Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age. It is not just an ovarian condition — it is a complex hormonal and metabolic disorder that impacts fertility, metabolism, and psychological health.
PCOS is characterized by:
- Ovulatory dysfunction (irregular or absent ovulation)
- Hyperandrogenism (elevated male hormones)
- Polycystic ovaries on ultrasound
It has significant reproductive, metabolic, and psychological implications if not properly managed.
Epidemiology
- Affects approximately 5–15% of women of reproductive age worldwide.
- Prevalence varies depending on the diagnostic criteria used.
- Increasing incidence is associated with rising obesity and sedentary lifestyles.
Etiology and Risk Factors
PCOS is a multifactorial disorder involving genetic and environmental factors.
- Insulin resistance plays a central role in disease development.
- Obesity increases the severity of symptoms.
- Family history of PCOS or type 2 diabetes increases risk.
- Lifestyle factors such as physical inactivity contribute significantly.
Pathophysiology
- Insulin resistance leads to hyperinsulinemia (elevated insulin levels).
- High insulin stimulates ovarian androgen production.
- Excess androgens interfere with normal follicular development.
- Chronic anovulation results in multiple immature follicles accumulating in the ovaries.
This explains why PCOS is both a hormonal and metabolic disorder.
Clinical Features
- Menstrual irregularities (oligomenorrhea or amenorrhea)
- Signs of hyperandrogenism such as hirsutism and acne
- Weight gain
- Infertility
Symptoms vary in severity among individuals.
Diagnostic Criteria
Diagnosis is commonly based on the Rotterdam criteria.
PCOS is diagnosed when at least two out of three of the following are present:
- Oligo-ovulation or anovulation
- Clinical or biochemical hyperandrogenism
- Polycystic ovaries on ultrasound
Other endocrine disorders must be excluded before confirming the diagnosis.
Investigations
- Hormonal profile (LH, FSH, androgen levels)
- Pelvic ultrasound showing enlarged ovaries with multiple small follicles
- Metabolic assessment (fasting glucose, oral glucose tolerance test, lipid profile)
Complications
- Increased risk of type 2 diabetes mellitus
- Metabolic syndrome
- Infertility and pregnancy complications
- Long-term risk of endometrial hyperplasia and carcinoma
Management
1. Lifestyle Modification (First-Line Treatment)
- Weight reduction
- Regular physical activity
- Dietary changes targeting insulin resistance
Even a 5–10% reduction in body weight can significantly improve ovulation and metabolic health.
2. Pharmacological Therapy
- Oral contraceptives for menstrual regulation
- Anti-androgens for hirsutism and acne
- Ovulation induction agents for infertility
- Insulin sensitizers (e.g., metformin) in selected patients
Conclusion
PCOS is a complex disorder requiring multidisciplinary management. Early diagnosis and intervention can help prevent long-term metabolic and reproductive complications.
Patient education, lifestyle intervention, and individualized treatment plans are essential for long-term control and improved quality of life.
