Polycystic Ovarian Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a reproductive health condition usually characterized by the development of numerous follicular cysts on the outside of the ovary. Normally, eggs are released from enlarged follicles during ovulation, but this process fails in PCOS. PCOS is often accompanied by amenorrhea (lack of menstruation) or very irregular periods. It affects at least 1 in 10 women but is rarely discussed, even though it is one of the leading causes of infertility in women.
How does it present?

  • There are many ways that PCOS can present. However, the official clinical diagnosis relies on the presence of 2 of the 3 symptoms of the ‘Rotterdam criteria’: numerous large-sized follicles observed by ultrasounds on the ovary’s surface, infrequent or irregular periods (also known as oligo-anovulation), and excess male sex hormones (hyperandrogenism). Because mature follicles release AMH, Anti-mullerian hormone (AMH) is often highly elevated in people with PCOS and is also sometimes used in diagnosis. It should be noted that like many medical guidelines, these criteria are approximate and may not diagnose 100% of patients correctly.
  • As PCOS is a very heterogeneous disorder, each individual may have a distinct combination of symptoms, and each of these conditions can manifest in a wide spectrum of ways. It can also be tied to other conditions associated with PCOS like insulin resistance. Talk to a medical professional for diagnosis if you are concerned you may have PCOS.

What causes PCOS?

  • Doctors and scientists still don’t know the main biological causes of PCOS. However, strong associations are found with certain comorbidities such as obesity, which are large risk factors for its development. Associations have also been found with other metabolic conditions, suggesting a connection between proper diet, nutrition, and overall metabolic health and PCOS. Environmental exposures, especially those during development, may predispose people to PCOS, but stronger evidence is required to determine exact drivers.
  • There are also strong genetic contributions to the development of PCOS, but many of the genes involved are still unknown. A family history of PCOS may therefore increase your lifetime risk of the syndrome.

What are the consequences?

  • Immediate consequences of PCOS are primarily the symptoms which it presents with, which include excess body hair (known as hirsutism) and acne caused by elevated male sex hormones, increased likelihood of infertility, and irregular menstruation. PCOS can also increase the likelihood for metabolic and cardiovascular disease.
  • In the long-term, PCOS can cause infertility, however, with proper treatment pregnancy is achievable by many patients.

How is it treated?

  • PCOS is very treatable with proper care. Treatment is ideally individualized to each patient and focused on management of the prevailing symptoms. Birth control to rebalance hormonal profiles are sometimes prescribed. Dietary and exercise interventions to improve metabolic conditions are important, especially for overweight patients. In rarer cases, for patients seeking to become pregnant, ovarian stimulation to induce ovulation may be performed. Please see a medical professional for advice on your specific situation and before attempting personal intervention.
  • For more information on life with, diagnosis of, and treatments for PCOS, please see the below resources.

What's Next? Big Questions.

  • There are many major unanswered questions in PCOS. What causes it to develop? Though genetics seems to be involved, specific factors remain elusive.
  • Why is it so intricately tied with metabolism and insulin resistance? What is the nature of the relationship?
  • Treatment is based on management of symptoms. How can we treat the underlying physiological causes?
  • Some studies suggest supplementation with inositol may improve fertility in women with PCOS. What is the relationship between inositol and PCOS? Other anti-aging therapeutics such as metformin may also hold promise and are already used to treat some of the metabolic outcomes of PCOS. Further research needs to be done to establish a therapeutic benefit and to identify the mechanisms of these possible treatments.
  • Epidemiological and mechanistic studies need to be performed to elucidate why metabolic and cardiovascular syndromes are associated with PCOS.
  • There is an association with increased inflammation and the development of PCOS, but the mechanism behind this association is unknown.