Polycystic Ovary Syndrome (PCOS)

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Vol. 2 No. 2 (2025)

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Submitted
December 2, 2024
Published
April 4, 2025

Polycystic Ovary Syndrome (PCOS): Causes, Symptoms, Diagnosis & Treatments

https://doi.org/10.69512/ajphi.v2i2.83
Prabha Bhandari, MD
Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
Gauri Adhikari, MD
Nepalese Army Institute of Health Sciences-College of Medicine, Kathmandu, Nepal
https://orcid.org/0000-0002-4250-9839
Lumanti Manandhar
Rajiv Gandhi University of Health Sciences, Bangalore, India
https://orcid.org/0009-0005-9167-3693
Dipendra Kandel, MD
Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
https://orcid.org/0000-0001-7790-1278

Corresponding Author(s) : Prabha Bhandari, MD

bhandariprabha991@gmail.com

The American Journal of Patient Health Info, Vol. 2 No. 2 (2025)

Abstract


  • PCOS involves a hormonal imbalance, with high levels of androgens, leading to symptoms like irregular menstrual cycles, hirsutism, acne, and hair loss.

  • Women with PCOS commonly experience irregular or absent menstrual periods due to chronic anovulation, impacting fertility and increasing the risk of endometrial cancer.

  • Many individuals with PCOS exhibit insulin resistance, resulting in elevated insulin levels, weight gain, and a heightened risk of type 2 diabetes and metabolic syndrome.

  • Polycystic ovaries can be identified through pelvic ultrasound as small follicles, although their presence alone does not confirm a PCOS diagnosis.

  • Lifestyle modifications, including a balanced diet, regular exercise, and weight loss, are key components of PCOS management.

