Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders among women of reproductive age, affecting approximately 1 in 10 worldwide. Despite its prevalence, it remains under diagnosed and often misunderstood. A detailed update on PCOS that sheds light on its symptoms, causes, complications, and treatment options. Here’s everything you need to know about PCOS—including when it typically starts, its connection to fertility and miscarriage, and whether pregnancy is still possible.

What is PCOS?

PCOS is a hormonal imbalance that affects how a woman’s ovaries function. The ovaries may develop numerous small cysts (fluid-filled sacs) and often fail to regularly release eggs (ovulation). The name “polycystic ovary syndrome” comes from these cysts, though not all women with PCOS actually have them.

PCOS often begins shortly after puberty, although it can develop later, especially in response to weight gain or lifestyle changes. It may become noticeable when menstrual cycles become irregular during the teenage years or early twenties. However, it is commonly diagnosed in women in their 20s and 30s—especially when they experience fertility challenges.

Main Causes of PCOS

While the exact cause of PCOS is unknown, several factors are believed to play a role:

1. Hormonal Imbalance: Women with PCOS have higher-than-normal levels of androgens (male hormones), which interfere with ovulation.
2. Insulin Resistance: Up to 70% of women with PCOS have insulin resistance, where the body’s cells don’t respond normally to insulin. This can lead to higher insulin levels, which in turn may increase androgen production.
3. Genetics: PCOS often runs in families, suggesting a hereditary component.
4. Inflammation: Chronic low-grade inflammation may also contribute to increased androgen levels and ovarian dysfunction.

• Irregular periods: Missed, infrequent, or prolonged menstrual cycles.
• Excess hair growth: Particularly on the face, chest, and back (a condition known as hirsutism).
• Acne: Persistent acne, especially on the face, chest, and upper back.
• Weight gain: Difficulty managing weight, often concentrated around the abdomen.
• Thinning hair: Hair loss or thinning on the scalp.
• Darkening of the skin: Particularly along neck creases, in the groin, and underneath breasts.
• Skin tags: Small excess skin growths in the armpits or neck area. 

Yes, women with PCOS have a higher risk of miscarriage, particularly in the first trimester. This may be due to hormonal imbalances, poor egg quality, insulin resistance, or an altered uterine environment. However, with early diagnosis and proper management—including medications like metformin or progesterone supplementation—this risk can often be reduced.

Can I Get Pregnant with PCOS?

Yes, many women with PCOS can and do become pregnant. While PCOS can make conception more difficult due to irregular ovulation, it’s still very possible with the right support. Options include:

• Lifestyle changes: Weight loss, balanced nutrition, and exercise can help regulate ovulation.
• Ovulation-inducing medications: Clomiphene citrate, letrozole, or gonadotropins can stimulate the ovaries.
• Metformin: Used especially when insulin resistance is present.
• Assisted reproductive technologies: Such as intrauterine insemination (IUI) or in vitro fertilisation (IVF).

The key is working closely with a fertility specialist who understands the complexities of PCOS.

How is PCOS Diagnosed?

A diagnosis usually requires at least two of the following three criteria (known as the Rotterdam criteria):

• Irregular or absent menstrual cycles
• Excess androgen levels (via blood test or symptoms)
• Polycystic ovaries visible on ultrasound

Your doctor may also conduct additional tests to rule out other conditions and assess overall health.

Long-Term Health Risks of PCOS

PCOS is more than just a reproductive issue—it can affect your overall health longterm. Risks include:

• Type 2 diabetes
• High blood pressure
• High cholesterol
• Heart disease
• Endometrial cancer
• Anxiety and depression
• Sleep apnea

Managing PCOS

While there is no cure for PCOS, symptoms and risks can be effectively managed:

• Diet & exercise: Focus on low-GI foods, whole grains, lean proteins, and regular movement.
• Hormonal birth control: Regulates periods and reduces androgen levels.
• Anti-androgen medications: Help with hair growth and acne.
• Insulin-sensitising drugs: Like metformin, to manage blood sugar and hormonal balance.

Conclusion

PCOS is a lifelong condition, but with the right care, women can live healthy, fulfilling lives—and even successfully become pregnant. Awareness, early diagnosis, and a personalised treatment plan are essential. If you suspect PCOS, don’t hesitate to consult your healthcare provider.