Polycystic Ovary Syndrome (PCOS): Causes and Treatments
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📌 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:
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Irregular or absent menstrual cycles
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Excess male hormones (androgens)
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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
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Runs in families; first-degree relatives have a higher risk
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Gene variants linked to hormone regulation, insulin signaling, and fat metabolism
💉 2. Insulin Resistance
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Insulin helps cells absorb glucose; resistance causes overproduction
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High insulin → ovaries produce more androgens (e.g., testosterone)
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Leads to anovulation, hirsutism, and acne
⚖️ 3. Hormonal Imbalance
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Imbalanced LH:FSH ratio → impaired follicle development
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Elevated androgens → excess facial/body hair, acne
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Low progesterone → irregular menstruation
🔥 4. Chronic Low-Grade Inflammation
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Women with PCOS often have elevated CRP and white blood cell levels
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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:
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Irregular or absent ovulation (oligo/anovulation)
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Clinical or biochemical signs of excess androgens (acne, hirsutism, etc.)
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Polycystic ovaries on ultrasound (≥12 follicles per ovary, ≥10 mm size)
🔬 Additional Diagnostic Tests:
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Serum testosterone, DHEA-S
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LH, FSH, prolactin
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Fasting glucose, insulin levels
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Pelvic ultrasound
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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
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Restore menstrual regularity
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Reduce androgen excess
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Improve fertility
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Manage metabolic risks (diabetes, heart disease)
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Enhance quality of life
💊 Treatment Options for PCOS
1. 🌿 Lifestyle Modifications (First-line Therapy)
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Weight Loss: 5–10% loss can restore ovulation
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Exercise: At least 150 mins/week moderate aerobic exercise
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Diet:
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Low glycemic index (GI) foods
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Anti-inflammatory foods (leafy greens, berries, turmeric)
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Avoid processed sugar and saturated fats
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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
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Ovulation induction (Clomid, Letrozole)
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Gonadotropin injections
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IVF if medication fails
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Ovarian drilling (laparoscopic surgery in severe cases)
4. 🌱 Natural and Holistic Remedies
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Myo-inositol & D-chiro-inositol: Improve ovulation and insulin resistance
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Omega-3 fatty acids: Reduce inflammation
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Spearmint tea: May reduce androgen levels
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Vitex agnus-castus (Chasteberry): Supports progesterone balance
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Acupuncture: Improves hormonal regulation
Consult a healthcare provider before starting supplements.
🍽️ PCOS Diet: Foods to Eat & Avoid
✅ Eat More Of:
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High-fiber foods (broccoli, beans, whole oats)
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Lean protein (chicken, fish, tofu)
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Anti-inflammatory spices (ginger, turmeric, cinnamon)
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Low GI fruits (berries, apples)
❌ Avoid:
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Refined carbs (white bread, pasta)
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Sugary drinks
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Trans fats
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Alcohol (can worsen inflammation)
🧠 Mental Health & PCOS
Women with PCOS are at higher risk for:
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Anxiety & depression
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Low self-esteem
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Eating disorders
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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
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You miss periods for over 3 months
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Difficulty getting pregnant
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Sudden weight gain or facial hair
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Persistent acne or scalp hair loss
Early intervention reduces complications and improves life quality.
📚 Scientific References & Resources
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Teede HJ, et al. "Evidence-based guideline for assessment and management of PCOS." Hum Reprod. 2018.
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Azziz R. "PCOS: clinical review." Endocrine Reviews. 2006.
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National Institutes of Health (NIH): https://www.nih.gov
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CDC on PCOS: https://www.cdc.gov/diabetes/basics/pcos.html
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Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/pcos
