Polycystic Ovarian Disorder

PCOS is a problem with hormones that affects women during their childbearing years (ages 15 to 44). Between 2.2 and 26.7 percent of women in this age group have PCOS.

Many women have PCOS but don't know it. In one study, up to 70 percent of women with PCOS hadn't been diagnosed.

PCOS affects a woman's ovaries, the reproductive organs that produce estrogen and progesterone — hormones that regulate the menstrual cycle. The ovaries also produce a small amount of male hormones called androgens.

2.2-26.7% Women aged 15-44 affected by PCOS

70% Women with PCOS remain undiagnosed

15-44 Childbearing years affected

Understanding PCOS

The ovaries release eggs to be fertilized by a man's sperm. The release of an egg each month is called ovulation.

Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) control ovulation. FSH stimulates the ovary to produce a follicle — a sac that contains an egg — and then LH triggers the ovary to release a mature egg.

PCOS is a "syndrome," or group of symptoms that affects the ovaries and ovulation.

Three Main Features of PCOS

Cysts in the ovaries — Many small, fluid-filled sacs grow inside the ovaries. The word "polycystic" means "many cysts."
High levels of male hormones — Elevated androgen levels disrupt normal ovarian function.
Irregular or skipped periods — Menstrual cycles are often infrequent, irregular, or absent.

How PCOS Works

In PCOS, many small, fluid-filled sacs grow inside the ovaries. These sacs are actually follicles, each one containing an immature egg. The eggs never mature enough to trigger ovulation.

The lack of ovulation alters levels of estrogen, progesterone, FSH, and LH. Estrogen and progesterone levels are lower than usual, while androgen levels are higher than usual.

Extra male hormones disrupt the menstrual cycle, so women with PCOS get fewer periods than usual.

Common Symptoms of PCOS

Irregular menstrual cycles — Fewer than 8 periods per year or cycles longer than 35 days
Excess androgen — Hirsutism (excess facial/body hair), acne, or male-pattern balding
Polycystic ovaries — Enlarged ovaries with multiple small cysts
Weight gain — Difficulty losing weight or unexplained weight gain
Insulin resistance — Leading to diabetes risk
Infertility — Difficulty getting pregnant due to irregular ovulation
Skin changes — Acanthosis nigricans (dark, velvety skin patches)

When Should You Seek Evaluation?

Consider consulting a specialist if you experience:

Irregular or absent menstrual periods
Difficulty getting pregnant
Excessive hair growth on face, chest, or back
Severe acne or oily skin
Weight gain or difficulty losing weight
Thinning hair or male-pattern balding
Dark patches of skin on the neck or other areas

Diagnosis & Treatment

Diagnosis typically involves a combination of:

Medical History & Physical Examination — Including assessment of symptoms and BMI
Hormonal Blood Tests — To check levels of androgens, LH, FSH, estrogen, progesterone, thyroid hormones, and prolactin
Glucose Tolerance Test — To assess for insulin resistance and diabetes
Pelvic Ultrasound — To visualize the ovaries and check for cysts

Treatment is tailored to individual symptoms and goals:

Lifestyle Modifications — Weight loss (5-10%) and exercise can significantly improve symptoms
Hormonal Contraceptives — Birth control pills to regulate cycles and reduce androgen levels
Anti-Androgen Medications — Such as spironolactone to reduce excess hair growth and acne
Insulin-Sensitizing Agents — Metformin to improve insulin sensitivity and ovulation
Fertility Medications — Clomiphene or letrozole to induce ovulation
Cosmetic Treatments — Laser hair removal or electrolysis for hirsutism

As a Consultant Endocrinologist, I specialize in the comprehensive management of PCOS, helping women manage their symptoms, reduce long-term health risks, and achieve their reproductive goals.