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Polycystic Ovary Syndrome (PCOS): Causes, Symptoms & Treatment

Polycystic ovary syndrome (PCOS) is a common hormonal disorder in women that causes irregular periods, elevated androgen levels, and cyst-like changes in the ovaries.

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Things worth knowing about "Polycystic Ovary Syndrome"

Polycystic ovary syndrome (PCOS) is a common hormonal disorder in women that causes irregular periods, elevated androgen levels, and cyst-like changes in the ovaries.

What is Polycystic Ovary Syndrome?

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders affecting women of reproductive age. It is estimated to affect approximately 1 in 10 women worldwide. PCOS is characterized by a combination of hormonal imbalances, metabolic changes, and characteristic alterations in the ovaries. The name refers to the numerous small cyst-like structures that can develop on the ovaries -- these are actually immature follicles rather than true cysts in the traditional medical sense.

Causes

The exact causes of PCOS are not yet fully understood. Current research suggests that a combination of genetic, hormonal, and environmental factors contributes to its development.

Insulin resistance: Many women with PCOS develop insulin resistance, meaning the body's cells do not respond effectively to insulin. This leads to elevated insulin levels, which in turn stimulate the ovaries to produce excess male sex hormones (androgens).
Elevated androgen levels: An excess of androgens such as testosterone disrupts the normal maturation of egg cells and can cause symptoms like acne and hair loss.
Genetic predisposition: PCOS tends to run in families, suggesting a hereditary component, as it occurs more frequently in women whose mothers or sisters are also affected.
Low-grade inflammation: Chronic low-level inflammation in the body may stimulate androgen production in the ovaries.

Symptoms

PCOS presents with a wide range of symptoms that can vary significantly in severity from one woman to another:

Irregular periods: Infrequent, absent, or unpredictable menstrual cycles (oligomenorrhea or amenorrhea)
Hyperandrogenism: Signs of excess androgens, including excessive body and facial hair (hirsutism), acne, and female-pattern hair loss
Polycystic ovaries: Detection of at least 12 small follicles in one or both ovaries on ultrasound
Weight gain: Many women with PCOS struggle with excess weight, particularly around the abdomen
Difficulty conceiving: PCOS is one of the leading causes of female infertility
Mood disturbances: Anxiety and depression are more common among women with PCOS

Diagnosis

PCOS is diagnosed using the internationally recognized Rotterdam Criteria. At least two of the following three criteria must be met:

Irregular or absent ovulation (oligo- or anovulation)
Clinical or biochemical signs of excess androgens
Polycystic ovaries visible on ultrasound

Blood tests are also performed to measure hormone levels (LH, FSH, testosterone, DHEAS, prolactin, thyroid hormones) as well as blood glucose and insulin levels. Other conditions that may cause similar symptoms must be ruled out before a definitive diagnosis can be made.

Treatment

There is currently no cure for PCOS, but symptoms can be effectively managed. Treatment is tailored to the individual based on her specific symptoms and whether she wishes to become pregnant.

Lifestyle Changes

A healthy diet, regular physical activity, and weight loss (in women who are overweight) are the most important first-line measures. Even a modest weight reduction of 5 to 10 percent of body weight can significantly improve hormonal balance and restore menstrual regularity.

Medical Treatment

Hormonal contraceptives: The combined oral contraceptive pill regulates the menstrual cycle and reduces androgen levels. It is a commonly used treatment option for women who are not trying to conceive.
Metformin: Originally developed for type 2 diabetes, metformin improves insulin sensitivity, can help regulate the menstrual cycle, and supports weight management in women with PCOS.
Anti-androgens: Medications such as spironolactone or cyproterone acetate block the effects of male hormones and can help reduce hirsutism and acne.
Fertility treatment: For women who wish to conceive, ovulation induction with clomiphene citrate or letrozole may be recommended. In some cases, assisted reproductive technologies such as IVF may be considered.

Long-Term Health Risks

Women with PCOS have an increased risk of developing type 2 diabetes, high blood pressure, cardiovascular disease, and, in rare cases, endometrial cancer (cancer of the uterine lining). Regular health check-ups and preventive screening are therefore especially important for women with this condition.

References

Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group: Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility, 81(1):19-25, 2004.
Teede HJ et al.: Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction, 33(9):1602-1618, 2018.
World Health Organization (WHO): Polycystic ovary syndrome. Fact Sheet, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome

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