Table 2.

Summary of resolutions and expert opinion.

	Resolution	Condensed expert opinion
1	PCOS is a well-established medical condition that negatively affects reproduction, general health, sexual health, and quality of life.	• PCOS is a multifaceted disease with an impact on various aspects of a woman's life, such as aesthetics, reproduction, metabolism, psychological well-being, and sexuality. • Phenotypization is fundamental for providing a tailored therapy.
2	The symptoms and signs of PCOS appear early in life especially in female newborns from PCOS carriers.	• Daughters of PCOS women inherit certain characteristics that become more evident across puberty. • Early recognition of PCOS in adolescence is fundamental to set up individualized strategies to ameliorate symptoms and to counteract reproductive and metabolic risks associated with this condition.
3	Women with PCOS have significantly increased risk of pregnancy-related complications including gestational diabetes.	• Women with PCOS have an increased risk of GDM than controls, especially if obesity/metabolic syndrome are present, and should be carefully investigated and monitored during early pregnancy with OGTT. • Changes in intestinal microbiota during pregnancy may contribute to the onset of metabolic dysfunction in both the mother and the offspring.
4	A male PCOS equivalent seems to exist, and it may impact on metabolic health and probably on reproduction.	• Male PCOS equivalent may be diagnosed in presence of PCOS-like hormonal pattern, metabolic abnormalities, overweight/obesity, and/or clinical signs of hyperandrogenism, above all in patients aged <35 years with a family history positive for PCOS. • The metabolic and hormonal profile should be assessed in first-degree male relatives of PCOS women and in men with early-onset AGA. This may help to prevent the risk of T2DM and CVD later in life. • Further studies are needed to confirm the existence of a male PCOS equivalent and to evaluate its impact on the testicular function.
5	The evidence supports that medical therapy for women with PCOS is effective, rational, and evidence-based.	• No single unified treatment for PCOS is available, and treatment should be individualized. • Targets for pharmacological treatment include biochemical and clinical androgen excess, menstrual irregularities, anovulation, insulin resistance, and metabolic profile. • Lifestyle counseling should be provided in all cases. • COCPs are the first-line treatment for long-term management of menstrual irregularities and hyperandrogenism. • Metformin should be recommended in overweight/obese adult PCOS women and considered in adolescents with PCOS for the management of weight, insulin resistance, and metabolic abnormalities.
6	The evidence supports a major research initiative to explore possible benefits of nutraceutical therapy for PCOS.	• MI and DCI show different insulin-mimetic properties. Inositol administration should be aimed to keep unaltered the MI/DCI ratio. • Treatment with MI/ALA combination may ameliorate hyperinsulinemia, decrease oxidative stress markers at oocyte level, and normalize endometrial inflammasome in PCOS women with idiopathic recurrent pregnancy loss. • The hormonal and clinical profile of overweight/obese women with PCOS may benefit from prolonged use of MI/ALA combination, such as a higher recovery of class II oocytes during ART. • NAFLD may be associated with PCOS. A timely diagnosis is warranted to avoid the NAFLD-related long-term complications. A nutraceutical approach could be useful in the treatment of NAFLD. • Hyperomocysteinemia may be associated with selected PCOS patients. Treatment with folic acid should be started to avoid the long-term consequences on the cardiovascular system. • Nutraceuticals, associated with diet and lifestyle modifications, can be important therapeutic option to manage pregnancy-related complications in PCOS pregnant patients.

AGA, androgenic alopecia; ALA, α-lipoic acid; ART, assisted reproductive techniques; COCP, combined oral contraceptive pills; DCI, D-chiro-inositol; GDM, gestational diabetes mellitus; MI, myoinositol; NAFLD, non-alcoholic fatty liver disease; OGTT, oral glucose tolerance test; T2DM, type 2 diabetes mellitus.