PCOS is a prevalent hormonal disorder that impacts the ovaries and is characterised by a set of symptoms linked to hormone imbalances. It typically arises when ovulation doesn’t occur, leading to the development of multiple small, fluid-filled sacs (or “cysts”) on the ovaries. Elevated levels of androgens, “male” hormones naturally present at lower levels in women, result in further menstrual and systemic disruptions.
Causes & Risk Factors
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The exact origins of PCOS remain unclear, but insulin resistance is frequently associated with it. When the body struggles to respond to insulin, glucose accumulates and can elevate androgen levels, worsening PCOS symptoms.
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Being overweight can make insulin resistance and PCOS symptoms worse.
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A family history of PCOS, especially in mothers or sisters, increases risk.
Symptoms & Long-Term Health Impacts
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PCOS is associated with irregular or infrequent ovulation, contributing to infertility.
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Other symptoms include hirsutism (body/facial hair), acne, weight gain, and metabolic issues.
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Women with PCOS face increased long-term health risks, including:
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Heart and blood vessel complications such as preeclampsia (a serious high blood pressure disorder of pregnancy that typically appears after 20 weeks of gestation), pregnancy-related cardiomyopathy (a group of heart muscle diseases that make it harder for the heart to pump blood throughout the body, leading to symptoms like fatigue, shortness of breath, and swelling), irregular heartbeat, and blood clots during pregnancy.
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Type 2 diabetes, dyslipidaemia (abnormal levels of fats, such as cholesterol and triglycerides, in the blood), and metabolic syndrome (a cluster of five medical risk factors high blood pressure, high blood sugar, high triglycerides, low HDL (good) cholesterol, and abdominal obesity that together significantly increase risk for heart disease, stroke, and type 2 diabetes).
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Increased risk of endometrial (inner lining of the uterus) hyperplasia (abnormal increase in the number of cells within a normal organ or tissue, causing it to enlarge) and endometrial cancer due to chronic hormonal imbalances.
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Diagnosis Criteria
PCOS is diagnosed using the Rotterdam criteria, requiring any two of the following:
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Signs of androgen excess (clinically or biologically: excess body or facial hair, weight gain)
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Ovulatory dysfunction (e.g., irregular or absent periods)
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Physical presentation of multiple cysts on the ovaries, seen through ultrasound, or elevated AMH levels
A diagnosis also requires ruling out other causes of these symptoms.
Management & Treatment
Lifestyle Interventions:
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Weight management and adopting a healthier lifestyle are first-line strategies. Achieving a 5 –10% weight reduction can improve metabolic, menstrual, and reproductive outcomes.
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No single diet is identified and recommended to manage PCOS. Those considered should address inflammation and insulin resistance.
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Regular moderate exercise (e.g., 150 minutes/week) supports weight control; more may be needed for weight loss.
Medications:
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Metformin is widely used to improve insulin sensitivity and regulate cycles beneficial for managing symptoms, though its effect on live birth rates via IVF is uncertain.
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Combined oral contraceptives (COCs) are used to regulate menstrual cycles, reduce androgenic symptoms, and lower endometrial cancer risk.
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Ovulation-inducing medications like letrozole and clomiphene (Clomid) are effective fertility treatments for PCOS-related absence of egg release from the ovaries.
Advanced Options:
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For fertility challenges, interventions like ovulation induction therapies or surgical procedures (e.g., ovarian drilling) offer additional pathways to restore ovulation.
Research & Evolving Understanding
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PCOS affects an estimated 5 –13% of women of reproductive age and is associated with increased risk of heart and blood vessel issues during pregnancy.
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A recent global survey suggests that the term “Polycystic Ovary Syndrome” may be misleading, urging a name change to reflect its metabolic and endocrine complexity, improve awareness, and reduce stigma.
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Emerging treatments, such as weight loss medications (e.g., GLP-1 agonists) and even artemisinin-based therapies, show promise in alleviating PCOS symptoms but require further research before widespread use.
PCOS is a complex endocrine and metabolic disorder marked by hormonal imbalances, insulin resistance, and ovulatory issues. Diagnosed using criteria like the Rotterdam guidelines, PCOS management combines lifestyle strategies, medication, and, when needed, fertility-specific interventions. With growing awareness and evolving research, care for PCOS is becoming increasingly holistic and effective.
Read more about PCOS in this write-up by Johns Hopkins Medicine.
