Polycystic Ovary Syndrome (PCOS): Causes, Symptoms & Modern Treatment

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Written by Zappelphilipp Marx•June 29, 2025
Ultrasound examination for suspected PCOS

Irregular periods, stubborn acne, and fertility struggles — Polycystic Ovary Syndrome (PCOS) has many faces. In this article, you'll learn what causes PCOS, how to recognize it, and which lifestyle and treatment strategies are backed by current medical guidelines.

Understanding PCOS – Basics of the Hormonal Disorder

PCOS is a complex metabolic and hormonal condition. It typically involves:

  • elevated androgen levels,
  • pronounced insulin resistance, and
  • many immature follicles (often misnamed “cysts”) in the ovaries.

This combination disrupts the menstrual cycle and contributes to skin and hair changes.

What Causes PCOS – Genetics, Insulin & Lifestyle

PCOS usually arises from a mix of genetic and environmental factors:

  • Family history suggests a genetic link.
  • Insulin resistance raises insulin levels, which can trigger excess androgen production.
  • Weight gain, inactivity, and chronic stress can worsen the hormonal imbalance.

Common PCOS Symptoms to Watch For

  • Infrequent or missing periods
  • Excess facial or body hair (chin, chest, back)
  • Persistent acne past puberty
  • Thinning hair along the scalp
  • Weight gain despite no change in diet
  • Difficulty getting pregnant

Not every woman has all symptoms. Even a few signs may warrant further evaluation.

Diagnosing PCOS – The Rotterdam Criteria

Diagnosis requires at least two of the following:

  • infrequent or absent ovulation,
  • elevated androgens (bloodwork or visible signs like acne or hirsutism),
  • polycystic ovaries on ultrasound.

Conditions like thyroid dysfunction, elevated prolactin, or adrenal disorders must be ruled out first.

Long-Term Health Risks of PCOS

  • Type 2 diabetes due to ongoing insulin resistance
  • High blood pressure and cholesterol issues
  • Increased risk of cardiovascular disease
  • Thickening of the uterine lining (endometrial cancer)

Early diagnosis and proactive management can greatly reduce these risks.

Nutrition & Exercise – Cornerstones of PCOS Care

A weight loss of just 5% can improve menstrual regularity in many people with PCOS (Clark et al. 1995).

  • Low-glycemic foods: vegetables, legumes, whole grains.
  • 150 minutes of cardio plus two strength sessions per week.
  • Myo-inositol may support cycle regularity and insulin sensitivity — but is no replacement for lifestyle changes.

Medication Options for PCOS

  • Metformin improves insulin response and lowers androgen levels (Pau et al. 2014).
  • Hormonal birth control helps regulate periods and reduce acne and excess hair.
  • Letrozole is more effective than Clomid at inducing ovulation (NEJM 2014).

Fertility with PCOS – Pathways to Pregnancy

First-Line Improvements

Weight reduction, low-GI nutrition, and consistent exercise can significantly increase natural ovulation rates.

Ovulation Induction

  • Letrozole – first choice, with a ~60% ovulation rate after six cycles.
  • Clomid (Clomiphene) – alternative option, but higher risk of twins.
  • Gonadotropins – injectable hormones for resistant cases, require close ultrasound monitoring.

Assisted Reproductive Technologies

If pregnancy doesn’t occur, IVF or ICSI offer success rates of 25–40% per embryo transfer. Metformin can reduce the risk of ovarian hyperstimulation.

Innovative Methods

In-vitro maturation (IVM) collects eggs with minimal hormonal stimulation — promising for high-risk patients, though not yet widely available.

Supporting Mental Health in PCOS

Up to 40% of people with PCOS experience anxiety or depression. Therapy, mindfulness training, and peer support groups have been shown to improve quality of life and treatment adherence.

Takeaway – Managing PCOS Proactively

A balanced combination of low-GI eating, regular exercise, and personalized medical treatment can relieve PCOS symptoms, lower long-term health risks, and boost fertility. The earlier you take action, the better the outcomes.

Frequently Asked Questions (FAQ)

PCOS (Polycystic Ovary Syndrome) is a hormonal and metabolic disorder that can cause irregular periods, infertility, acne, and excess hair growth. It is typically associated with high levels of androgens (male hormones), insulin resistance, and many immature follicles in the ovaries.

Irregular or missing periods, thinning hair on the scalp, increased body hair (especially on the face, chest, or back), acne, weight gain, and trouble getting pregnant are common signs. Not all women have all symptoms—just one or two may be enough to justify testing.

Diagnosis usually follows the Rotterdam criteria: At least two of the following must be present—irregular ovulation or absence of periods, elevated androgen levels (confirmed by blood test or symptoms like excess hair growth), and polycystic ovaries visible via ultrasound. Other conditions are ruled out first.

Yes—many women with PCOS do become pregnant, although it may take more time or require medical support. Weight loss, regular exercise, and a healthy diet can improve fertility. If needed, medications or assisted reproduction (like IVF) may help.

Myo-Inositol is a naturally occurring compound that may help regulate cycles and improve insulin sensitivity. While it shows promise, it's most effective when combined with lifestyle changes—not as a standalone solution.

Common treatments include Metformin (to improve insulin resistance), hormonal birth control (to regulate periods and reduce acne or hair growth), and Letrozole (to stimulate ovulation). The choice depends on whether you're trying to conceive or manage other symptoms.

PCOS increases the risk of type 2 diabetes, high blood pressure, heart disease, and endometrial cancer (from unopposed estrogen). Early diagnosis and proactive treatment greatly reduce these risks.

Yes—losing just 5–10% of your body weight can improve menstrual regularity and fertility, especially if you're overweight. Even small changes can make a big difference.

According to clinical research, Letrozole is generally more effective for inducing ovulation in PCOS and has fewer side effects than Clomiphene. Letrozole is now considered the first-line treatment for women trying to conceive.

IVM is an emerging fertility treatment where immature eggs are collected and matured in the lab. It’s promising for women at risk of ovarian hyperstimulation, but it's not yet widely available.

Up to 40% of people with PCOS experience anxiety or depression. The psychological burden can be significant. Mental health support, mindfulness practices, and peer groups can boost overall well-being and treatment success.