Polycystic Ovary Syndrome (PCOS) is a common hormonal condition impacting women during their reproductive years. It is defined by a collection of specific signs and symptoms that arise from a complex hormonal imbalance. The condition affects a significant portion of the female population, with global prevalence estimates ranging from 6% to 13%. Despite how common it is, a large number of cases, potentially up to 70%, remain undiagnosed worldwide.
Common Symptoms of PCOS
One of the most frequent indicators of Polycystic Ovary Syndrome is a disruption to the menstrual cycle. This irregularity can manifest in several ways, including having infrequent periods, often defined as fewer than nine a year, or experiencing unpredictable cycles. Some individuals may have no periods at all, a condition known as amenorrhea, while others might endure unusually heavy and prolonged bleeding when menstruation does occur.
Another prominent set of symptoms stems from hyperandrogenism, which is an elevated level of androgens. Androgens are sometimes referred to as “male hormones,” though they are naturally present in women in small amounts. When these hormone levels are too high, they can cause distinct physical signs. Hirsutism, the growth of coarse, dark hair in a pattern typically seen in males—such as on the face, chin, chest, and back—is a common manifestation.
The same hormonal imbalance can affect the skin and hair on the scalp. Many women with PCOS experience persistent and severe acne that does not respond well to typical treatments, often continuing into adulthood. Simultaneously, they may notice thinning hair on their head, a condition called androgenic alopecia, which resembles male-pattern baldness.
Weight management issues are also strongly associated with PCOS. A significant number of individuals with the condition find it difficult to lose weight or experience unexplained weight gain, particularly in the abdominal region. Other skin changes may also appear, such as acanthosis nigricans, which are dark, velvety patches of thickened skin that typically develop in body folds like the neck, armpits, and groin. Small, benign skin growths known as skin tags are also more common.
Underlying Causes and Associated Health Risks
A primary driver behind many PCOS symptoms is insulin resistance. In this state, the body’s cells do not respond efficiently to insulin, so the pancreas produces an excess amount to compensate. This elevated insulin level signals the ovaries to increase their production of androgens. This overproduction of androgens, or hyperandrogenism, interferes with the development and release of eggs from the ovaries (ovulation), leading to irregular periods and potential infertility.
There is also evidence that chronic low-grade inflammation contributes to the hormonal disturbances in PCOS. Women with the condition often have elevated markers of inflammation. This persistent inflammatory state is another factor that can stimulate the ovaries to produce more androgens, further perpetuating the hormonal imbalance.
These underlying biological issues create a predisposition to long-term health concerns. Insulin resistance places individuals with PCOS at a much higher risk of developing type 2 diabetes and metabolic syndrome, a cluster of conditions including high blood pressure and unhealthy cholesterol levels. These factors collectively elevate the risk for cardiovascular disease. Furthermore, infrequent menstruation can lead to a thickening of the uterine lining, increasing the risk of endometrial cancer.
How PCOS Is Diagnosed
The diagnosis of PCOS is made by evaluating a patient’s symptoms and running specific tests to rule out other conditions. Healthcare providers commonly use a set of diagnostic guidelines known as the Rotterdam criteria. To receive a diagnosis under these criteria, an individual must present with at least two of three specific findings. The first is irregular or absent menstrual periods.
A second criterion is the presence of high androgen levels. This can be identified either through clinical signs, such as excess hair growth or acne, or through biochemical confirmation from a blood test. The third criterion is the appearance of polycystic ovaries on a pelvic ultrasound. The term “polycystic” refers to the presence of 12 or more small follicles on an ovary, which are immature eggs that have failed to develop.
To gather the necessary information, a doctor will perform a comprehensive evaluation. This process begins with a physical examination to check for the visible signs of hyperandrogenism. Blood tests are then used to measure hormone levels and to check for related metabolic issues by assessing glucose and cholesterol levels. A pelvic ultrasound is often performed to visualize the ovaries.
Management and Treatment Strategies
The management of PCOS often begins with lifestyle modifications, which are considered a foundational approach to controlling symptoms. A primary focus is placed on adopting a balanced diet and incorporating regular physical activity. For individuals who are overweight, studies show that even a modest weight loss of 5-10% of their total body weight can have a significant positive impact. This amount of weight reduction can help restore regular ovulation and improve insulin sensitivity.
When lifestyle changes are not sufficient to manage the condition, various medical interventions are available. The choice of medication is tailored to address the specific symptoms and health goals of the individual. For regulating the menstrual cycle and reducing androgen levels, combination hormonal birth control pills are frequently prescribed. These medications help to establish a regular period and can also improve acne.
To address the metabolic aspects of PCOS, particularly insulin resistance, medications like metformin are often used. Metformin is a drug primarily used for type 2 diabetes, but it can help improve how the body uses insulin, thereby lowering blood sugar and androgen levels. For symptoms like hirsutism or severe acne that persist, anti-androgen medications may be prescribed.
For individuals with PCOS who are trying to conceive, specific treatments are available to address infertility. Medications such as clomiphene or letrozole are commonly used to induce ovulation. These oral medications stimulate the ovaries to release an egg, increasing the chances of pregnancy. Other fertility treatments may be considered if these initial options are not successful.