Understanding Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is one of the most common endocrine (hormonal) disorders, affecting approximately  1 in 10 women worldwide (12%) of reproductive (childbearing) age.^1-2  Despite its prevalence, many women remain unaware they have this condition, as it often is undiagnosed. People with PCOS are more likely to be overweight or obese. Higher body weight and body mass index (BMI) are associated with more severe symptoms of PCOS.¹ This condition is characterised by a combination of symptoms related to reproductive hormones, metabolism, and occasionally mental health, varying in severity. In this article, we will explore the causes, symptoms, diagnosis, and management of PCOS to highlight the complexities associated with this condition. Yazen offers support and medical weight loss with a holistic approach to health, combined with pharmaceutical treatment.

What is PCOS (Polycystic Ovary Syndrome)?

PCOS primarily affects the ovaries, leading them to produce higher amounts of androgens (male hormones, such as testosterone) than normal. While all women make small amounts of androgens, those with PCOS can have elevated levels, leading to various symptoms and complications. These symptoms often lead to various health issues, including infertility, weight gain, and an increased risk of developing type 2 diabetes and heart disease. A key feature of PCOS is an increased number of follicles (immature eggs) in the ovaries. The name “polycystic” ovary syndrome is actually misleading, because it is follicles, not cysts, that are abundant in the ovaries.¹

The exact cause of PCOS is still unclear, but it is thought to result from a mix of genetic, environmental, and lifestyle factors. Hormonal imbalances in PCOS can disrupt the menstrual cycle, leading to irregular periods. It is a lifelong condition that often starts during puberty and may coincide with the onset of menstruation.

Symptoms and complications with PCOS

PCOS can present a variety of symptoms, and not every woman experiences the same signs, it can vary widely among women. Some of the most common include irregular menstrual cycles, excessive hair growth (hirsutism), acne, and weight gain. These symptoms are often due to elevated levels of androgens (male hormones), in the body. A blood test may be conducted to check levels of androgens and other hormones to aid in the diagnosis of PCOS. In addition to these symptoms, women with PCOS may face complications such as infertility and an increased risk of miscarriage. During pregnancy, there is a higher likelihood of developing gestational diabetes and high blood pressure, which can lead to conditions like preeclampsia. Long-term, PCOS can increase the risk of developing type 2 diabetes, heart disease, and stroke.

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The most common symptoms of PCOS include^1-5:

1. Irregular or Absent Menstrual Cycles: Women with PCOS may experience infrequent (fewer than eight periods per year), prolonged menstrual cycles (over 35 days) and some may not have periods at all. This irregularity is due to a lack of ovulation, making it difficult to conceive naturally. This is often the reason why  women with undiagnosed PCOS seek medical advice and the first step to get proper care.
2. Follicles on the Ovaries: Many women with PCOS have multiple small follicles in the ovaries, which can be detected by ultrasound. These follicles are actually immature eggs that have not been released during ovulation.
3. Difficulty Getting Pregnant: Irregular or absent ovulation can make it harder for many women to conceive. PCOS is one of the leading causes of infertility in women.
4. Excess Hair Growth (Hirsutism): Due to high levels of androgens (male hormones), like testosterone, PCOS can cause excess hair growth on the face, chest, back, and buttocks. This condition, known as hirsutism, can be distressing and impact self-esteem.
5. Acne and Oily Skin: Increased androgen production can result in oily skin and acne, particularly on the face, chest, and back. This can be persistent and difficult to treat with conventional acne medications.⁵
6. Weight Gain and Difficulty Losing Weight: Many women with PCOS experience weight gain, especially around the abdomen. This is often linked to insulin resistance and hormonal imbalances, making weight management a crucial aspect of PCOS treatment.
7. Thinning Hair or Hair Loss (Alopecia): Elevated androgen levels may cause male-pattern thinning or loss of hair on the scalp.
8. Mental Health Issues: PCOS can negatively impact mental health, leading to increased anxiety, depression, and low self-esteem. Visible symptoms like weight gain and excess body hair can worsen body image concerns. Eating disorders, especially bulimia, are also more common among women with PCOS.⁴

PCOS and impact on Pregnancy

PCOS is one of the leading causes of infertility in women. Women with PCOS may experience ^3,6-7:

• Irregular or absent ovulation: Hormonal imbalance in PCOS can disrupt the normal functions of the ovaries and prevent ovulation. This can make it harder for many women to get pregnant. It takes longer to conceive when you have sparse ovulations, but fertility treatments  are often very successful in PCOS.
• Miscarriage: Women with PCOS may be at a higher risk of miscarriage due to hormonal imbalances and insulin resistance. These factors can affect the uterine environment and the ability to sustain a pregnancy.
• Gestational Diabetes: Women with PCOS are at a higher risk of developing gestational diabetes during pregnancy. This condition can lead to complications for both the mother and the baby if not properly managed.
• High Blood Pressure: Women with PCOS are at a higher risk of developing high blood pressure during pregnancy. This can lead to conditions like preeclampsia, which require careful monitoring and management.
• Preeclampsia: Women with PCOS are at a higher risk of developing preeclampsia, a condition characterized by high blood pressure and damage to the kidneys and liver. This serious condition can pose significant risks to both the mother and the baby.

