Exact pathophysiology = unclear

• often have raised testosterone
• inappropriate gonadotrophin secretion - probably as a result of ovarian dysfunction rather than cause
• most common hormonal abnormalities: excess Luteinising hormone (LH) and Insulin resistance

Diagnostic criteria have varied over the years and vary according to authority group! Include the following:

• evidence of ovarian dysfunction
• exclusion of other disorders - eg other hormonal causes (Hypothyroidism, Hyperprolactinaemia, Cushing’s disease)
• biochemical evidence of hyperandrogenism
• ?USS evidence

Major features

• menstrual dysfunction - usually a chronic pattern
• anovulation
• signs of hyperandrogenism - male hair distribution, acne
• ~50% are obese
• Acanthosis nigricans - possibly due to insulin resistance
• Hypertension
• chronic pelvic pain

treatments aimed at so-called metabolic derangements, such as anovulation, hirsutism, and menstrual irregularities. Ovarian Pathology

References include:
https://emedicine.medscape.com/article/256806-overview
https://teachmeobgyn.com/gynaecology/ovarian/polycystic-ovary-syndrome/