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2 Pathophysiological basis: coupling of metabolic imbalance and reproductive axis 2.1 Heterogeneous phenotypes and neuroendocrine characteristics of PCOS Polycystic Ovary Syndrome is a clinically heterogeneous syndrome, and diagnosis remains syndromic: clinicians identify combinations of hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology (PCOM), while excluding disorders with similar presentations (49)