Polycystic Ovary Syndrome (PCOS) is a common condition that affects hormones. In recent years, I have seen many young women seeking treatment for infertility being diagnosed with PCOS. The condition can cause irregular menstrual periods, excessive hair growth, acne, and infertility. Many cases go undetected, and those that are identified are often discovered during investigations for infertility.

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PCOS is a hormonal imbalance that occurs when the ovaries, the organs that produce and release eggs, generate excess hormones. Normally, the ovaries produce androgens, some of which are converted into oestrogens, while the rest remain in circulation. In PCOS, however, the ovaries produce higher-than-normal levels of androgens. This disrupts the balance of reproductive hormones, leading to irregular menstrual cycles, missed periods, unpredictable ovulation, or anovulatory cycles, all of which can result in infertility. Affected women may also experience increased facial hair, acne, and, in some cases, male-pattern baldness.

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Weight gain is common and further increases the risk of developing diabetes, hypertension, and ischemic heart disease. Symptoms of PCOS are often more severe in obese women. Additionally, PCOS increases the risk of cancer of the inner lining (endometrium) of the uterus.

Women can develop PCOS at any time after puberty, though it is most commonly seen in those in their 20s and 30s. The exact cause remains unknown. However, obesity, stress, and elevated androgen levels are considered significant risk factors. Insulin resistance is also believed to contribute to the development of PCOS and diabetes. Studies suggest that individuals with PCOS often have chronic low-grade inflammation, which stimulates the ovaries to produce more androgens. Genetic factors may also play a role, with some women inheriting a predisposition to the condition. A higher prevalence of PCOS has been observed in women involved in intense competitive sports or physically demanding professions such as the police or military, possibly due to higher androgen levels, increased muscle mass, and greater bone density.

In PCOS, multiple fluid-filled sacs, or cysts, develop along the outer edge of the ovaries. These cysts contain immature eggs, known as follicles. Unlike in a healthy hormonal cycle, these follicles do not release eggs regularly. As a result, women may have menstrual cycles without ovulation, leading to infertility. In many cases, PCOS is first diagnosed during infertility evaluations.

Irregular periods and increased facial hair often raise suspicion of PCOS. Diagnosis is typically confirmed through ultrasound, which reveals multiple fluid-filled cysts. The condition commonly affects both ovaries but may sometimes involve only one, in which case symptoms may be milder.

PCOS (Polycystic Ovarian Syndrome) differs from PCOD (Polycystic Ovarian Disease). In PCOD, the ovaries produce many immature eggs, often leading to enlarged ovaries and cyst formation. While the symptoms may be similar, they are generally milder. PCOS is considered a more serious condition, involving significant metabolic and hormonal disturbances, whereas PCOD is largely a lifestyle-related condition. PCOD is usually managed through diet, exercise, and medication, and rarely leads to severe infertility. On ultrasound, PCOD typically shows fewer and smaller cysts compared to PCOS, where cysts are larger and more numerous.

Treatment of PCOS includes lifestyle modifications such as a balanced diet, regular physical exercise, and weight management to reduce obesity and insulin resistance. Managing stress through meditation, breathing exercises, and engaging in creative or relaxing activities is equally important. Changes in physical appearance, such as excessive hair growth, can be addressed through cosmetic procedures. Medications may be prescribed to manage metabolic issues, diabetes, hormonal imbalance, and to induce ovulation in women planning to conceive.

PCOS is a lifelong hormonal and metabolic disorder that increases the risk of infertility, diabetes, lipid abnormalities, and heart disease. However, with awareness, a healthy lifestyle, timely diagnosis, and appropriate treatment, its long-term complications can be reduced, and many women can successfully conceive.

The writer is a specialist in internal medicine.