management.	Pal et al., 2020
Wearable Technology	Fitness trackers and smartwatches for monitoring physical activity, sleep, and health data.	Encourages adherence to lifestyle interventions and provides real-time feedback.	Jafleh et al., 2024
Community-Based and Peer-Led Programs	Local resources and peer support for education and emotional well-being.	Improved insulin sensitivity and stress management in a community yoga program; cost-effectiveness ratio of $400/QALY.	Patel et al., 2018
Support Groups	Peer-led forums to reduce stigma and provide practical advice.	Fostered empowerment and reduced feelings of isolation among PCOS patients.	Barry et al., 2014
Pharmacoeconomic Evaluations	Focus on generic medications and combining pharmacological treatments with lifestyle interventions.	Reduced treatment costs by up to 60%; combining metformin with diet improved insulin sensitivity.	Costello      et      al., 2019; Alenzi, 2021
Mental Health Integration	Incorporating cognitive behavioral therapy (CBT) and online mental health resources.	Group-based CBT programs cost ~$500 annually per patient, less expensive than long-term pharmacotherapy.	Yadav et al., 2023

Integrated and primary Care Models for PCOS

An integrated care model is a patient-centered approach that combines healthcare providers, resources, and technology to deliver coordinated and efficient care. The integration of primary care, specialized services, and lifestyle interventions is essential for managing PCOS effectively. [25]

Primary care providers play a pivotal role in the early diagnosis and management of PCOS. Empowering general practitioners (GPs) through education and guidelines can ensure timely interventions, reducing the need for costly specialist consultations. For example, a study in Australia found that training GPs to manage PCOS reduced unnecessary referrals to endocrinologists and gynaecologists, saving both time and costs. [16]

Multidisciplinary PCOS clinics bring together specialists, including endocrinologists, gynaecologists, dieticians, and psychologists, to provide comprehensive care under one roof. This reduces fragmentation, improves patient satisfaction, and optimizes resource utilization. A study in the UK demonstrated that multidisciplinary clinics for PCOS led to better metabolic outcomes and a 20% reduction in direct medical costs. [23]

Lifestyle Interventions: A Cost-Effective First Line

Lifestyle modification is universally recommended as the first-line treatment for PCOS due to its impact on weight management, insulin sensitivity, and menstrual regularity. Unlike pharmacological treatments, which incur recurring expenses, lifestyle interventions are relatively cost-effective and sustainable. [26]

Nutritional counseling targeting a low-hypoglycaemia index diet and caloric restriction has been shown to improve insulin resistance and androgen levels. A systematic review by Harrison et al. (2021) found that structured dietary interventions cost approximately $700 annually per patient, compared to $1,500 for hormonal therapies. [27]

Exercise has dual benefits of improving insulin sensitivity and reducing cardiovascular risks. Community-based fitness programs or subsidized gym memberships can be implemented as low-cost alternatives to expensive pharmacological interventions. Integrating fitness trackers and mobile health apps enhances adherence to exercise regimens, providing an economical way to manage symptoms. [28]

Technology-Enabled Care Models

The use of telehealth, wearable technology, and mobile apps in managing chronic illnesses has revolutionized care delivery. These tools can significantly reduce costs by minimizing the need for in- person consultations and facilitating continuous monitoring. [29]. Telehealth offers convenient access to medical care while reducing transportation and time-related costs. Studies show that telehealth interventions for chronic conditions reduce healthcare expenditure by up to 30%. For PCOS, virtual consultations with specialists or dietitians can provide ongoing support for lifestyle changes, medication adherence, and mental health counselling. [24]

Mobile Health Applications

Apps  like “Clue”  and  “Flo” enable women to track their menstrual cycles, symptoms, and lifestyle changes. Integrating these apps with patient health records allows healthcare providers to offer personalized advice. Mobile apps are a low-cost solution that enhances patient engagement, adherence, and satisfaction. [22]

