Incretin-based medications like liraglutide and semaglutide demonstrate meaningful weight loss and metabolic improvements in women with polycystic ovary syndrome (PCOS), with liraglutide showing the strongest evidence for reducing visceral fat, improving glycemia, and lowering inflammatory markers. Semaglutide appears to increase natural conception likelihood, while tirzepatide lacks PCOS-specific data. These findings matter because PCOS affects up to 15% of reproductive-age women, and obesity drives much of its pathophysiology through insulin resistance and chronic inflammation. Traditional treatments like metformin provide only modest, temporary weight loss insufficient to break this metabolic cycle. The incretin approach represents a mechanistic breakthrough by directly targeting the adipose dysfunction and hyperinsulinemia that perpetuate PCOS symptoms. However, significant evidence gaps remain around reproductive safety, long-term cardiovascular outcomes, and which PCOS phenotypes respond best. The research is still early-stage with small, heterogeneous studies, but the biological rationale is compelling. This represents an important step toward precision medicine for PCOS, potentially transforming treatment beyond symptom management to addressing root metabolic causes.