04 February 2026, Wednesday

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a chronic endocrine disorder characterized by ovulatory dysfunction, hyperandrogenism, and morphological changes in the ovaries.
 

Causes and Risk Factors

The etiology of PCOS is not fully understood. Proposed mechanisms include:

•    Dysfunction in the hypothalamic–pituitary axis
•    Insulin resistance and hyperinsulinemia
•    Genetic predisposition
•    Obesity (especially visceral)
•    Elevated LH/FSH ratio
•    Chronic anovulation and menstrual irregularities

Risk factors:

•    Early-onset obesity, especially abdominal
•    Family history of PCOS or type 2 diabetes
•    Metabolic syndrome
 

Classification and Phenotypes

PCOS is diagnosed when at least two of the following three Rotterdam criteria are met:

1.    Oligomenorrhea or anovulation
2.    Clinical or biochemical signs of hyperandrogenism
3.    Polycystic ovarian morphology on ultrasound

Phenotypes:

•    Phenotype A (classic PCOS): anovulation + hyperandrogenism + PCO morphology
•    Phenotype B: anovulation + hyperandrogenism (no PCO morphology)
•    Phenotype C: ovulatory + hyperandrogenism + PCO morphology
•    Phenotype D: anovulation + PCO morphology (no hyperandrogenism)
 
Clinical Symptoms

•    Menstrual irregularities (infrequent, irregular, or absent periods)
•    Anovulation and infertility
•    Hirsutism (male-pattern hair growth)
•    Acne, oily skin, seborrhea
•    Central (abdominal) obesity
•    Insulin resistance
•    Emotional disturbances: depression, anxiety, somatoform symptoms
 

Diagnosis and Treatment

Diagnosis is based on history, clinical features, laboratory tests, and imaging.
Other conditions must be excluded before confirming PCOS.

Main diagnostic methods:

•    Hormonal panel
•    Evaluation of glucose metabolism
•    Pelvic ultrasound

Treatment

Treatment strategy depends on age, reproductive goals, clinical symptoms, and metabolic background.

Main approaches:

1.    Lifestyle modification:

o    Weight loss if BMI is elevated (5–10% reduction can restore ovulation)
o    Physical activity

2.    Pharmacological therapy:

o    Hormonal therapy (e.g., combined oral contraceptives)
o    Insulin-sensitizing agents (e.g., metformin)
o    Antiandrogens (for hirsutism)
o    Ovulation inducers (for conception planning)
 

Complications and Prevention

If untreated, PCOS may lead to:

•    Infertility
•    Obesity, metabolic syndrome
•    Type 2 diabetes
•    Increased cardiovascular risk
•    Endometrial hyperplasia and cancer

Prevention:

•    Maintaining a healthy body weight
•    Regular menstrual cycle monitoring
•    Timely hormonal regulation
•    Monitoring carbohydrate metabolism
 

PCOS and Pregnancy

PCOS is one of the leading causes of anovulatory infertility.
With proper weight control and comprehensive treatment, natural conception is often possible. If not, ovulation induction and IVF are recommended.
 

When to See a Doctor

•    Menstrual periods are infrequent, irregular, or absent
•    New or worsening hirsutism or acne
•    Difficulty conceiving