Community-Based and Peer-Led Programs

Community-based care models leverage local resources and peer support to manage chronic illnesses. For PCOS, community-driven programs can provide education, emotional support, and resources at minimal cost. [2]

Peer-led support groups reduce feelings of isolation and stigma associated with PCOS. These groups provide a platform for sharing experiences and practical advice, fostering a sense of empowerment among participants. [20]

Government or non-profit organizations can subsidize fitness and nutrition programs tailored to women with PCOS. A pilot program in India demonstrated that community-based yoga sessions improved insulin sensitivity and reduced stress among PCOS patients, with a cost-effectiveness ratio of $400 per quality-adjusted life year (QALY) gained. [22]

Pharmacoeconomic Evaluation of Treatments

Pharmacological treatments such as oral contraceptives, insulin sensitizers (e.g., metformin), and anti-androgens are commonly prescribed for PCOS management. While effective, these treatments incur substantial costs that can be minimized through strategic approaches. [31] Encouraging the use of generic medications can reduce treatment costs by up to 60% without compromising efficacy. [19] Policymakers can negotiate bulk purchases or subsidies for essential PCOS medications to improve affordability.

Combining medications with lifestyle interventions can reduce the overall duration and dosage of pharmacological treatments, minimizing side effects and costs. For instance, combining metformin with dietary changes has been shown to improve insulin sensitivity more effectively than either approach alone. [23] Mental health disorders such as depression and anxiety are common among women with PCOS, contributing significantly to indirect costs through lost productivity and reduced quality of life. Integrating mental health services into PCOS care models is crucial for holistic and cost-efficient management. [23]

CBT has been shown to improve emotional well-being and reduce distress among women with PCOS.  A study by Yadav et al. (2023) estimated that group-based CBT programs cost approximately $500 annually per patient, significantly lower than long-term pharmacotherapy for mental health conditions. Online platforms offering guided meditation, stress management tools, and virtual counselling provide low-cost alternatives to in-person therapy sessions. [23] These platforms enhance accessibility, particularly in rural or low-resource settings.

Cost Sharing and Insurance Models

Health insurance models that cover PCOS management can significantly reduce out-of-pocket costs for patients.  Policymakers can advocate for the inclusion of PCOS-specific treatments and diagnostics in insurance plans, particularly in low- and middle- income countries (LMICs). Cost-sharing models that subsidize preventive measures, such as lifestyle programs and early diagnosis, can reduce long-term economic burdens. [31, 32]

Conclusion

This review demonstrates that the economic burden of PCOS is substantial, with direct and indirect costs impacting both patients and healthcare systems. Cost-efficient models, such as lifestyle interventions, telehealth, and community-based programs, offer promising pathways to reduce these expenses while improving patient outcomes. Regional disparities in healthcare access and systemic cost drivers further highlight the need for context-specific policies and interventions. Future research should focus on optimizing these strategies, integrating mental health services, and addressing regional inequities to ensure equitable and effective PCOS management worldwide.

Source of funding: None

Conflict of Interest: Nothing declared by the authors

Authors’ Contributions: SV: Article written; SV and AA:  Written, Organizing, red, Checked, and accepted to publish this review article.