Keywords

Androgen excess Hormonal imbalance Irregular menstrual periods Insulin resistance Polycystic Ovarian syndrome (PCOS)
Bhandari, MD, P., Adhikari, MD, G., Manandhar, L., & Kandel, MD, D. (2025). Polycystic Ovary Syndrome (PCOS): Causes, Symptoms, Diagnosis & Treatments. The American Journal of Patient Health Info, 2(2). https://doi.org/10.69512/ajphi.v2i2.83
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References
  1. Polycystic ovary syndrome: common questions and answers [Internet]. PubMed. 2023. Available from: https://pubmed.ncbi.nlm.nih.gov/36920819/
  2. World Health Organization: WHO, World Health Organization: WHO. Polycystic ovary syndrome [Internet]. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
  3. Rosenfield RL, Ehrmann DA. The Pathogenesis of polycystic ovary Syndrome (PCOS): The hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine Reviews [Internet]. 2016 Jul 26;37(5):467–520. Available from: https://doi.org/10.1210/er.2015-1104
  4. Zeng X, Xie YJ, Liu YT, Long SL, Mo ZC. Polycystic ovarian syndrome: Correlation between hyperandrogenism, insulin resistance and obesity. Clinica Chimica Acta [Internet]. 2019 Nov 13;502:214–21. Available from: https://doi.org/10.1016/j.cca.2019.11.003
  5. Singh S, Pal N, Shubham S, Sarma DK, Verma V, Marotta F, et al. Polycystic ovary Syndrome: etiology, current management, and future therapeutics. Journal of Clinical Medicine [Internet]. 2023 Feb 11;12(4):1454. Available from: https://doi.org/10.3390/jcm12041454
  6. Hocking S, Samocha-Bonet D, Milner KL, Greenfield JR, Chisholm DJ. Adiposity and insulin resistance in humans: the role of the different tissue and cellular lipid depots. Endocrine Reviews [Internet]. 2013 Aug 1;34(4):463–500. Available from: https://doi.org/10.1210/er.2012-1041
  7. Sendur SN, Yildiz BO. Influence of ethnicity on different aspects of polycystic ovary syndrome: a systematic review. Reproductive BioMedicine Online [Internet]. 2020 Dec 17;42(4):799–818. Available from: https://doi.org/10.1016/j.rbmo.2020.12.006
  8. Walter K. What is polycystic ovary syndrome? JAMA [Internet]. 2022 Jan 18;327(3):294. Available from: https://doi.org/10.1001/jama.2021.19776
  9. Allen LA, Shrikrishnapalasuriyar N, Rees DA. Long‐term health outcomes in young women with polycystic ovary syndrome: A narrative review. Clinical Endocrinology [Internet]. 2021 Oct 8;97(2):187–98. Available from: https://doi.org/10.1111/cen.14609
  10. Polycystic ovary syndrome (PCOS) - Diagnosis and treatment - Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443
  11. Diagnosis and treatment of polycystic ovary Syndrome [Internet]. PubMed. 2016. Available from: https://pubmed.ncbi.nlm.nih.gov/27419327/
  12. Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, et al. Clinical Practice Guideline for the evaluation and Treatment of Children and Adolescents with Obesity. PEDIATRICS [Internet]. 2023 Jan 9;151(2). Available from: https://doi.org/10.1542/peds.2022-060640
  13. Karakas SE. New biomarkers for diagnosis and management of polycystic ovary syndrome. Clinica Chimica Acta [Internet]. 2017 Jun 16;471:248–53. Available from: https://doi.org/10.1016/j.cca.2017.06.009
  14. American Society of Bariatric Physicians’ Obesity Algorithm Guides Physicians through Obesity Treatment for Patients : Bariatric Times [Internet]. Available from: https://bariatrictimes.com/american-society-of-bariatric-physicians-obesity-algorithm-guides-physicians-through-obesity-treatment-for-patients/
  15. Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ, et al. Polycystic ovary syndrome. The Lancet Diabetes & Endocrinology [Internet]. 2022 Aug 4;10(9):668–80. Available from: https://doi.org/10.1016/s2213-8587(22)00163-2
  16. Kamalanathan S, Sahoo JP, Sathyapalan T. Pregnancy in polycystic ovary syndrome. Indian Journal of Endocrinology and Metabolism [Internet]. 2013 Jan 1;17(1):37. Available from: https://doi.org/10.4103/2230-8210.107830
  17. Shah D, Bansal S. Polycystic ovaries – beyond menopause. Climacteric [Internet]. 2013 Jul 29;17(2):109–15. Available from: https://doi.org/10.3109/13697137.2013.828687
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Prabha Bhandaria, Gaury Adhikarib, Lumanti Manandharc, Dipendra Kandeld

a Kathmandu University School of Medical Sciences, Dhulikhel, Nepal

b Nepalese Army Institute of Health Sciences-College of Medicine, Kathmandu, Nepal

c Rajiv Gandhi University of Health Sciences, Bangalore, India

d Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal

Background

Polycystic ovary syndrome (PCOS) is a hormonal disorder affecting females of reproductive age. It occurs when your ovaries produce an excess of hormones called androgens. These androgens create an imbalance in your other reproductive hormones, leading you to have various symptoms like irregularity in menstruation and excess hair, along with the development of cysts in your ovaries. [1] It is estimated to affect up to 8-13% of women worldwide, making it one of the most prevalent endocrine disorders in this population. [2]

Causes and Risk Factors of PCOS

Figure 1.

  • Genetics: Family history plays a significant role in developing PCOS. If you have someone with a first-degree relative, such as a mother or sister, who has PCOS, then you are at higher risk of developing the condition itself. This suggests a genetic predisposition to PCOS. [3]
  • Hormonal Imbalances: PCOS is marked by elevated levels of androgens, such as testosterone, in the blood. These high levels of androgens can impair the functioning of the ovaries and lead to the development of cysts. [3,4]
  • Insulin Resistance: Insulin resistance is closely linked to PCOS and can lead to increased insulin in the blood. Increased insulin, in turn, stimulates the ovaries to produce more androgens, disrupting the normal hormonal balance and contributing to the symptoms of PCOS. [5]
  • Obesity: Obesity is strongly associated with PCOS. Excess body fat, particularly abdominal fat, can exacerbate insulin resistance and increase the production of androgens, further contributing to the hormonal imbalances seen in PCOS. [5,6]
  • Ethnicity: PCOS affects women of all ethnicities, but some groups may be at higher risk than others. Studies have found that women of South Asian, Middle Eastern, and Hispanic descent may have a higher prevalence of PCOS compared to women of other ethnic backgrounds. [7]

Symptoms of PCOS

The most common symptoms of PCOS are:

Figure 2.

