(1) The Concept of Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is an endocrine disorder that affects up to 20% of women. “Polycystic” refers to the presence of multiple cyst-like structures in the ovaries, typically seen through pelvic ultrasound. The ovaries are often slightly enlarged with many follicles, and the number of small cysts seen is double that of a normal ovary. “Syndrome” refers to the various symptoms that women with PCOS experience due to hormonal imbalances.

Despite being so common, the severity and impact of PCOS vary from person to person. Some women may feel no symptoms or only mild effects.

PCOS differs from PCO (Polycystic Ovaries), which affects one-third of women. PCO only refers to the appearance of multiple cysts in the ovaries without associated endocrine abnormalities such as irregular menstruation, anovulation, or other hormonal imbalances. PCO does not require treatment, but PCOS does.

In a normal menstrual cycle, several follicles in both ovaries compete to grow and ovulate, but only one follicle matures and releases an egg. In women with PCOS, many small follicles are present in the ovaries (more than 12 in at least one ovary), but none mature enough to dominate, so no egg is released. For most women, proper diagnosis and treatment are the first steps toward managing PCOS.

(2) Causes of Polycystic Ovary Syndrome (PCOS)

The exact cause of PCOS is still unclear. What is known is that PCOS is not a single-gene disorder. Research suggests that it may result from the combined effects of several different genes, referred to as polygenic inheritance. Polygenic inheritance means that multiple genes work together to influence the condition. Current research indicates that PCOS may be hereditary, or it may be caused by lifestyle and environmental factors.

(3) Symptoms of Polycystic Ovary Syndrome (PCOS)

The symptoms of PCOS vary from person to person, and a woman may experience some or all of the following:

  • Irregular or absent menstruation Most women with PCOS do not have regular periods. Some may experience irregular bleeding outside of normal menstrual cycles (every 23-35 days) or experience no periods at all (amenorrhea). Some women may have heavy or intermittent bleeding without any clear pattern.
  • Hirsutism (Excess Hair Growth) Due to increased androgen levels, women with PCOS may experience increased facial or body hair. This symptom, known as hirsutism, can persist until androgen levels are reduced. Hair growth may vary, including thicker or more visible facial hair, and increased hair on the arms, legs, abdomen, back, chest, or pubic area.
  • Scalp Hair Loss Similar to hirsutism, high androgen levels can cause male-pattern hair loss in women, which will improve once androgen levels decrease.
  • Acne and/or Oily Skin Acne or oily skin is a common symptom, particularly persistent acne beyond puberty, which can be distressing. It often appears in hormone-sensitive areas, such as the cheeks, chin, and neck. The severity of acne varies, from small, painless bumps under the skin to large, painful cysts that take longer to heal.
  • Unexplained and Persistent Weight Gain The metabolic disorder in PCOS makes it difficult for the body to properly use insulin. Insulin helps convert sugars and starches from food into energy. In women with PCOS, insulin resistance occurs, meaning the body cannot use insulin efficiently, leading to a buildup of sugars and starches in the blood. This can cause weight gain, as the body stores the unused sugars and starches as fat.