Polycystic Ovary Syndrome (PCOS) is the most common hormonal disorder in women of reproductive age and the most common cause of infertility due to ovulation disorders.
PCOS is caused by an imbalance in sex hormones and can affect one in ten women of childbearing age. It is often associated with the presence of several small follicles in the ovaries, although this is not always the case.
More than half of women with PCOS are overweight and a large proportion have impaired insulin sensitivity (including an increased risk of gestational diabetes). Elevated insulin levels can increase the levels of androgens (male hormones) that a woman produces, which can lead to irregular menstrual periods and difficulty ovulating. Both these factors can decrease the chance of achieving a pregnancy.
Typical symptoms include irregular, long or completely absent menstrual cycles. In addition, many women present with oily skin, acne and/or excessive hair growth (hirsutism).
PCOS is diagnosed based on an assessment of the menstrual cycle, combined with a gynecological ultrasound examination and hormone testing. Blood tests are used to rule out other conditions that can cause cycle disturbances, such as thyroid disorders and excessive production of prolactin (the milk hormone). Androgen levels as well as hormones that regulate ovarian function (FSH and LH) are also evaluated. Measurement of AMH (anti-Müllerian hormone) levels can additionally be used to support the diagnosis. The elevated testosterone levels underlying these changes can also be detected by measuring a blood sample.
Sometimes, making small changes in lifestyle can help control these imbalances. Losing weight (in cases where there are signs of obesity) can help control androgens and regulate periods. Increasing physical activity, in addition to weight loss, can also be beneficial for this regularisation, as well as diets high in fibre, vegetables and wholegrain foods.
The symptoms of PCOS may improve significantly with age, provided that the weight remains normal. In overweight women, weight loss alone may well be enough to induce ovulation, even if it not sufficient alone it sensitizes the ovaries to ovulation induction treatments and reduces the risks associated with pregnancy. In addition to actual weight reduction medication, weight management can be supported with, for example, metformin medication.
In cases where results are not achieved with these measures, it is advisable to seek pregnancy through infertility treatments.
The main fertility-related challenge in PCOS is ovulation disorders. In a normal menstrual cycle, the ovaries release an egg (ovulation) approximately once a month. In women with PCOS, ovulation may occur very infrequently or may be absent altogether. This is due to hormonal imbalance, which interferes with the maturation and release of eggs. Without ovulation, pregnancy cannot occur naturally.
Although PCOS can make it more difficult to conceive, it does not mean that pregnancy is impossible. In fact, the likelihood of having at least one child is the same as for women without PCOS—however, it often takes longer to achieve the first pregnancy. About half of women with PCOS conceive without medical assistance.
If the menstrual cycle is long (over 35 days), it is advisable to seek help from a specialist.
If needed, doctors specializing in fertility treatments can prescribe medications to stimulate ovulation or recommend more advanced treatments such as insemination or IVF. In most cases, ovulation induction with oral medication is sufficient, making treatment relatively simple when managed by experienced professionals.
If pregnancy is not a current goal, treatment for PCOS focuses on managing symptoms. Irregular cycles can be treated with hormonal contraception, such as birth control pills, and excessive hair growth may be addressed with anti-androgen medication.
PCOS (Polycystic Ovary Syndrome) is a common hormonal condition affecting people of reproductive age. It is associated with irregular menstrual cycles, hormonal imbalance, and changes in ovarian function. PCOS is a long-term condition, but with the right care, symptoms can be managed effectively.
Common symptoms include irregular or absent periods, ovulation disturbances, acne, increased hair growth on the face or body, hair thinning, and weight changes. Some people experience only mild symptoms, while others may notice more significant effects.
PCOS is diagnosed based on a combination of menstrual cycle history, ultrasound examination, and hormone testing. Blood tests are used to assess hormone levels and to rule out other conditions that can cause similar symptoms, such as thyroid disorders or elevated prolactin levels. A diagnosis is made based on overall findings, not a single test.
PCOS can affect fertility mainly through irregular or absent ovulation. Without regular ovulation, becoming pregnant may take longer. However, many people with PCOS conceive naturally, and effective treatments are available to support ovulation when needed.
There is no single treatment that suits everyone with PCOS. Care is tailored to individual symptoms and life goals. Treatment may include lifestyle changes, hormonal treatments to regulate the menstrual cycle or medications to support ovulation.
