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

PCOS is a common hormonal disorder affecting people with ovaries, characterized by:

• Irregular or absent periods
• Excess androgen (male hormones) → acne, hirsutism (excess hair growth)
• Polycystic ovaries (multiple small follicles on ultrasound)

It is a leading cause of infertility and increases the risk of diabetes, heart disease, and metabolic syndrome.

Causes

The exact cause is unknown, but key factors include:

1. Insulin Resistance (70% of cases) → High insulin → ↑ androgens
2. Hormonal Imbalance → High LH (luteinizing hormone), low FSH → ↑ testosterone
3. Genetics (runs in families)
4. Chronic Inflammation → Linked to insulin resistance
5. Environmental Factors (obesity, endocrine disruptors)

Risk Factors

• Family history of PCOS or diabetes
• Obesity (worsens insulin resistance)
• Sedentary lifestyle
• Insulin resistance or prediabetes

Symptoms

Symptoms vary but commonly include:

1. Menstrual Irregularities

• Infrequent, heavy, or absent periods
• Difficulty ovulating → infertility

2. Androgen Excess (Hyperandrogenism)

• Hirsutism (facial/body hair)
• Acne, oily skin
• Male-pattern baldness

3. Metabolic Symptoms

• Weight gain (especially abdominal)
• Dark skin patches (acanthosis nigricans)
• Prediabetes/diabetes

4. Ovarian Cysts (Not Always Present!)

• “String of pearls” appearance on ultrasound

Types of PCOS

PCOS is classified based on hormonal and metabolic profiles:

1. Insulin-Resistant PCOS (Most common)
   • High insulin → ↑ androgens
   • Weight gain, prediabetes
2. Post-Pill PCOS
   • Temporary PCOS-like symptoms after stopping birth control
3. Inflammatory PCOS
   • Chronic inflammation → hormone disruption
   • Fatigue, headaches, joint pain
4. Adrenal PCOS (Rare)
   • High DHEA-S (adrenal androgen) but normal ovarian androgens

Diagnosis (Rotterdam Criteria)

Diagnosis requires 2 out of 3:

1. Irregular/absent periods
2. Hyperandrogenism (clinical or lab-confirmed)
3. Polycystic ovaries on ultrasound

Tests Performed:

• Blood tests: LH, FSH, testosterone, DHEA-S, AMH, insulin, glucose
• Pelvic ultrasound (to check ovarian cysts)
• Glucose tolerance test (for insulin resistance)

Treatment (Depends on Goals)

1. Lifestyle Changes (First-Line Treatment)

• Weight loss (5-10% improves symptoms significantly)
• Low-glycemic diet (whole grains, lean protein, healthy fats)
• Exercise (30+ mins daily, mix cardio + strength training)

2. Medications

For Hormonal Regulation

• Birth control pills (regulate periods, reduce androgens)
• Metformin (improves insulin resistance)
• Anti-androgens (spironolactone, flutamide) → reduce acne/hair growth

For Fertility

• Clomiphene (Clomid) or Letrozole (induce ovulation)
• IVF (if other treatments fail)

For Hair/Skin Symptoms

• Topical retinoids (acne)
• Laser hair removal (hirsutism)

Complications

• Infertility (from lack of ovulation)
• Type 2 diabetes (50% risk by age 40)
• Cardiovascular disease (high cholesterol, hypertension)
• Endometrial cancer (from unopposed estrogen)
• Depression/anxiety (due to hormonal and body image issues)

Prevention

• Maintain a healthy weight
• Exercise regularly
• Balanced diet (low sugar, high fiber)
• Early diagnosis & management

Prognosis

• No cure, but manageable with lifestyle + meds
• Fertility often improves with treatment
• Long-term metabolic risks require monitoring