Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting women of reproductive age: according to some estimates, it occurs in 5–10% of women in this group worldwide, while others suggest over 20%. In newer medical texts, it is called polyendocrine metabolic ovarian syndrome (PMOS). Below is information about the mechanism, manifestations, and what this diagnosis means.
What it is
PCOS is a condition in which a hormonal imbalance alters the function of the ovaries. Multiple cysts may form in the follicles: from a few to more than twenty. A cyst is a fluid-filled sac containing an egg that should be released during ovulation; when it is not released, ovulation is blocked, and the cycle is disrupted—up to amenorrhea. At the same time, the pulsatile secretion of gonadotropin-releasing hormone from the hypothalamus is disrupted: the pituitary gland releases less follicle-stimulating and luteinizing hormones, and the egg either does not mature or does not exit the follicle.
Symptoms usually begin in girls and young women under 18, during puberty, and last until menopause; after menopause, some manifestations disappear or change. It affects anyone with ovaries, and manifestations can be mild, severe, or absent altogether.
Symptoms: what occurs and what to discuss with a doctor
The main manifestations include:
- irregular cycles or long intervals between periods;
- excessive hair growth (hirsutism), hair loss, oily skin, and acne;
- weight gain or difficulty losing weight, severe fatigue;
- difficulty conceiving;
- depression or anxiety, dark thick patches of skin on the neck or armpits (acanthosis nigricans).
What is known: symptoms vary depending on constitution and origin. For example, hirsutism may be mild or absent in women of South Asian and Scandinavian origin, whereas it is more pronounced in women from the Middle East and Mediterranean.
What to discuss with a doctor: if symptoms affect daily life, work, and relationships. These manifestations are common and have many other causes—their presence does not mean PCOS, but they should be checked.
Causes and insulin resistance
The cause of PCOS is unknown. It is likely that hormones such as insulin and testosterone do not work as they should. The risk is higher if a close relative has this condition or if you are of Asian origin.
Insulin resistance is a major symptom and one of the drivers. Theca cells in the ovaries respond hypersensitively to insulin, proliferate, and hyperthecosis occurs; insulin resistance enhances the androgen potential of these cells. High insulin levels promote fat deposition around the abdomen, and in most women with PCOS, the body mass index is 30 or higher. Dark patches on the skin are a visible skin marker of insulin resistance.
How it is diagnosed
If a family doctor suspects this condition, they refer you to a gynecologist or endocrinologist—a specialist in reproduction or hormones. Then blood tests are usually ordered to check hormone levels and insulin resistance, as well as an ovarian ultrasound. Ultrasound is performed only for those who are already 18 years old.
Long-term risks
PCOS can increase the risk of serious conditions: type 2 diabetes, high blood pressure, cardiovascular diseases, non-alcoholic fatty liver disease, and uterine cancer. The latter is associated with the fact that due to improper ovarian function, high estradiol levels without progesterone predominate—this increases the risk of endometrial hyperplasia. PCOS is also linked to sleep apnea and pregnancy complications.
The risk of these conditions is reduced by regular preventive check-ups. If you already have high blood pressure, this is also a reason for regular monitoring.
Who to contact
Routinely—to a family doctor if you think you may have manifestations of PCOS or if symptoms interfere with life. Then a gynecologist and endocrinologist become involved.
PCOS cannot be cured, but therapy and lifestyle changes help with symptoms. The doctor discusses treatment options depending on symptoms and pregnancy plans.
When to see a doctor immediately: sudden signs of stroke or heart attack, serious injury, or another life-threatening condition—call 103 or 112.
This is reference material: it does not replace consultation with a doctor who sees your specific situation.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer