New pathophysiology, updated diagnostics and the age of incretin mimetics

With a prevalence of 8-13%, polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age – and yet up to 70% of those affected remain undiagnosed. In 2025 and 2026, new insights into the pathophysiology have fundamentally expanded the picture of PCOS: the gut-microbiome axis, the neuroendocrine gut-brain axis and chronic low-grade inflammation are playing an increasingly central role. At the same time, GLP-1 receptor agonists such as semaglutide and tirzepatide are experiencing a clinical breakthrough as an off-label option for PCOS with a metabolic phenotype.