Polycystic ovary syndrome: pragmatic management across levels of care

Polycystic ovary syndrome (PCOS) is a common endocrine condition requiring coordinated management across reproductive, metabolic, and psychological domains. This narrative review explores pragmatic strategies that can be applied across levels of care, considering workforce capacity, referral thresholds, and patient access.
PubMed, Embase, and Ovid were searched (2000–2025) for guidelines, systematic reviews, clinical trials, and qualitative studies. Evidence was synthesised with attention to feasibility in primary versus secondary care.
Menstrual irregularity can usually be managed in primary care with combined oral contraceptives or progestins, with referral for fertility or complex cases. Dermatological symptoms such as hirsutism and acne may require topical or hormonal therapy, with escalation to anti-androgens or dermatology input. Cardiometabolic and glycaemic risk should be screened routinely in general practice, with specialist referral for complex profiles. Emotional wellbeing—including anxiety, depression, eating disorders, and body image concerns—can be screened in primary care using validated questionnaires with onward referral as needed.
Pragmatic PCOS care requires clear delineation between primary and specialist roles, integration of digital tools, and patient-centred education to reduce duplication, improve efficiency, and enhance outcomes.