PCOS (Polycystic Ovary Syndrome)

What is PCOS?

            Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting 10% to 13% of women of reproductive age worldwide. The condition occurs when a hormonal imbalance—often driven by elevated androgen levels—disrupts normal ovarian function, sometimes leading to the growth of small cysts. Alarmingly, studies suggest that up to 70% of affected women globally remain undiagnosed. 

PCOS is a leading cause of anovulation (the absence of ovulation) and female infertility. While the condition often runs in families, its symptoms vary widely from person to person. It is also a chronic metabolic condition that persists well beyond a woman's reproductive years. 

Compared to those without the condition, women with PCOS face a higher risk of long-term physical and emotional health complications, including insulin resistance, type 2 diabetes, and obesity. 

Symptoms of PCOS

The primary symptoms of PCOS include:

• Irregular periods or a complete absence of menstruation
• Excessive facial or body hair growth
• Severe acne and oily skin
• Male-pattern baldness or thinning hair
• Unexplained weight gain or obesity
• Infertility 

If you experience one or more of these symptoms, consult a gynaecologist for professional medical advice. PCOS manifests differently in everyone; a woman might only experience infertility or irregular periods without showing other symptoms. Conversely, having these symptoms does not automatically mean you have PCOS, as a formal medical diagnosis is required. 

Early diagnosis is crucial. If left unmanaged, PCOS can increase your risk of developing serious health problems later in life, including type 2 diabetes, high blood pressure, elevated cholesterol, heart disease, and sleep apnoea. 

Causes of PCOS

While the exact cause of PCOS remains unknown, research shows that it stems from a combination of factors, including heredity, environment, lifestyle, and weight.

• Genetics: If a female relative—such as a mother, sister, or aunt—has PCOS, your risk of developing the condition increases significantly. While scientists have not identified a single responsible gene, research suggests the genetic link is complex and involves multiple genes.
• Insulin Resistance: Insulin regulates your blood sugar levels. If you are insulin resistant, your body cannot effectively use the insulin it produces. To compensate, your body creates excess insulin, which triggers the ovaries to produce too many androgens, like testosterone. This hormonal imbalance leads to symptoms such as excessive hair growth, acne, and irregular periods.
• Weight and Lifestyle: Insulin resistance often causes weight gain, which can lead to obesity. Conversely, an unhealthy diet and a lack of physical activity can raise insulin levels further, worsening PCOS symptoms.

Overview

• Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting women from their reproductive years into later stages of life.
• The condition occurs when disrupted hormonal signaling leads to abnormally high androgen levels and other endocrine imbalances. Consequently, individuals with PCOS may experience infrequent or irregular menstrual periods, pelvic pain accompanied by heavy bleeding, abnormal ovulation, and ovarian cysts. Physical symptoms also include oily skin, acne, and hair changes—such as excessive facial or body hair or female-pattern hair thinning. 
• PCOS is a leading cause of irregular menstruation and one of the most common drivers of infertility. Because of these irregular cycles, women with PCOS also face a higher risk of developing endometrial hyperplasia and endometrial cancer. While the condition can emerge as early as adolescence, it is most frequently diagnosed when individuals encounter difficulties becoming pregnant. 
• Furthermore, PCOS is a chronic metabolic condition linked to long-term health risks, including insulin resistance, type 2 diabetes, and obesity. Although there is currently no cure, lifestyle modifications, medications, and fertility treatments can effectively manage symptoms, improve fertility, and protect long-term health. While the exact cause remains unknown, individuals with a family history of PCOS or type 2 diabetes are at a higher risk. 

Scope of the Problem

PCOS is a major global public health concern. Experts estimate that it affects 10% to 13% of women worldwide, yet up to 70% of affected individuals remain undiagnosed.

The prevalence of PCOS and its severity can vary among different racial and ethnic groups, with some populations showing a higher genetic predisposition to metabolic complications. Additionally, structural racism and other social determinants of health heavily influence the equity of care, shaping how different groups seek and receive quality medical services. 

Symptoms

Symptoms of PCOS vary significantly from person to person, and an individual’s symptoms can change over time. 

Possible symptoms include:

• Irregular, unpredictable, or absent periods
• Heavy, prolonged, or painful periods
• Difficulty conceiving or infertility
• Excessive hair growth on the face or body (hirsutism)
• Female-pattern hair thinning or baldness
• Acne or oily skin 

Women with PCOS face an increased risk of developing other health complications, such as: 

• Gestational diabetes or pregnancy-induced hypertension
• Weight gain, particularly around the abdomen
• Obesity
• Type 2 diabetes and hypertension (high blood pressure)
• High cholesterol and cardiovascular disease
• Sleep apnea
• Metabolic dysfunction-associated steatohepatitis (liver inflammation)
• Endometrial hyperplasia or endometrial cancer (abnormal growth or cancer of the uterine lining) 

PCOS can severely impact overall quality of life. Women with the condition frequently experience anxiety, depression, eating disorders, and poor body image. Furthermore, symptoms like infertility, obesity, and unwanted hair growth carry social stigma in many cultures. This stigma can negatively affect personal relationships, professional life, community belonging, and mental well-being.