Diagnosing PCOS 

Diagnosing PCOS can be challenging, as the symptoms can be similar to those of other conditions and other similar potential causes (like thyroid issues) must be ruled out. Medical professionals diagnose PCOS using a combination of methods and criteria, including discussing medical history, conducting physical exams, and performing various tests. The key criteria for diagnosis include at least two of the following criteria ^1-3:

1. Irregular Periods: Fewer than eight menstrual cycles a year or very irregular cycles. A healthcare provider will ask about a woman’s menstrual history, weight, and other symptoms. This helps understanding the pattern and severity of symptoms.
2. Elevated Androgen Hormonal Levels: Blood tests are crucial for analysing hormonal imbalances and insulin resistance. These tests typically measure levels of androgens, SHBG (sex steroid binding globuline) and AMH (Anti-Müllerian Hormone).
3. Polycystic Ovaries: An ultrasound can help detect an increased number of follicles in the ovaries. However, not all women with PCOS have an increased number of follicles.

PCOS: Causes, Insulin Resistance and Risk Factors

PCOS is a multifactorial disorder, meaning several underlying factors contribute to its development. The exact cause of PCOS remains unclear, but some potential contributors include:

• Insulin Resistance: Many women with PCOS are insulin resistant, which means their cells don’t respond well to insulin. This can lead to higher blood sugar levels and more androgen production, worsening symptoms, contributing to an increased risk of type 2-diabetes.⁸
• Hormonal Imbalance: Women with PCOS often have an imbalance in reproductive hormones, with higher levels of luteinizing hormone (LH) and androgens (male hormones), which can disrupt normal ovulation and also cause symptoms like excessive “male” hair growth.⁸
• Genetic predisposition: PCOS tends to run in families, suggesting a hereditary component.^2,8-9
• Environmental factors: Exposure to endocrine disruptors, may contribute to the development of PCOS.¹⁰

Management and Treatment 

There is no cure for PCOS, but it can be managed effectively through lifestyle modifications and medical treatment.^11-12 Management is customised to the individual’s symptoms and their desire to become pregnant. With proper treatment and management, most women with PCOS can get pregnant and have a healthy pregnancy. ^{1-3, 8-9}

Lifestyle Changes

Lifestyle changes are a cornerstone of managing PCOS symptoms and can enhance insulin sensitivity, hormonal balance and overall health, making it easier to conceive and maintain a healthy pregnancy ^1,13:

• Weight Management: For overweight women with PCOS, even a modest weight loss (5-10%) can help improve symptoms like irregular periods and insulin resistance ¹⁴. A healthy, balanced diet, low in sugar and refined carbohydrates, rich in fiber, lean protein and healthy fats, combined with regular exercise, can support weight loss and overall health. 
• Diet: A healthy, balanced diet, low in sugar and refined carbohydrates, rich in fiber, lean protein and healthy fats, can support weight loss and overall health, by enhancing insulin sensitivity and hormonal balance, making it easier to conceive and maintain a healthy pregnancy.¹⁵
• Exercise: Regular physical activity, including both aerobic and strength training, can enhance insulin sensitivity, help regulate hormonal imbalances and overall health.
• Mental health support: Because PCOS can take a toll on mental health, support is essential. Cognitive behavioral therapy (CBT), support groups, and counseling can help women manage anxiety, depression and stress, to navigate the emotional challenges associated with the condition.¹⁶

Medical treatments

Medications can be an effective way to treat PCOS symptoms. Each of these medications or medical treatments targets specific symptoms, helping to manage and treat PCOS effectively:

• Hormonal Birth Control Pills: Hormonal contraceptives can help regulate menstrual cycles, lower androgen levels and reduce symptoms like acne and excess hair growth. However, it’s important to note that obesity and the use of combined oral contraceptives containing oestrogen significantly increase the risk of thrombosis (blood clots). Therefore, for women with severe excess weight, contraceptives that do not contain oestrogen may be a better alternative.¹⁷
• Metformin: Insulin-sensitizing agents, such as metformin, is most commonly used to treat type 2 diabetes but is often prescribed to women with PCOS to improve insulin resistance and lower insulin levels, which can stimulate ovulation and help regulate menstrual cycles.
• Anti-Androgen Medications: These can help reduce unwanted hair growth and address other symptoms related to high testosterone levels. Laser hair removal is another effective method for reducing excessive hair growth associated with PCOS.
• Fertility treatments: For women with PCOS trying to become pregnant, fertility treatments (ovulation induction medications), like clomiphene citrate or letrozole can stimulate ovulation and improve fertility in women with PCOS.
• In Vitro Fertilization (IVF): IVF is a type of assisted reproductive technology that can help women with PCOS get pregnant. This method involves fertilizing an egg outside the body and then implanting it into the uterus.
• GLP-1 receptor agonists: Combining standard therapy for weight loss with GLP-1 receptor agonists has been shown to  improve metabolic and hormonal outcomes in PCOS patients, such as pregnancy rate, menstrual frequency, obesity, excess of androgen and insulin levels.^11-12

Living with PCOS

Living with polycystic ovary syndrome (PCOS) can be challenging, but there are various treatment options available to help manage the symptoms and improve quality of life.