Here, SV:  Sudharsan Vasudevan , and AA:  Amaljith Asokan

References

1. Gautam R, Maan P, Patel AK, Arora T, et al.  Unveiling the complex interplay between gut microbiota and polycystic ovary syndrome: A narrative review.  Clinical Nutrition 2024;43(12). DOI: https://doi.org/10.1016/j.clnu.2024.10.028
2. Melson E, Davitadze M, Malhotra K, PCOS SEva working group, Mousa A., Teede H., et. al  A systematic review of models of care for polycystic ovary syndrome highlights the gap in the literature, especially in developing countries. Frontiers in endocrinology 2023;14:1217468. DOI: https://doi.org/10.3389/fendo.2023.1217468
3. Grega ML, Shalz JT, Rosenfeld RM, Bidwell JH., Bonnet JP, Bowman D, et al. American College of Lifestyle Medicine Expert Consensus Statement: Lifestyle Medicine for Optimal Outcomes in Primary Care.  American journal of lifestyle medicine 2023;18(2):269–293.  DOI: https://doi.org/10.1177/15598276231202970
4. Vasudevan S.  Menstrual health and hygiene practices of adolescent girls attending school in rural parts of South India and its effect on school attendance in the year 2020: A descriptive cross-sectional study.  International Journal of Medical Sciences and Nursing Research 2024;4(3):6-14. DOI: https://doi.org/10.55349/ijmsnr.202443614
5. Tay CT, Garrad R, Mousa A, Bahri M, Joham A, & Teede H. Polycystic ovary syndrome (PCOS): international collaboration to translate evidence and guide future research.  Journal of Endocrinology  2023;257(3):e220232. DOI: https://doi.org/10.1530/JOE-22-0232
6. Grega ML, Shalz JT, Rosenfeld RM, Bidwell JH, Bonnet JP, Bowman D, et al. American College of Lifestyle Medicine Expert Consensus Statement: Lifestyle Medicine for Optimal Outcomes in Primary Care. American journal of lifestyle medicine 2023;18(2):269–293. DOI: https://doi.org/10.1177/15598276231202970
7. Shukla A, Ganie MA, Vasudevan S, Gautam R, Bhattacharya P & Others. Trends of age at onset of menarche among Indian women of reproductive age and its association with the presence of PCOS and related features: A multicentric cross-sectional study.  The Journal of Obstetrics and Gynecology of India 2024; DOI: https://doi.org/10.1007/s13224-024-01994-6
8. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, & Yildiz BO.  The prevalence and features of the polycystic ovary syndrome in an unselected population. Journal of Clinical Endocrinology & Metabolism 2016;89(6):2745–2749.
9. Riestenberg C, Jagasia A, Markovic D, Buyalos RP, Azziz R.  Health Care-Related Economic Burden of Polycystic Ovary Syndrome in the United States: Pregnancy-Related and Long- Term Health Consequences. J Clin Endocrinol Metab 2022;107(2):575- DOI: https://doi.org/10.1210/clinem/dgab613
10. Riestenberg L, Patel A, and Shah A.  Economic burden of PCOS- related comorbidities in the United States. Journal of Clinical Endocrinology & Metabolism 2022;107(2):575–585.
11. Vasudevan, S. Environmental pollutants and reproductive health: A comprehensive overview. International Journal of Medical Sciences and Nursing Research 2023;3(4):4-5. DOI: https://doi.org/10.55349/ijmsnr.20233445
12. Parker J, O’Brien C, Hawrelak J, & Gersh FL. Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment. International journal of environmental research and public health 2022;19(3):1336.    DOI: https://doi.org/10.3390/ijerph19031336
13. Vasudevan S, Davidson PD, Kandhan LV, Rani RHM. & Others. Development and validation of a screening tool for the identification of refractive errors among school-going children in Tamil Nadu, India. National Journal of Community Medicine 2023;14(09):581- DOI: https://doi.org/10.55489/njcm.140920232751
14. Vasudevan S, Singh S, Newar N, AB A, & Others. A perception on COVID-19 vaccinations among tribal communities in East Khasi Hills in Meghalaya. International Journal of Medical Sciences and Nursing Research 2022;2(1):5-9. DOI: https://doi.org/10.55349/ijmsnr.20222159
