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What is Polycystic ovarian syndrome (PCOS)?


What is Polycystic ovarian syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a hormonal disorder with over production of male harmone (Androgen) and insulin resistance (Insulin resistance is a condition in which the body produces insulin but does not use it effectively which again lead to hormonal imbalance) that causes varieties of symptoms like irregular menstrual periods, overweight ,obesity, hirsuitism (excessive hair growth all over body), acne etc.

Incidence-The condition occurs in about 5 to 10 percent of female population of developed countries .Much higher incidence is reported in india 3.7 to 22.5% and In Indian adolescents it is 9.13 to 36%.

Cause of PCOD-The cause of polycystic ovary syndrome (PCOS) is not fully understood, but genetics may be a factor. PCOS can be passed down from either your mother’s or father’s side. PCOS problems are caused by hormonal changes. One hormone change triggers another, which changes another.

How PCOS patients presents-

  • Menstrual irregularities is the commonest problem PCOD patients present with. This can be in the form of scanty menses, prolonged menstrual cycles, prolonged and heavy menses or absent menses.
  • Weight gain and obesity– Because of hormonal imbalances most women gradually gain weight. There are few women or adolescents who do not gain weight. They are known as Lean PCOS.
  • Male-pattern hair growth (hirsutism is the excessive growth of thick, dark terminal hair in women where hair growth is normally absent) may be seen on the upper lip, chin, neck, sideburn area, chest, upper or lower abdomen, upper arm, and inner thigh
  • Pimples- ( Acne) is a skin condition that causes oily skin and blockages in hair follicles .Mostly occurs on face, but sometimes may be seen on back and upper chest.
  • Infertility– Many women with PCOS do not ovulate regularly, and it may take these women longer to become pregnant. An infertility evaluation is often recommended after 6 to 12 months of trying to become pregnant.
  • Metabolic syndrome– Many patients with polycystic ovary syndrome (PCOS) also have features of the metabolic syndrome, including insulin resistance, Diabetes, obesity, and dyslipidemia (abnormal Lipid profile), suggesting an increased risk for cardiovascular disease(CVD).

Risk Factors for PCOS

  • Early or late Menarche- age of first menses.
  • Obesity
  • Family History of PCOS ,irregular periods or Diabetes.
  • Sedentary and improper life style.


When a patient goes to a doctor with any of the above mentioned symptoms then the doctor takes full history, asks for other symptoms and examines thoroughly and then may advise certain tests to confirm the diagnosis.

There is no single test for diagnosing polycystic ovary syndrome (PCOS). One may be diagnosed with PCOS based upon symptoms, blood tests, and a physical examination. Expert groups have determined that a woman must have two out of three ( Rotterdam criteria ) of the following to be diagnosed with PCOS:

Irregular menstrual periods caused by anovulation or irregular ovulation.

Evidence of elevated male hormone (Testosterone) levels. The evidence can be based upon signs (excess hair growth, acne, or male-pattern balding) .

Polycystic ovaries on pelvic ultrasound.- it shows enlarged ovary with multiple cysts. This is seen in almost 30% of cases.

Investigations-In women with moderate to severe hirsutism (excess hair growth), blood tests for testosterone and In dehydroepiandrosterone sulfate (DHEA-S) may be recommended.
  • TSH and Prolactin hormones should also be done as Hypothyroidism and or Hyperprolactinemia may be associated with PCOS.
  • If PCOS is confirmed, blood glucose and cholesterol testing are usually performed.
  • An oral glucose tolerance test is the best way to diagnose pre diabetes and/or diabetes.

Adolescent PCOS

In adolescents, presence of oligomenorrhea (scanty menses) or amenorrhea (absent menses) beyond two years of menarche should be considered an early clinical sign of PCOS, followed by (Rotterdam criteria ) of adults for diagnosis of PCOS as mentioned above.
  • Serum total testosterone (cut off 60 ng/dL)
  • Fasting serum Insulin level
  • Oral glucose tolerance test (OGTT) zero, two hours after 75 gm glucose load.
  • Serum 17– hydroxyprogesterone (assessed at 8 am)
  • Serum TSH Serum and
  • prolactin levels


Both pharmacological and non-pharmacological management strategies are crucial in the overall management of PCOS. Usually treatment depends upon the symptoms for which the patient comes. As PCOS can not be cured permanently but can be managed well. long term treatment plan should be given to manage her bothersome symptoms and also to prevent long term sequelae.


Lifestyle modification forms the mainstay of treatment. This includes-

Physical activity- In adults and adolescents with PCOS, daily strict physical activity sessions for at least 30min/day or 150min/ week are recommended.

Weight loss — Weight loss is one of the most effective approaches for managing insulin abnormalities, irregular menstrual periods, and other symptoms of PCOS. For example, many overweight women with PCOS who lose 5 to 10 percent of their body weight notice that their periods become more regular. Weight loss can often be achieved with a program of diet and exercise.

Diet – it is recommended to follow calorie restricted diet (low carbohydrate and fat, high protein diet)

Weight loss surgery may be an option for severely obese women with PCOS. Women can lose significant amounts of weight after surgery, which can restore normal menstrual cycles, reduce high androgen levels and hirsutism, and reduce the risk of type 2 diabetes.

Oral contraceptives — Oral contraceptives (OCs; with combined estrogen and progestin) are the most commonly used treatment for regulating menstrual periods in women with polycystic ovary syndrome (PCOS). OCs protect the woman from endometrial (uterine) hyperplasia or cancer by inducing a monthly menstrual period. OCs are also effective for treating hirsutism and acne. Women with PCOS occasionally ovulate, and oral contraceptives are useful in providing protection from pregnancy. Although an OC allows for bleeding once per month, this does not mean that the PCOS is “cured;” irregular cycles generally return when the OC is stopped. Oral contraceptives decrease the body’s production of male hormones( androgens).

Anti-androgen drugs (such as spironolactone) decrease the effect of androgens. These treatments can be used in combination to reduce and slow hair growth. Oral contraceptives and anti-androgens can also reduce acne.

Metformin — Metformin is used to decrease insulin resistance in these patients. It improves the effectiveness of insulin produced by the body. It was developed as a treatment for type 2 diabetes but may be recommended for women with PCOS with obesity and insulin resistance.

If a woman does not have regular menstrual cycles, the first-line treatment is a hormonal method of birth control, such as birth control pills. If the woman cannot take birth control pills, one alternative is to take metformin; a progestin is usually recommended periodically to have withdrawal bleeding in addition to metformin, for six months or until menstrual cycles are regular.

Metformin may help with weight loss. Although metformin is not a weight-loss drug, some studies have shown that women with PCOS who are on a low-calorie diet lose more weight when metformin is added. If metformin is used, it is essential that diet and exercise are also part of the recommended regimen because the weight that is lost in the early phase of metformin treatment may be regained over time.

Treatment of infertility

In PCOS lack of ovulation is the cause of infertility, The primary treatment for women who are unable to become pregnant, is weight lossh. Even a modest amount of weight loss may allow the woman to begin ovulating normally. In addition, weight loss can improve the effectiveness of other infertility treatments.

Ovulation inducing drugs (like clomiphene, Letrozole etc) are also used in conjunction with Matformin. Your doctor will discuss it with you. Prevention- PCOS cannot be prevented fully but early diagnosis and management helps prevent long-term complications, such as infertility, metabolic syndrome, obesity, diabetes, and heart disease.