PCOS symptoms: How is polycystic ovary syndrome recognised and treated?
Polycystic ovary syndrome is a metabolic condition affecting women of reproductive age. Symptoms can include irregular cycles, acne, excess hair growth and reduced fertility. Dr Alina Staikov explains what you need to know.
What is PCOS?
PCOS – also known as PCO or PCO syndrome – stands for polycystic ovary syndrome (also sometimes ovary syndrome). It’s a metabolic condition affecting women of reproductive age and is linked to the menstrual cycle, hormones and ovaries.
What happens in the body with PCOS
In each monthly cycle, several small follicles develop in the ovaries. In a healthy cycle, only one continues to grow and triggers ovulation, while the others regress. In PCOS, the ovaries produce excess male hormones. This leads to multiple small follicles (<10 mm) that rarely mature enough to ovulate. The condition is not self-inflicted, nor can it be cured, and is associated with certain long-term risks. However, symptoms can usually be managed well, and pregnancy is often still possible.
Short answers to common questions about PCOS
PCOS is a complex metabolic condition affecting women of reproductive age. The most common symptoms include irregular or absent periods, acne, unwanted hair growth, weight gain and reduced fertility. Many women also experience insulin resistance. This may be because androgens (male hormones) produced by the ovaries as a result of the metabolic imbalance directly affect blood sugar metabolism.
Irregular or absent periods, acne, excess hair growth on the face, abdomen and other areas not typical for women – as well as hair loss, weight gain, fatigue, emotional distress and difficulty conceiving.
If a woman of reproductive age notices that her cycle has changed significantly – or has always been very irregular – this can be a first sign. If other symptoms like those described above appear, she should seek advice from a gynaecologist.
The exact causes still aren’t fully understood, although it’s clear that the condition isn’t self-inflicted. What is known, however, is the underlying mechanism: a hormonal imbalance, often occurring in combination with insulin resistance.
Diagnosis involves tracking the menstrual cycle, examining the body and ovaries (via ultrasound) and analysing blood samples to assess hormone levels, as well as checking for insulin resistance. A definitive diagnosis is only made once other possible causes have been ruled out. A certain combination of symptoms is sufficient for diagnosis; not all symptoms need to be present.
A healthy lifestyle – including a balanced diet and regular exercise – can help reduce symptoms. In some cases, even a modest weight loss of around 5% can help regulate the cycle and improve fertility. Reducing stress and maintaining a balanced social life are also important for emotional well-being and can positively influence the course of the condition.
In principle, yes. Modern medicine offers a range of effective treatments and many patients respond well.
Typical symptoms: how PCOS is often noticed
The symptoms of polycystic ovary syndrome vary widely and differ in how strongly they appear. The list below offers a simple list of symptoms that women can use for an initial self-check. For an accurate diagnosis, however, it’s essential to visit a gynaecologist.
Symptoms from A to Z
These symptoms may point to polycystic ovary syndrome:
- changes in the menstrual cycle
- blemished skin, acne
- hair loss
- weight gain
- low energy and fatigue
- emotional fluctuations
- difficulty getting pregnant, including infertility
- other non-specific symptoms triggered by hormonal imbalance
How does PCOS affect the cycle and ovulation?
Because the body produces too many male hormones, the hormonal balance is disrupted. This manifests as noticeable cycle irregularities, and sometimes periods stop altogether. Ovulation occurs only rarely or not at all. That’s why it can be harder to get pregnant with PCOS. That said, thanks to modern treatment options, the condition can usually be managed quite effectively.
PCOS isn’t self-inflicted and can’t be cured – but it can be managed quite well with modern treatment options.
Effects of PCOS on skin and hair
Women with PCOS often report acne, increased body hair on the face, back, abdomen and pubic area, as well as a pattern of hair loss typically linked to male hormones. Targeted medical treatment and a healthier lifestyle have both proven effective.
Excess weight impacts the condition
Most women affected find it difficult to maintain a healthy weight or are already overweight, with abdominal fat being particularly significant. There’s also a risk of developing fatty liver disease. A balanced, healthy diet combined with regular exercise is recommended.
When energy levels are low
Because PCOS can be physically and emotionally demanding, many women feel tired and drained. Staying active is one of the best ways to recharge. Why not try yoga, aquafit or salsa? Or join a healthy cooking class with friends?
PCOS and mental well-being
Physical changes – as well as the emotional strain of possibly not being able to have a child – can take a toll on mental health. It’s not uncommon for patients to experience self-doubt, emotional distress or even depression. This is where talking to a gynaecologist can prove helpful.
How do those affected cope with PCOS?
Women with PCOS say that managing the condition requires a certain level of self-discipline. Many report a clear improvement in their quality of life through a combination of medication, dietary changes and regular exercise. To reduce stress, some also attend yoga or meditation classes. A positive mindset can also help stabilise both physical and emotional well-being.
A healthy lifestyle reduces symptoms and alleviates suffering.
PCOS: cause and effect
The exact cause of polycystic ovary syndrome hasn’t been fully determined yet. Genetic factors and overweight, together with secondary insulin resistance, are thought to play a role. It’s also possible that the hormonal conditions for PCOS are already established in the female foetus. Scientists still disagree on whether the ovaries, insulin resistance, or both are responsible for PCOS.
Hormones out of balance
For conception to be more likely, the luteinising hormone (LH) and follicle-stimulating hormone (FSH) need to be in the right balance. When this balance is disrupted, medicine refers to it as hormonal dysregulation.
