Overview
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. It affects approximately 10% of women of reproductive age. It is characterized by many small cysts in the ovaries, irregular periods, male-pattern hair growth (hirsutism), and insulin resistance.
PCOS affects not only fertility but also metabolic health, cardiovascular disease, and emotional well-being. Early diagnosis and management can prevent long-term complications.
Symptoms
Symptoms usually begin in adolescence:
- Irregular periods (fewer than 8 periods per year, cycle longer than 35 days)
- Absence of menstruation (amenorrhea)
- Male-pattern hair growth (face, chest, back, abdomen)
- Acne (especially chin and back)
- Oily skin
- Hair loss (at hairline edges, crown area)
- Weight gain (especially in the abdominal area)
- Difficulty losing weight
- Dark skin patches on neck, armpits (acanthosis nigricans)
- Infertility (difficulty conceiving)
- Sleep apnea
- Depression, anxiety
Causes
The exact cause is unknown; multiple factors play a role:
- Insulin resistance: Present in 70% of women with PCOS; high insulin increases androgen production
- Excess androgen production: Excessive release of male hormones
- Low-grade chronic inflammation
- Genetic predisposition: Family history
Risk Factors
- Family history of PCOS
- Obesity (worsens symptoms)
- Insulin resistance
- Low birth weight or rapid weight gain in infancy
- Early adrenarche
Complications
Reproductive:
- Infertility
- Miscarriage
- Preterm birth
- Gestational diabetes, preeclampsia
Metabolic:
- Type 2 diabetes (50% increased risk)
- Metabolic syndrome
- High blood pressure
- High cholesterol
- Fatty liver disease
- Obstructive sleep apnea
Endometrial:
- Thickening of the uterine lining (endometrial hyperplasia)
- Endometrial cancer risk (long-term, if no periods)
Psychological:
- Depression
- Anxiety
- Eating disorders
- Low self-esteem
When to See a Doctor
- Irregular periods
- Hirsutism (male-pattern hair growth)
- Infertility problem
- Rapid, unexplained weight gain
- Acne and skin problems (starting in adulthood)
- Unexplained hair loss
- Irregular periods in adolescence
Diagnosis and Treatment
Diagnosis (Rotterdam criteria, 2 / 3 required):
- Irregular or absent periods
- Excess androgen clinically or in labs
- Polycystic ovary appearance on ultrasound
Tests performed:
- Detailed physical examination
- Pelvic ultrasound (ovary size, cysts)
- Hormone tests: testosterone, DHEA-S, LH, FSH, prolactin, TSH
- Fasting glucose and insulin, HbA1c
- Lipid profile
- Oral glucose tolerance test
Treatment (symptom-targeted):
1. Lifestyle changes (foundation):
- Healthy weight loss (even 5-10% loss significantly improves symptoms)
- Low glycemic index, healthy diet
- Regular exercise
2. Period regulation:
- Combined oral contraceptives (birth control pills)
- Progesterone (cyclic or continuous)
3. For hirsutism and acne:
- Anti-androgens (spironolactone)
- Birth control pills
- Topical anti-acne products, systemic treatments
- Laser hair removal, IPL
4. For insulin resistance:
- Metformin
- Inositol supplements
5. For fertility:
- Clomiphene citrate (ovulation induction)
- Letrozole
- Gonadotropins
- IVF (in vitro fertilization)
- Bariatric surgery (in obese women)
- Laparoscopic ovarian drilling (LOD)
Prevention and Lifestyle
- Maintain a healthy weight
- Exercise regularly (at least 150 minutes per week)
- Eat a low-glycemic-index diet
- Avoid processed foods
- Increase fiber and omega-3 intake
- Manage stress
- Get enough sleep
- Quit smoking
- Track your menstrual cycles
- Annual health check-ups (diabetes, cholesterol, blood pressure)
- Seek mental health support if needed