Polycystic Ovary Syndrome (PCOS): Causes and Treatments

📌 Introduction to PCOS

Polycystic Ovary Syndrome (PCOS) is a chronic hormonal disorder affecting the reproductive system of people with ovaries, especially during their childbearing years. The hallmark features include:

• Irregular or absent menstrual cycles

• Excess male hormones (androgens)

• Polycystic ovaries, visible on ultrasound

PCOS is not just a reproductive issue—it’s a metabolic and endocrine disorder that can influence weight, insulin sensitivity, mood, and cardiovascular health.

🌍 Global prevalence: 1 in 10 women of reproductive age suffer from PCOS (CDC)
🧪 Often underdiagnosed: Up to 70% of women with PCOS remain undiagnosed (WHO)

📖 What Causes PCOS?

PCOS does not have a single known cause, but rather a combination of genetic, hormonal, and environmental factors.

🧬 1. Genetic Predisposition

• Runs in families; first-degree relatives have a higher risk

• Gene variants linked to hormone regulation, insulin signaling, and fat metabolism

💉 2. Insulin Resistance

• Insulin helps cells absorb glucose; resistance causes overproduction

• High insulin → ovaries produce more androgens (e.g., testosterone)

• Leads to anovulation, hirsutism, and acne

⚖️ 3. Hormonal Imbalance

• Imbalanced LH:FSH ratio → impaired follicle development

• Elevated androgens → excess facial/body hair, acne

• Low progesterone → irregular menstruation

🔥 4. Chronic Low-Grade Inflammation

• Women with PCOS often have elevated CRP and white blood cell levels

• Inflammation may stimulate the ovaries to produce androgens

🧭 How PCOS is Diagnosed

Doctors typically use the Rotterdam Criteria—diagnosis requires 2 out of 3 of the following:

1. Irregular or absent ovulation (oligo/anovulation)

2. Clinical or biochemical signs of excess androgens (acne, hirsutism, etc.)

3. Polycystic ovaries on ultrasound (≥12 follicles per ovary, ≥10 mm size)

🔬 Additional Diagnostic Tests:

• Serum testosterone, DHEA-S

• LH, FSH, prolactin

• Fasting glucose, insulin levels

• Pelvic ultrasound

• TSH and 17-OHP to exclude other disorders

🧩 Types of PCOS

Type	Features	Common in
Insulin-Resistant PCOS	High insulin, weight gain	Obese women
Post-Pill PCOS	Triggered by stopping birth control	Women off contraceptives
Inflammatory PCOS	Inflammation, fatigue, headaches	Autoimmune-prone
Adrenal PCOS	High DHEA-S (adrenal androgen)	Lean women with stress

🚨 Common Symptoms of PCOS

Reproductive Symptoms	Metabolic Symptoms	Cosmetic/Other
Irregular periods	Weight gain	Acne
Infertility	Insulin resistance	Excess facial/body hair
Miscarriage	High cholesterol	Hair thinning (alopecia)
Anovulation	Fatty liver	Skin tags

🎯 Goals of PCOS Treatment

1. Restore menstrual regularity

2. Reduce androgen excess

3. Improve fertility

4. Manage metabolic risks (diabetes, heart disease)

5. Enhance quality of life

💊 Treatment Options for PCOS

1. 🌿 Lifestyle Modifications (First-line Therapy)

• Weight Loss: 5–10% loss can restore ovulation

• Exercise: At least 150 mins/week moderate aerobic exercise

• Diet:

  • Low glycemic index (GI) foods

  • Anti-inflammatory foods (leafy greens, berries, turmeric)

  • Avoid processed sugar and saturated fats

2. 💊 Medications

Purpose	Medication	Notes
Regulate cycles	Combined oral contraceptives	Normalize bleeding, reduce acne
Lower insulin	Metformin	Improves ovulation
Reduce androgens	Spironolactone	Takes 3–6 months to show effects
Induce ovulation	Clomiphene, Letrozole	First-line for fertility
Hair reduction	Eflornithine cream	Topical facial hair control

3. 🧫 Fertility Treatments

• Ovulation induction (Clomid, Letrozole)

• Gonadotropin injections

• IVF if medication fails

• Ovarian drilling (laparoscopic surgery in severe cases)

4. 🌱 Natural and Holistic Remedies

• Myo-inositol & D-chiro-inositol: Improve ovulation and insulin resistance

• Omega-3 fatty acids: Reduce inflammation

• Spearmint tea: May reduce androgen levels

• Vitex agnus-castus (Chasteberry): Supports progesterone balance

• Acupuncture: Improves hormonal regulation

Consult a healthcare provider before starting supplements.

🍽️ PCOS Diet: Foods to Eat & Avoid

✅ Eat More Of:

• High-fiber foods (broccoli, beans, whole oats)

• Lean protein (chicken, fish, tofu)

• Anti-inflammatory spices (ginger, turmeric, cinnamon)

• Low GI fruits (berries, apples)

❌ Avoid:

• Refined carbs (white bread, pasta)

• Sugary drinks

• Trans fats

• Alcohol (can worsen inflammation)

🧠 Mental Health & PCOS

Women with PCOS are at higher risk for:

• Anxiety & depression

• Low self-esteem

• Eating disorders

• Sleep disturbances

🧘 Therapy, support groups, mindfulness practices, and regular exercise can significantly help.

🧓 Long-Term Risks of Untreated PCOS

Condition	Risk Level
Type 2 diabetes	↑↑
Endometrial cancer	↑
Cardiovascular disease	↑↑
Sleep apnea	↑
NAFLD (Fatty liver)	↑↑

📆 When to Seek Medical Help

• You miss periods for over 3 months

• Difficulty getting pregnant

• Sudden weight gain or facial hair

• Persistent acne or scalp hair loss

Early intervention reduces complications and improves life quality.

📚 Scientific References & Resources

1. Teede HJ, et al. "Evidence-based guideline for assessment and management of PCOS." Hum Reprod. 2018.

2. Azziz R. "PCOS: clinical review." Endocrine Reviews. 2006.

3. National Institutes of Health (NIH): https://www.nih.gov

4. CDC on PCOS: https://www.cdc.gov/diabetes/basics/pcos.html

5. Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/pcos