Introduction:

Multiple systemic and local factors are involved in the genesis of polycystic ovary syndrome that have a multidirectional relationship about which many there are questions yet to be clarified and some confusion and uncertainty persist.

Objective:

To describe the current approach to the causes and mechanisms involved in the origin and development of polycystic ovary syndrome.

Methods:

A state-of-the-art literature review was performed. The factors and pathways proposed to explain the etiopathogenesis and pathophysiology of genetic, environmental, endocrine and metabolic alterations associated with the syndrome and its clinical expression are described.

Conclusions:

The pathophysiology of polycystic ovary syndrome is complex. Many aspects remain unclear, but there is increasing knowledge that sheds light on the enigmas that still persist and on the understanding of previously unknown phenomena. There is a growing conviction that the central alteration is at the ovarian level, that the syndrome is heterogeneous in all its elements and that knowledge of the great diversity of factors and mechanisms involved is fundamental, not only from the scientific point of view but also for its practical utility.