  • Irregular menstrual periods, including absent periods or heavy or prolonged bleeding.
  • Excess growth of hair on the face and chest.
  • Thinning or loss of the scalp hair.
  • Severe acne, particularly in adulthood and is often difficult to treat.
  • Raised, velvety discoloration called acanthosis nigricans, primarily present on the nape of the neck, underarms, groin, and underneath breasts.
  • Weight gain or difficulty losing weight. [8]

PCOS and Other Health Conditions

PCOS is not just limited to its symptoms. It is also linked with an increased risk of developing other health conditions. Here are some of the disease conditions commonly associated with PCOS.

Figure 3.

  • Diabetes: Insulin resistance is common among numerous PCOS-afflicted women, causing decreased sensitivity to insulin. Consequently, this condition can elevate blood sugar levels and heighten the likelihood of developing type 2 diabetes during your perimenopause age and beyond. [9]
  • Hypertension: Women diagnosed with PCOS face a heightened likelihood of experiencing high blood pressure compared to those of similar age without the condition. High blood pressure represents a significant contributor to heart disease and stroke among women living with PCOS. [9]
  • Cholesterol Problem: Women with PCOS often have higher LDL (bad) cholesterol and low HDL (good) cholesterol levels. High cholesterol also raises your risk of heart disease and stroke. [9]
  • Sleep Apnea: Many women with PCOS are overweight or obese, which can cause repeated momentary stops in breathing while sleeping. It raises your risk of heart disease and diabetes. [9]
  • Endometrial Cancer: Women with PCOS have been found to have an increased risk of developing endometrial cancer (the lining of the uterus or womb) due to problems with ovulation, obesity, insulin resistance, and diabetes. [9]

Diagnosis of PCOS

A single test cannot precisely diagnose PCOS. Your doctor might recommend the following to establish the diagnosis:

Figure 4.

1. Pelvic Exam

A pelvic examination involves a physical examination of the reproductive organs to identify abnormalities and rule out other conditions. During this exam, your doctor checks for enlarged ovaries and signs of other gynecological issues, such as ovarian tumors or endometriosis. [10]

2. Ultrasonography

Transvaginal ultrasound is the most reliable method for detecting polycystic ovaries. It involves placing a probe into the vagina to obtain a detailed image of the ovaries and uterus. It also helps to count the number of follicles present in the ovary. The presence of 12 or more small follicles (2-9 mm in diameter) in each ovary or increased ovarian volume (>10 mL) is a key indicator of PCOS. In the case of young or sexually inactive women, transabdominal ultrasound can be used to look for polycystic ovaries. [10,11]

3. Blood Tests

A Blood test is used to measure the level of hormones, and they can help exclude the possible causes of menstrual problems or androgen excess that mimics PCOS. The hormones that are measured are:

  • Androgens: Androgens are the major culprit in PCOS. There is an elevated level of androgens, such as testosterone and androstenedione. [11]
  • LH and FSH: The ratio of luteinizing hormone (LH) to follicle-stimulating hormone (FSH) is often altered in PCOS, with an increased LH to FSH ratio being a common finding. [11]
  • Prolactin and Thyroid Hormones: These are measured to rule out other causes of irregular menstruation or symptoms similar to PCOS, such as hyperprolactinemia or thyroid dysfunction. [12]
  • Sex Hormone-Binding Globulin (SHBG): This protein binds to androgens and estrogens; lower levels can indicate higher levels of free androgens. [13]
  • Other Tests: Other tests include tests to look for glucose intolerance, cholesterol, and triglyceride levels, and screening for depression, anxiety, and sleep apnea. [13]

Treatment of PCOS

Treating PCOS involves addressing its diverse symptoms and underlying metabolic issues.

