PCOS (Polycystic Ovary Syndrome)
Navigate PCOS with evidence-based information on diagnosis and management
Overview
Polycystic Ovary Syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, affecting up to 1 in 10. Despite its name, PCOS is a metabolic and hormonal condition that extends far beyond the ovaries. It is diagnosed using the Rotterdam criteria: the presence of at least two of three features -- irregular or absent ovulation, signs of excess androgens, and polycystic ovarian morphology on ultrasound.
Importantly, not all PCOS looks the same. There are four recognized phenotypes, and some individuals are lean with normal androgen levels but anovulatory cycles. Insulin resistance affects 50-70% of those with PCOS regardless of body weight, which means metabolic screening is essential for everyone with the diagnosis.
Beyond the physical symptoms, PCOS carries elevated rates of depression, anxiety, body image disturbance, and disordered eating. A comprehensive management plan addresses metabolic health, hormonal balance, mental wellbeing, and -- when desired -- fertility, without centering weight as the sole focus.
Symptoms
Irregular or absent periods
Cycles longer than 35 days, fewer than 8 cycles per year, or amenorrhea due to oligo/anovulation.
Excess androgens
Acne, hirsutism (excess facial/body hair), or thinning scalp hair caused by elevated testosterone or DHEAS.
Insulin resistance
Difficulty managing blood sugar, sugar cravings, skin tags, or acanthosis nigricans, regardless of body weight.
Weight changes
Difficulty losing weight or unexplained weight gain, particularly around the midsection.
Mood disturbances
Higher rates of depression, anxiety, and mood swings linked to hormonal imbalance and the psychosocial burden of symptoms.
Fatigue
Persistent tiredness often related to blood sugar fluctuations and poor sleep quality.
Skin changes
Persistent acne along the jawline, chest, or back that may not respond to standard skincare.
Fertility challenges
Anovulation is the most common cause of infertility in PCOS, but treatment is highly effective.
Treatment Options
Lifestyle and nutrition
Anti-inflammatory diet, regular exercise (aerobic + resistance), and stress management improve insulin sensitivity and hormone balance.
Inositol supplementation
Myo-inositol (4g) + D-chiro-inositol (100mg) daily improves insulin sensitivity, ovulation, and egg quality.
Metformin
Insulin-sensitizing medication that can improve metabolic markers, regulate cycles, and support ovulation.
Oral contraceptives
Combined pills regulate cycles, reduce androgens, protect the endometrium, and manage acne and hirsutism.
Letrozole (for fertility)
First-line ovulation induction for PCOS-related infertility, with higher live birth rates than clomiphene.
Anti-androgen therapy
Spironolactone for persistent acne and hirsutism when OCPs alone are insufficient.
Frequently Asked Questions
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Important Notice
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for medical decisions specific to your situation.