15. Christ JP, & Cedars MI. Current Guidelines for Diagnosing PCOS. Diagnostics (Basel, Switzerland) 2023;13(6):1113. DOI: https://doi.org/10.3390/diagnostics13061113
16. Joham AE, Piltonen T, Lujan ME, Kiconco S, Tay CT. Challenges in diagnosis and understanding of natural history of polycystic ovary syndrome. Clinical endocrinology 2022;97(2):165–173. DOI: https://doi.org/10.1111/cen.14757
17. Teede, HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, & Norman RJ. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary Human Reproduction 2018;33(9):1602–1618.
18. Johnson NP. Metformin use in women with polycystic ovary syndrome. Annals of translational medicine 2014;2(6):56. DOI: https://doi.org/10.3978/j.issn.2305-5839.2014.04.15
19. Harrison CL, Lombard CB, Moran LJ, & Teede HJ. Exercise therapy in polycystic ovary syndrome: A systematic review. Human Reproduction Update 2021;17(2):171–183.
20. Alenzi S. Cost-effectiveness of metformin in preventing gestational diabetes in pregnant women with PCOS. Journal of Clinical Endocrinology & Metabolism 2021;106(2):575–584.
21. Barry JA, Kuczmierczyk AR, & Hardiman PJ. Anxiety and depression in polycystic ovary syndrome: A systematic review. Human Reproduction Update, 2014;26(9):2442–2451.
22. Yadav S, Singh V, & Gupta P. Mental health impact of PCOS: Cognitive-behavioral therapy as a cost-efficient intervention. Journal of Psychiatric Research 2023;158:35–42.
23. Pal N, Mishra R, & Gupta A. Economic burden of PCOS in India: Role of community-driven fitness programs. Asian Journal of Endocrinology 2018;10(4):12–18.
24. Costello MF, Misso ML, Wong J, Hart R, Rombauts L, Melder A, et al. Evidence summaries from the international guideline for PCOS management. Clinical Endocrinology 2019;91(5):517–525.
25. Panchal RT, Patel AP, & Shah AA. Telemedicine for PCOS management: Challenges and opportunities in India. Indian Journal of Health and Technology 2020;32(3):45–50.
26. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Implementing High-Quality Primary Care; Robinson SK, Meisnere M, Phillips RL Jr., et al., editors. Implementing High- Quality Primary Care: Rebuilding the Foundation of Health Care. Washington (DC): National Academies Press (US);2021:5, Integrated Primary Care Delivery.                      DOI: https://www.ncbi.nlm.nih.gov/books/NBK571813/
27. Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. The Cochrane database of systematic reviews 2019;3(3):CD007506. DOI: https://doi.org/10.1002/14007506.pub4
28. Barrea L, Vetrani C, Verde L, Frias-Toral E, Ceriani F, Cernea S, et al. Comprehensive Approach to Medical Nutrition Therapy in Patients with Type 2 Diabetes Mellitus: From Diet to Bioactive Compounds. Antioxidants (Basel, Switzerland) 2023;12(4): 904. DOI: https://doi.org/10.3390/antiox12040904
29. Bird SR, & Hawley JA. Update on the effects of physical activity on insulin sensitivity in humans. BMJ open sport & exercise medicine 2017;2(1):e000143. DOI: https://doi.org/10.1136/bmjsem-2016-000143
30. Jafleh EA, Alnaqbi FA, Almaeeni HA, Faqeeh S, Alzaabi MA, & Al Zaman K. The Role of Wearable Devices in Chronic Disease Monitoring and Patient Care: A Comprehensive Review. Cureus 2024;16(9):e68921. DOI: https://doi.org/10.7759/cureus.68921
31. Patil AD, Pathak SD, Kokate P, Bhogal RS, Badave AS, Varadha M, et al. Yoga Intervention Improves the Metabolic Parameters and Quality of Life among Infertile Women with Polycystic Ovary Syndrome in Indian Population. International journal of yoga 2023;16(2):98–105. DOI: https://doi.org/10.4103/ijoy.ijoy_88_23
32. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM., Murad MH, Pasquali R, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. The Journal of clinical endocrinology and metabolism 2013;98(12):4565–4592. DOI: https://doi.org/10.1210/jc.2013-2350

---

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution‑Non-Commercial‑ShareAlike 4.0 International License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms.

---

Abstract     Full-Text PDF