Figure 5.

1. Lifestyle Measures

Weight loss is one of the most essential factors in managing PCOS. Even a 5-10% weight loss can enhance insulin sensitivity, lower androgen levels, and restore regular menstrual cycles, thereby improving fertility. [14] Dietary modifications with balanced nutrition and low glycemic index foods can help manage weight. Regular physical activity and combining aerobic and resistance training can also help with weight reduction and reduce the risk of type 2 diabetes and cardiovascular disease. [15]

2. Medications

There are various medications prescribed for PCOS, and here is the list:

  • Combined Oral Contraceptives: These agents contain both estrogen and progestin. They help decrease androgen production and regulate the level of estrogen. This helps regulate the menstrual cycle and helps with acne and hirsutism. [10]
  • Antiandrogens: These consist of drugs like spironolactone. They block the effects of androgens and help with excessive hair growth and acne. Spironolactone is known to cause birth defects, so you need to follow effective birth control methods while taking it. [10,11]
  • Metformin: It enhances insulin’s ability to lower blood sugar levels and is known to reduce both insulin and androgen levels. Metformin may also help restart ovulation after a few months of use. [10,11]

3. Fertility Treatments

Medications like clomiphene citrate, letrozole, and gonadotrophins may be used to induce ovulation in some women. Clomiphene is an oral anti-estrogen medication and is taken during the first part of the menstrual cycle. Letrozole is one of the medications used in the treatment of breast cancer and is also used to stimulate the ovaries. Gonadotrophins, administered via injection, contain FSH and LH, aiding follicle growth and ovulation. These treatments offer hope for women with PCOS who are seeking to enhance their fertility. [10,11] When these medical treatments fail, assisted reproductive technologies, such as intrauterine insemination (IUI) and in vitro fertilization (IVF), can also be used. With appropriate medical care and support, many women with PCOS can achieve successful pregnancies. [16]

PCOS and Its Effect on Pregnancy

PCOS significantly affects pregnancy due to its impact on your hormonal balance and ovulation. If you have PCOS, you will experience irregular menstrual cycles and anovulation, making it more difficult for you to conceive. The condition heightens the risk of various complications during pregnancy, including gestational diabetes, characterized by high blood sugar levels during pregnancy, which can affect both your and your baby's health. Additionally, women with PCOS face an elevated risk of preterm birth, delivering before completing 37 weeks of pregnancy, which can increase the likelihood of health issues for your newborn. Preeclampsia, a condition characterized by high blood pressure and signs of organ damage, is also more prevalent in women with PCOS during pregnancy. This poses serious risks to both maternal and fetal well-being. Furthermore, miscarriage rates are higher among women with PCOS compared to those without the condition, adding emotional distress to an already challenging journey. [16]

Will My PCOS Symptoms Go Away at Menopause?

The hormonal imbalance in PCOS does not change with age, so you may continue to have symptoms of PCOS. However, in some women, the menstrual cycle gets more regular as they get closer to menopause. Moreover, the risk of health problems linked with PCOS, such as diabetes, stroke, and heart attack, increases with age and may be higher in women with PCOS than those without. [17]

Questions To Ask Your Doctor?

  1. How long will it take for my periods to occur at regular intervals if I have PCOS?
  2. Should I consider any specific precautions or treatments if I want to conceive?
  3. How often should I be screened for the potential complications of PCOS?
  4. Are there any support groups or counseling services you recommend?
  5. Are there any supplements that could help manage my symptoms?

Conflict of Interest

GA is a paid research assistant at ehealthyinfo, and LM worked as a paid medical journalist at ehealthyinfo from 2022 to 2023. DK and PA are nonpaid research assistants at ehealthyinfo. There are no other conflicts of interest to declare.

