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Heart rate variability (HRV) provides a non-invasive approach for assessing autonomic regulation; however, conventional HRV indices primarily characterize the magnitude and spectral distribution of variability. We therefore propose a multidimensional framework for investigating autonomic alterations in PMOS\/PCOS. It integrates conventional HRV with heart rate fragmentation, nonlinear complexity, and deceleration and acceleration capacities derived from phase-rectified signal averaging. This Review evaluates the evidence supporting these dimensions and discusses how validated wearable monitoring, standardized preprocessing, and digital phenotyping may support future context-aware autonomic research. Prospective PMOS\/PCOS-specific validation is required before these approaches can inform metabolic risk stratification, treatment monitoring, or clinical decision-making.<\/jats:p>","DOI":"10.3389\/fendo.2026.1951746","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:16:55Z","timestamp":1790068615000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Heart rate dynamics in polyendocrine metabolic ovarian syndrome: from heterogeneity to wearable digital phenotyping"],"prefix":"10.3389","volume":"17","author":[{"given":"Tingting","family":"Ye","sequence":"first","affiliation":[{"name":"Acupuncture and Massage Academy, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junran","family":"Wang","sequence":"additional","affiliation":[{"name":"Acupuncture and Massage Academy, Chengdu 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