Recent advances in polyendocrine metabolic ovarian syndrome and obesity: a comprehensive review

PURPOSE OF REVIEW: This review evaluates recent advances in polyendocrine metabolic ovarian syndrome (PMOS), emphasizing its complex association with obesity and the ongoing transition toward precision medicine. The synthesis of current evidence addresses pathophysiology, emerging biomarkers, and multiomics approaches, highlighting their potential to enhance diagnosis, risk stratification, and individualized management. RECENT FINDINGS: PMOS is a multifactorial disorder involving insulin resistance, hyperandrogenism, genetic predisposition, gut dysbiosis, and environmental factors. Obesity intensifies metabolic and reproductive dysfunction through mechanisms including chronic inflammation, adipose tissue dysfunction, and altered gut-ovary signalling. Traditional phenotype-based classifications do not adequately capture this biological heterogeneity. Multiomics approaches that integrate genomics, transcriptomics, proteomics, metabolomics, and microbiome data have identified distinct molecular subtypes, including insulin-resistant, steroidogenic, inflammatory, and neuroendocrine clusters. Novel biomarkers, including anti-Müllerian hormone, free androgen index, and specific metabolomic and lipidomic signatures, have the potential to improve diagnostic accuracy and phenotyping. SUMMARY: The integration of multiomics represents a pivotal advancement toward patient-centred care in PMOS by enabling early risk prediction and mechanism-based therapies. While current evidence remains largely exploratory, these developments support a shift from uniform treatment strategies to precision endocrinology, with the potential to substantially improve long-term metabolic and reproductive outcomes.