Peer Reviewed By

Sumit Saurav Karna, MD

Charleston Area Medical Center, WV, USA

References

  1. Polycystic ovary syndrome: common questions and answers [Internet]. PubMed. 2023. Available from: https://pubmed.ncbi.nlm.nih.gov/36920819/
  2. World Health Organization: WHO, World Health Organization: WHO. Polycystic ovary syndrome [Internet]. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
  3. Rosenfield RL, Ehrmann DA. The Pathogenesis of polycystic ovary Syndrome (PCOS): The hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine Reviews [Internet]. 2016 Jul 26;37(5):467–520. Available from: https://doi.org/10.1210/er.2015-1104
  4. Zeng X, Xie YJ, Liu YT, Long SL, Mo ZC. Polycystic ovarian syndrome: Correlation between hyperandrogenism, insulin resistance and obesity. Clinica Chimica Acta [Internet]. 2019 Nov 13;502:214–21. Available from: https://doi.org/10.1016/j.cca.2019.11.003
  5. Singh S, Pal N, Shubham S, Sarma DK, Verma V, Marotta F, et al. Polycystic ovary Syndrome: etiology, current management, and future therapeutics. Journal of Clinical Medicine [Internet]. 2023 Feb 11;12(4):1454. Available from: https://doi.org/10.3390/jcm12041454
  6. Hocking S, Samocha-Bonet D, Milner KL, Greenfield JR, Chisholm DJ. Adiposity and insulin resistance in humans: the role of the different tissue and cellular lipid depots. Endocrine Reviews [Internet]. 2013 Aug 1;34(4):463–500. Available from: https://doi.org/10.1210/er.2012-1041
  7. Sendur SN, Yildiz BO. Influence of ethnicity on different aspects of polycystic ovary syndrome: a systematic review. Reproductive BioMedicine Online [Internet]. 2020 Dec 17;42(4):799–818. Available from: https://doi.org/10.1016/j.rbmo.2020.12.006
  8. Walter K. What is polycystic ovary syndrome? JAMA [Internet]. 2022 Jan 18;327(3):294. Available from: https://doi.org/10.1001/jama.2021.19776
  9. Allen LA, Shrikrishnapalasuriyar N, Rees DA. Long‐term health outcomes in young women with polycystic ovary syndrome: A narrative review. Clinical Endocrinology [Internet]. 2021 Oct 8;97(2):187–98. Available from: https://doi.org/10.1111/cen.14609
  10. Polycystic ovary syndrome (PCOS) - Diagnosis and treatment - Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443
  11. Diagnosis and treatment of polycystic ovary Syndrome [Internet]. PubMed. 2016. Available from: https://pubmed.ncbi.nlm.nih.gov/27419327/
  12. Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, et al. Clinical Practice Guideline for the evaluation and Treatment of Children and Adolescents with Obesity. PEDIATRICS [Internet]. 2023 Jan 9;151(2). Available from: https://doi.org/10.1542/peds.2022-060640
  13. Karakas SE. New biomarkers for diagnosis and management of polycystic ovary syndrome. Clinica Chimica Acta [Internet]. 2017 Jun 16;471:248–53. Available from: https://doi.org/10.1016/j.cca.2017.06.009
  14. American Society of Bariatric Physicians’ Obesity Algorithm Guides Physicians through Obesity Treatment for Patients  : Bariatric Times [Internet]. Available from: https://bariatrictimes.com/american-society-of-bariatric-physicians-obesity-algorithm-guides-physicians-through-obesity-treatment-for-patients/
  15. Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ, et al. Polycystic ovary syndrome. The Lancet Diabetes & Endocrinology [Internet]. 2022 Aug 4;10(9):668–80. Available from: https://doi.org/10.1016/s2213-8587(22)00163-2
  16. Kamalanathan S, Sahoo JP, Sathyapalan T. Pregnancy in polycystic ovary syndrome. Indian Journal of Endocrinology and Metabolism [Internet]. 2013 Jan 1;17(1):37. Available from: https://doi.org/10.4103/2230-8210.107830
  17. Shah D, Bansal S. Polycystic ovaries – beyond menopause. Climacteric [Internet]. 2013 Jul 29;17(2):109–15. Available from: https://doi.org/10.3109/13697137.2013.828687

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