PCOS (Polycystic ovaries, or polycystic ovarian syndrome), is a hormonal imbalance disorder where women have abnormalities and imbalance in the metabolism of important sex hormones (estrogen and progesterone), resulting in menstrual cycle fluctuations, trouble with ovulation, and signs of increased male hormones in the body. The latter is primarily due to cystic ovaries making more of the male sex hormones (androgens), whereas normal female ovaries make only a tiny amount of the same. Hence, one of the major problems arising from PCOS is the difficulty many patients encounter while trying to get pregnant.

PCOS is mainly a genetic disease, although the causes are still poorly understood. Women with PCOS have tiny cysts (benign outgrowths) on their ovaries. Ovaries need to have 12 or more cysts to qualify as polycystic ovaries. It is these cysts that interfere with normal hormonal balance in the female body.

Due to the increased production of the male sex hormones, patients with PCOS often suffer from acne, obesity, unwanted facial and body hair, and sometimes voice changes. The body may also develop insulin resistance, leading to an increased risk of diabetes later on in life.




Symptoms of PCOS tend to be very mild at first, and may go unnoticed. These commonly include:

Weight gain. Nearly half of all women with PCOS are obese.


Extra facial and body hair, darker and thicker that the rest of the body hair (Hirsutism)

Thinning out of scalp hair


Irregular periods. A majority of women with PCOS have fewer than 9 periods a year.

Difficulty getting pregnant. Conception may take longer than in other women, or women with PCOS may have fewer children than they had planned. In addition, the rate of miscarriage is also higher in affected women.


A complete and in-depth history along with a complete physical exam are required to make an accurate diagnosis of PCOS. These need to include questions about onset, duration and severity of menstrual cycles, family history, and any previous symptoms.

Physical exam should include blood sugars, blood pressure, BMI, pattern of hair distribution, and skin and hair exam

Pelvis ultrasound is recommended for a detailed look at the ovaries


Certain lifestyle changes, such as diet and exercise, are considered first-line treatment for adolescent girls and women with polycystic ovarian syndrome. Losing even 10 lbs weight in an overweight patient with PCOS dramatically improves the hormonal imbalance and helps regulate the menstrual cycle.

Birth control pills are often prescribed as first line treatment, to reduce the hormonal imbalance and improve regularity of menstrual cycles. Alongside is used another drug called Metformin, which is primarily used in diabetes to decrease insulin resistance in the body. It has been shown to improve ovulation rates in patients with PCOS, and decreases the amount of circulating androgens (male hormones) in the body. A good side effect of Metformin is weight loss, which is desirable in most patients with PCOS.


Dr. Annie

Physician, mom and wife

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