Navigating PCOS: A Holistic Approach 

PCOS is a complex condition that impacts multiple aspects of a woman’s health, including reproductive, metabolic, and mental well-being. Comprehensive care involves addressing all aspects of PCOS, including reproductive, metabolic, and mental health. While there is no cure, many women can lead healthy, fulfilling lives with early diagnosis, lifestyle changes, and appropriate medical management. A multidisciplinary approach, involving healthcare providers from various specialties, can provide more effective management of PCOS. By understanding and addressing the various aspects of PCOS, women can take proactive steps to manage their symptoms and improve their overall health. If you suspect you may have PCOS, consulting with a healthcare provider is crucial for proper diagnosis and treatment. Yazen offers support and medical weight loss, also for those with PCOS. Our teams provide a holistic approach to health by combining pharmaceutical treatment with support for lifestyle changes, mental health and sustainable long-term weight loss.

Reviewed by: Rebecka Kaplan Sturk, MD, Senior Consultant Obstetrics and Gynecology, with extensive experience in the treatment of PCOS.

References:

1. Danson et al. 2024. Diagnosis and management of polycystic ovarian syndrome. CMAJ. January 29;196:E85-94. https://pmc.ncbi.nlm.nih.gov/articles/PMC10833093/ 
2. Tay et al. 2024. 2023 International Evidence‐Based Polycystic Ovary Syndrome Guideline Update: Insights From a Systematic Review and Meta‐Analysis on Elevated Clinical Cardiovascular Disease in Polycystic Ovary Syndrome. J Am Heart Assoc. 2024;13:e033572. https://doi.org/10.1161/JAHA.123.033572  
3. Singh et al. 2023. Polycystic Ovary Syndrome: Etiology, Current Management and Future Therapeutics. J. Clin. Med. 2023, 12, 1454. https://doi.org/10.3390/jcm12041454 
4. Lalonde-Bester et al 2024. Prevalence and Etiology of Eating Disorders in Polycystic Ovary Syndrome: A Scoping Review. Advances in Nutrition. 15:4, 2161-8313. https://doi.org/10.1016/j.advnut.2024.100193 
5. Carmina et al. 2022. Female Adult Acne and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. Journal of the Endocrine Society. 6, 1–11. https://doi.org/10.1210/jendso/bvac003
6. Huo et al. 2025. Changing trends in the global burden of polycystic ovarian syndrome-related infertility over the past 30 years: retrospective data analysis of the global burden of disease study 2019. BMC Women's Health. 25:35. https://doi.org/10.1186/s12905-024-03537-7 
7. Khomami et al. 2024. Systematic review and meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Nat Commun. 15:5591. https://doi.org/10.1038/s41467-024-49749-1 
8. Purwar et al. 2022. Insulin Resistance in Polycystic Ovarian Syndrome. Cureus. 14(10): e30351. https://doi.org/10.7759/cureus.30351
9. Mousa et al. 2023. Technical Report for the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Monash University. Report. https://doi.org/10.26180/23625288.v1
10. Srnovršnik et al. 2023. Polycystic Ovary Syndrome and Endocrine Disruptors (Bisphenols, Parabens, and Triclosan)—A Systematic Review. Life. 13:138. https://doi.org/10.3390/life13010138
11. Bo et al. 2025. Comparative efficacy of pharmacological interventions on metabolic and hormonal outcomes in polycystic ovary syndrome: a Network Meta-Analysis of Randomized controlled trials. BMC Women's Health. 25:64. https://doi.org/10.1186/s12905-025-03594-6 
12. Zhou et al. 2023. Effects of GLP1RAs on pregnancy rate and menstrual cyclicity in women with polycystic ovary syndrome: a meta-analysis and systematic review. BMC Endocr Disord. 23:245. https://doi.org/10.1186/s12902-023-01500-5 
13. Cowan et al. 2023. Lifestyle management in polycystic ovary syndrome – beyond diet and physical activity. BMC Endocr Disord. 23:14. https://doi.org/10.1186/s12902-022-01208-y
14. Moran et al. 2010. Polycystic Ovary Syndrome and Weight Management. Women’s Health. 6(2):271-283. https://doi.org/10.2217/WHE.09.89 
15. Barrea et al.2019. Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS). Nutrients. 11:2278. https://doi.org/10.3390/nu11102278 
16. Rosano et al. 2022. Obesity and contraceptive use: impact on cardiovascular risk. ESC Heart Failure. 9: 3761–3767. https://doi.org/10.1002/ehf2.14104 
17. Tang  et al. 2022. The effects of cognitive behavioral therapy in women with polycystic ovary syndrome: A meta-analysis. Front. Psychol. 13:796594.  https://doi.org/10.1002/ehf2.14104 

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