Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders in women of reproductive age. It affects approximately 1 in 10 women, yet many go undiagnosed for years. PCOS is more than just a reproductive condition—it impacts metabolic, hormonal, and emotional health as well.
Let’s explore what PCOS is, what causes it, how it’s diagnosed, and the treatment options available to help manage this complex condition.
What Is PCOS?
PCOS is a hormonal disorder characterized by irregular ovulation, excess androgen (male hormone) levels, and polycystic-appearing ovaries on ultrasound. However, not all women with PCOS have visible cysts, and not all ovarian cysts mean someone has PCOS.
Key features of PCOS may include:
• Irregular or absent menstrual periods
• Elevated androgens (testosterone)
• Polycystic-appearing ovaries
A diagnosis is made when two out of three of these features are present, according to the Rotterdam criteria.
Common Symptoms of PCOS
Symptoms can vary widely and may begin during adolescence or later in adulthood. They often include:
• Irregular or missed periods
• Acne or oily skin
• Excess facial or body hair (hirsutism)
• Scalp hair thinning (female-pattern hair loss)
• Weight gain or difficulty losing weight
• Ovarian cysts (not always present)
• Infertility or difficulty ovulating
• Mood changes, anxiety, or depression
• Darkening of the skin (especially in skin folds, called acanthosis nigricans)
What Causes PCOS?
The exact cause of PCOS is not fully understood, but several factors likely contribute:
1. Insulin Resistance
Many women with PCOS have insulin resistance, which means their bodies don’t respond well to insulin. This leads to elevated insulin levels, which can stimulate the ovaries to produce more androgens like testosterone.
2. Hormonal Imbalance
Excess androgens interfere with the development and release of eggs during ovulation, leading to irregular menstrual cycles and infertility.
3. Genetics
PCOS tends to run in families. If your mother or sister has it, your risk is higher.
4. Inflammation
Chronic low-grade inflammation may also play a role by stimulating androgen production in the ovaries.
How Is PCOS Diagnosed?
Diagnosis involves a combination of medical history, physical examination, blood tests, and imaging:
• Menstrual history: Irregular or infrequent cycles
• Blood tests: Elevated androgens, insulin resistance, thyroid and prolactin levels to rule out other causes
• Pelvic ultrasound: May show enlarged ovaries with multiple small follicles (“string of pearls” appearance)
Note: A woman does not need visible cysts to be diagnosed with PCOS.
Treatment Options for PCOS
While there is no cure for PCOS, it can be effectively managed with a combination of lifestyle changes, medications, and hormonal therapy.
1. Lifestyle Modifications
• Diet: Focus on whole foods, high fiber, lean protein, and healthy fats; minimize processed foods and sugar
• Exercise: Regular physical activity improves insulin sensitivity and supports weight management
• Weight loss: Even a 5-10% reduction in body weight can help regulate menstrual cycles and improve fertility
2. Medications
• Metformin: Improves insulin sensitivity and may help regulate periods
• Oral contraceptives: Regulate periods and reduce androgen-related symptoms like acne and hair growth
• Spironolactone: Blocks androgen effects on hair and skin
• Clomiphene or letrozole: Used to induce ovulation in women trying to conceive
• GLP-1 receptor agonists: May aid in weight loss and improve metabolic health
3. Other Treatments
• Laser hair removal or electrolysis for hirsutism
• Mental health support for anxiety, depression, or body image concerns
Associated Health Risks of PCOS
Women with PCOS are at increased risk for several long-term health issues:
• Type 2 diabetes
• High cholesterol and heart disease
• High blood pressure
• Endometrial hyperplasia or cancer due to prolonged unopposed estrogen
• Infertility
• Sleep apnea
• Depression and anxiety
Final Thoughts
PCOS is a lifelong condition, but with early diagnosis and a personalized treatment plan, symptoms can be managed, and risks minimized. If you suspect you may have PCOS—especially if you’re experiencing irregular periods, acne, excess hair growth, or unexplained weight gain—speak with your healthcare provider.
Managing PCOS is about more than fertility—it’s about supporting your long-term metabolic and hormonal health.