Polycystic Ovary Syndrome (PCOS)
PCOS (polycystic ovary syndrome) is a common hormonal condition affecting ovulation, diagnosed per the 2023 International Evidence-Based Guideline, endorsed by the Endocrine Society, ASRM, and ESHRE.
Symptoms
Irregular or absent periods, excess hair growth (hirsutism), acne, and hair thinning from elevated androgens; many with PCOS also have insulin resistance and difficulty with weight management.
Causes and risk
A combination of genetic predisposition and insulin resistance; PCOS is heterogeneous, meaning symptom patterns vary significantly from person to person.
How it is evaluated
Diagnosis follows the Rotterdam criteria -- 2 of 3 features (irregular ovulation, clinical or lab evidence of excess androgens, and polycystic ovaries on ultrasound) after excluding other causes, per the ACOG Practice Bulletin. Routine insulin-resistance testing is not recommended by the 2023 guideline.
Treatment
Lifestyle measures are the foundation; combined oral contraceptives are first-line for irregular periods and excess androgen symptoms, and metformin is used primarily for metabolic features, per the 2023 International Evidence-Based Guideline, which also notes that inositol supplements offer limited clinical benefit.
When to seek care
Rapid onset of significant hair growth, voice deepening, or other signs of rapid virilization warrant prompt evaluation to rule out an androgen-secreting tumor. Combined oral contraceptives carry a blood clot risk that is further elevated in PCOS -- sudden leg swelling, chest pain, or shortness of breath while on them needs emergency evaluation.