Understanding PCOS

What is PCOS?

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting roughly 8–13% of reproductive-age women, with prevalence varying by diagnostic criteria. PCOS is characterized by ovulatory dysfunction, clinical/biochemical hyperandrogenism, and/or polycystic ovarian morphology (PCOM) after excluding other causes. The 2023 international guideline endorses (for adults) the modified Rotterdam approach: any 2 of 3 features (hyperandrogenism, ovulatory dysfunction, PCOM). In adolescents, diagnosis requires both hyperandrogenism and ovulatory dysfunction; ultrasound is not recommended within 8 years of menarche.

Pathophysiology

PCOS is multifactorial, with contributions from genetics, insulin resistance, and dysregulated steroidogenesis/inflammation. Insulin resistance is highly prevalent in PCOS and drives hyperandrogenism and cardiometabolic risk.

How PCOS Is Diagnosed (Practical Summary)

After excluding mimickers (e.g., thyroid disease, hyperprolactinemia, non-classic CAH, Cushing syndrome), assess:

• Ovulatory dysfunction: cycles >35 days, <8 menses/year, or amenorrhea.

• Hyperandrogenism: hirsutism (e.g., modified Ferriman–Gallwey score), acne, and/or elevated androgens (e.g., total/free testosterone by reliable assay).

• PCOM (adults): increased follicle number/ovarian volume on high-quality ultrasound (thresholds depend on transducer and lab). AMH may assist when high-quality TVUS is unavailable but should not be used in adolescents.

Common symptoms

• Irregular or absent menses (oligo/anovulation)

• Hirsutism, acne, androgenic alopecia (hyperandrogenism)

• Weight gain/central adiposity, difficulty losing weight

• Acanthosis nigricans (insulin resistance)

• Fertility challenges due to anovulation

PCOS is also associated with higher rates of depression and anxiety; routine screening is recommended.

Living well with PCOS

PCOS is manageable. Combine lifestyle measures with targeted pharmacotherapy and regular monitoring. Address mental health proactively, and seek multidisciplinary support (primary care, endocrinology/gynecology, dietetics, mental health). With consistent care, menstrual regularity, symptom control, cardiometabolic risk, and fertility outcomes can substantially improve.

A woman tracking her menstrual cycles for better health management.

References

1. Dason, E. S., et al. (2024). Diagnosis and management of polycystic ovarian syndrome. CMAJ, 196(3), E85–E95. https://www.cmaj.ca/content/196/3/E

2. Teede, H. J., et al. (2023). Recommendations from the 2023 International Evidence-Based Guideline for the Assessment and Management of PCOS. J Clin Endocrinol Metab, 108(10), 2447–2462.

3. ESHRE/ASRM/Monash University. (2023). PCOS Guideline—Summary for Practice.. https://www.monash.edu/__data/assets/pdf_file/0003/3371133/PCOS-Guideline-Summary-2023.pdf

4. Christ, J. P., et al. (2023). Current guidelines for diagnosing PCOS. Diagnostics, 13(6), 1156. https://pmc.ncbi.nlm.nih.gov/articles/PMC10047373/

5. Bozdag, G., et al. (2016). The prevalence and phenotypic features of PCOS: A systematic review and meta-analysis. Human Reproduction, 31(12), 2841–2855.

6. StatPearls. (2025). Polycystic Ovarian Syndrome. NCBI Bookshelf. (OGTT preferred over HbA1c; periodic rescreening.)

7. Cowan, S., et al. (2023). Lifestyle management in PCOS. Nutrients, 15(1), 123. https://pmc.ncbi.nlm.nih.gov/articles/PMC9841505/

8. Martin, K. A., et al. (2018). Evaluation and treatment of hirsutism in premenopausal women. J Clin Endocrinol Metab, 103(4), 1233–1257. (Contraception required with anti-androgens.)