Diagnosis

A diagnosis of PCOS requires the presence of at least two of the following criteria, provided other conditions causing similar symptoms have been ruled out: 

• Signs of hyperandrogenism: Physical symptoms of high androgen levels (such as excess facial or body hair, scalp hair loss, severe acne, or oily skin) or elevated testosterone levels in a blood test.
• Ovulatory dysfunction: Irregular, infrequent, or completely absent menstrual periods.
• Polycystic ovaries: An ultrasound showing an enlarged ovary with multiple small, underdeveloped follicles. 

This means that a person can be diagnosed with PCOS without having "polycystic" ovaries on an ultrasound, as multiple follicles are not an absolute requirement for diagnosis. 

• Blood tests are highly effective for identifying elevated androgen levels in individuals who do not exhibit visible physical symptoms like acne or excess hair. They are also useful to verify whether ovulation is occurring normally in individuals who maintain regular menstrual cycles. 
• When evaluating a patient, healthcare providers consider genetic risk factors, since a family history of PCOS or type 2 diabetes increases individual susceptibility. Clinicians also take the patient's current life stage into account because irregular cycles are often perfectly normal during early adolescence (following menarche) or during the transition to menopause (perimenopause).

Finally, it is recommended that newly diagnosed individuals undergo additional blood testing to evaluate underlying insulin resistance and assess overall cardiovascular risk.

The Difference Between PCOD and PCOS

It is important to clarify the distinction between PCOD (Polycystic Ovarian Disease) and PCOS (Polycystic Ovary Syndrome). While they sound similar, they differ significantly in severity and scope.

                                                      PCOD vs PCOS

• PCOD: This condition occurs when the ovaries accumulate a large number of immature or partially mature eggs, which can develop into tiny follicles over time. This causes the ovaries to enlarge and secrete excess androgens. Symptoms include irregular menstrual cycles, weight gain, bloating, acne, and hair thinning. PCOD is relatively common, highly manageable through lifestyle adjustments and medication, and does not typically prevent normal pregnancy.
• PCOS: In contrast, PCOS is a more severe endocrine and metabolic syndrome. Rather than just affecting the ovaries, it impacts the entire metabolic system. Symptoms include highly irregular periods, excessive facial or body hair, severe acne, rapid weight gain, and infertility. If left unmanaged, PCOS increases the risk of long-term health complications such as type 2 diabetes, cardiovascular disease, and endometrial cancer. Treatment typically involves a combination of lifestyle changes, targeted medications, and occasionally, hormone therapy.

Treatment of PCOS

While there is currently no cure for PCOS, early intervention and proper management can substantially improve quality of life, aid fertility, and lower the risk of long-term cardiovascular issues or endometrial hyperplasia.

• Lifestyle Interventions: Adopting healthy habits—such as regular physical activity, yoga, meditation, and a balanced diet—is crucial for managing symptoms and reducing stress, even if these changes do not result in immediate weight loss. Exercise remains one of the most effective ways to improve insulin sensitivity.
• Medical Management: Combined oral contraceptive pills can successfully regulate the menstrual cycle, protect the uterine lining, and reduce acne or hirsutism (excess hair growth). Anti-androgens may also be prescribed to target severe skin and hair symptoms. All treatment courses should be decided through shared decision-making between the patient and their healthcare provider.
• Fertility Support: For individuals experiencing infertility due to ovulatory dysfunction, options include medications or surgical interventions designed to stimulate ovulation. Assisted reproductive technologies (ART), such as In-Vitro Fertilization (IVF), are also highly effective. Pregnant individuals with PCOS require close monitoring, as the condition carries a higher risk of pregnancy-related complications.

WHO Response

The World Health Organization (WHO) actively promotes global research into the prevention, diagnosis, and treatment of infertility and broader menstrual disorders associated with PCOS. By identifying and prioritizing critical unanswered questions in reproductive healthcare, WHO works alongside Member States and international partners to elevate public awareness and establish clear clinical guidelines for healthcare providers.

Additionally, WHO supports data collection to track the global prevalence of infertility. By assisting Member States in integrating fertility care into national health policies and financing structures, WHO aims to ensure that comprehensive reproductive healthcare remains accessible to all without causing financial hardship.

PCOS awareness is marked by two primary global events: World PCOS Day of Unity on September 1st,which kicks off PCOS Awareness Month, and PCOS Advocacy Day, held earlier in the spring. Both campaigns mobilize patients, advocates, and healthcare professionals to accelerate research and expand patient access to care. 

Note: In this text, the terms "women" and "female" are used inclusively to refer to all individuals who menstruate and may be at risk for developing PCOS.