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

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written by Zappelphilipp Marx•29 June 2025
Ultrasound examination in suspected PCOS

Irregular periods, persistent acne and difficulty conceiving? Polycystic Ovary Syndrome (PCOS) presents in many ways. This article offers a concise overview of how PCOS develops, how to recognise it, and which lifestyle changes and medical treatments are proven to help.

Understanding PCOS – A Hormonal Imbalance

PCOS is a common endocrine and metabolic condition. It is typically characterised by:

  • elevated androgen levels (male hormones),
  • insulin resistance, and
  • multiple immature follicles (often mislabelled as “cysts”) in the ovaries.

This combination disrupts ovulation and leads to skin and hair changes.

Root Causes of PCOS – Genes, Insulin & Lifestyle

  • Genetics: PCOS often runs in families.
  • Insulin resistance: high insulin levels stimulate androgen production.
  • Environmental factors: excess weight, inactivity and stress can worsen symptoms.

Common PCOS Symptoms to Watch For

  • Infrequent or absent periods
  • Excess facial or body hair (e.g. on the chin, chest or back)
  • Persistent acne beyond teenage years
  • Thinning hair on the crown
  • Unexplained weight gain
  • Difficulty conceiving

Not all women experience every symptom. Even a single sign can warrant a medical assessment.

How PCOS is Diagnosed – The Rotterdam Criteria

PCOS is diagnosed if at least two of the following are present:

  • infrequent or absent ovulation,
  • elevated androgens or clinical signs (e.g. hirsutism),
  • polycystic ovaries on ultrasound.

Other conditions such as thyroid disorders or adrenal imbalances must be ruled out first.

Long-Term Health Risks Associated with PCOS

  • Type 2 diabetes due to chronic insulin resistance
  • High blood pressure and abnormal lipid levels
  • Cardiovascular disease
  • Endometrial hyperplasia or cancer

Early intervention greatly reduces the risk of long-term complications.

Diet & Exercise – The Foundation of PCOS Therapy

A modest weight loss of just 5% can significantly improve menstrual regularity in overweight individuals (Clark et al., 1995).

  • Low glycaemic index foods: vegetables, legumes, whole grains
  • 150 minutes of cardio plus 2 strength sessions weekly
  • Myo-inositol and omega-3 may offer additional support but are no replacement for lifestyle change

Pharmaceutical Treatments for PCOS

  • Metformin: improves insulin sensitivity and lowers androgens (Pau et al., 2014).
  • Hormonal contraceptives: regulate periods and reduce acne & excess hair growth.
  • Letrozole: more effective than Clomiphene in inducing ovulation (NEJM, 2014).

Fertility Treatment Options for PCOS

Step 1: Optimising the Basics

Weight reduction, a balanced diet and regular exercise can increase the chances of spontaneous ovulation.

Step 2: Ovulation Induction

  • Letrozole: first-line treatment with ~60% success after six cycles
  • Clomiphene: alternative option but higher multiple pregnancy rates
  • Gonadotropins: injectable hormones requiring ultrasound monitoring

Step 3: Assisted Reproduction

If conception remains unsuccessful, IVF or ICSI can offer pregnancy rates of 25–40% per cycle. Metformin may help reduce the risk of ovarian hyperstimulation.

Step 4: In-Vitro Maturation (IVM)

IVM collects immature eggs with minimal hormonal stimulation – a safer alternative for women at risk of overstimulation, though still limited in availability.

Mental Health & Emotional Wellbeing

Up to 40% of people with PCOS experience anxiety or depression. Professional support, mindfulness and support groups can significantly enhance mental health and treatment adherence.

Conclusion – Taking Control of PCOS

A personalised combination of diet, physical activity and medication helps manage PCOS symptoms, reduce long-term risks and improve fertility outcomes. Starting early maximises your chances of success.

Frequently Asked Questions (FAQ)

PCOS (Polycystic Ovary Syndrome) is a hormonal and metabolic disorder affecting women of reproductive age. It’s characterised by elevated androgens (male hormones), insulin resistance, and the presence of many immature follicles (often mistakenly called “cysts”) in the ovaries.

Irregular or absent periods, excessive hair growth (particularly on the face or chest), acne, thinning scalp hair, weight gain, and difficulty conceiving. Not everyone with PCOS shows all of these symptoms—just one or two may be enough to warrant investigation.

Diagnosis typically follows the Rotterdam criteria: at least two of the following—irregular ovulation or absence of periods, high androgen levels (confirmed by blood test or symptoms), and polycystic ovaries on ultrasound. Other conditions like thyroid issues or adrenal disorders are excluded first.

Yes, many women with PCOS do become pregnant—either naturally or with help. Weight management, dietary changes, and exercise can boost fertility, and medical treatments such as Letrozole or IVF are available if needed.

Myo-Inositol is a supplement that may improve insulin sensitivity and support ovulatory function. It’s often used alongside other therapies and lifestyle changes, not as a standalone remedy.

Medications include Metformin (improves insulin resistance), hormonal contraceptives (regulate periods and reduce acne/hair growth), and ovulation inducers like Letrozole. The choice depends on whether fertility or symptom relief is the priority.

Women with PCOS are at higher risk of type 2 diabetes, high blood pressure, cardiovascular disease, and endometrial cancer. Early diagnosis and proactive lifestyle or medical interventions can significantly reduce these risks.

Absolutely. Losing just 5–10% of your body weight can restore regular cycles and improve fertility in many cases—especially when combined with a low-glycaemic diet and physical activity.

Yes. Studies show that Letrozole is more effective than Clomiphene in inducing ovulation for women with PCOS. It also carries a lower risk of multiple pregnancies.

IVM is a newer fertility method in which immature eggs are collected and matured outside the body. It’s especially suitable for women at risk of ovarian hyperstimulation but is not yet standard practice.

Yes, up to 40% of women with PCOS experience anxiety or depression. A holistic treatment plan should include psychological support such as counselling, mindfulness, or peer groups to improve mental wellbeing and adherence to medical therapy.