Anti-androgen therapy in polyendocrine metabolic ovary syndrome (PMOS, formerly PCOS): efficacy, safety, and phenotype-oriented clinical decision-making

This review discusses the role of anti-androgen therapy in managing polyendocrine metabolic ovarian syndrome (PMOS), previously known as polycystic ovary syndrome (PCOS). It highlights the importance of addressing hyperandrogenism, which contributes to reproductive, metabolic, and psychological issues in affected women. The review evaluates the efficacy and safety of various anti-androgen agents, such as combined oral contraceptives, spironolactone, cyproterone acetate, and finasteride, alongside emerging therapies. It emphasizes integrated management strategies, including pharmacotherapy, lifestyle changes, and insulin sensitizers like metformin. Special considerations are given to adolescents, women planning pregnancy, and those with obesity. The review also addresses controversies regarding cardiovascular safety, treatment duration, and the need for predictive biomarkers, proposing a phenotype-guided framework for clinical management.