Male hormones in the female body – what does this mean?
In PCOS, more LH than FSH is released, which prevents a dominant follicle from developing and, as a result, blocks ovulation. The unruptured follicles remain hormonally active, which is why male hormones increase in the body.
The hormonal imbalance prevents ovulation.
PCOS and insulin resistance
When the body’s cells respond only poorly to insulin, they take up less sugar from the blood, which causes blood sugar levels to rise. The pancreas interprets this as a signal to produce even more insulin. But what happens when insulin levels stay chronically elevated in relation to polycystic ovary syndrome?
Effect
Because several follicles mature instead of just one, the production of male hormones (androgens) is already strongly stimulated. The androgens have a braking effect, which means even more insulin is released to help transport blood sugar into the cells. The excess male hormones lead to increased hair growth in unwanted areas (hirsutism), acne, and other symptoms. Since many women with polycystic ovary syndrome are insulin resistant, the risk of type 2 diabetes increases.
Not a good match: PCOS and stress
When you’re constantly under pressure, stress hormones such as cortisol are released, which can have a negative effect on women with PCOS. Reducing stress through conscious breaks, walks in nature, good time management and a slightly calmer approach to life can help.
A possible player: the gut flora (gut microbiome)
It hasn’t been conclusively proven yet, but a change in the composition of gut bacteria (dysbiosis) may also influence weight or excess weight and, in turn, polycystic ovary syndrome. Women with PCOS can improve gut health by eating more vegetables and fruit, including probiotic foods such as unsweetened yoghurt, and avoiding fast food.
PCOS and pregnancy: What are the options?
Here’s the good news: Most women with PCOS can still get pregnant. The first steps include tracking your cycle and having a gynaecological exam, eating a balanced diet, exercising and ensuring the right timing for conception. If ovulation happens only rarely, various medications to trigger it can provide valuable support. Regular ultrasound monitoring is recommended throughout. Promising studies have been done using medications that affect blood sugar metabolism – or using inositol. If pregnancy still doesn’t occur, a consultation at a fertility centre is advised.
Women with PCOS can still get pregnant.
Bright prospects despite PCOS
Women with polycystic ovary syndrome often have lots of questions about the long-term course of the condition, managing insulin resistance or diabetes. There are long-term risks, including effects on the womb lining. These play a key role in treatment, counselling and care for these patients. That said, the outlook is generally good. Modern medications, regular check-ups at the gynaecologist or GP, periodic ultrasounds and blood tests, plus a balanced diet and exercise not only boost quality of life, but also help make it much more likely that pregnancy occurs despite PCOS.
Managing PCOS in daily life
Cutting back on sugary and fatty foods, avoiding sweet drinks and getting regular exercise – like cycling, swimming or hiking – not only aids weight loss but also strengthens heart and circulation, boosts metabolism and eases the burden of PCOS.
Tip 1: Healthy eating makes you happy
Eating well has a positive effect on your weight and overall well-being. If it’s difficult to adopt new habits, nutritional counselling can help.
Tip 2: Get your metabolism going
Regular exercise helps maintain a healthy weight and reduces PCOS symptoms.
Tip 3: Sleep well despite PCOS
Late meals, caffeine, alcohol and a phone’s blue light are typical sleep disruptors, including for women with PCOS. Around seven hours’ sleep at regular times help ensure sweet dreams.
Tip 4: Reduce stress
Being always on call, feeling overwhelmed and other stress factors add to the pressure of the condition. A steady routine, downtime and time with family and friends will help patients find balance.
Tip 5: PCOS and monk’s pepper
This remedy is said to influence the pituitary gland, lower prolactin levels and improve the balance between LH and FSH. Only use it in consultation with a doctor.
What treatment options are available?
Alongside changes to diet, more exercise and general lifestyle improvements, specific medications can be prescribed by a gynaecologist. These medications aim to lower male hormone levels, treat insulin resistance and promote ovulation.
It's a challenge: a PCOS diagnosis
The first requirement is that at least two of the key PCOS characteristics are present. These are:
- a disrupted cycle
- excess male hormones
- polycystic ovaries
To confirm the diagnosis accurately, various medical tests are needed:
- taking of medical and family history (is there a genetic predisposition?)
- analysis of cycle data
- physical examination, especially for excess hair growth
- ultrasound examination of the ovaries
- blood tests
Blood tests as part of the diagnosis
Blood analysis reveals the levels of female and male hormones and their derivatives, of thyroid hormones, of adrenal gland hormones and of pituitary hormones, including prolactin. Another useful indicator is anti-Müllerian hormone (AMH), which is produced in the ovaries and signals how many eggs are present. Known as the ovarian reserve, this is an important marker for PCOS diagnosis. In addition to these steps, checks for diabetes or other metabolic disorders are carried out.
Why is an early diagnosis so important?
If left untreated, the risks for type 2 diabetes, lipid metabolism disorders, high blood pressure, heart and circulatory diseases and infertility rise. On top of that, patients continue to suffer from symptoms like acne and excess body hair, which affect their quality of life. That’s why it’s crucial for women who suspect PCOS to consult their doctor.
Specialist centres for those affected
These places specialise in treating PCOS patients: university hospitals, gynaecology practices offering a wide range of treatments or specialising in endocrinology, and fertility clinics.
Sources
Ms Dr. med. Alina Staikov, founder, CEO and medical director of gynpoint
University Hospital Zurich: PCO syndrome
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