Polycystic ovary syndrome (PCOS)

In PCOS, the ovaries do not function optimally. An increase in ovarian volume and the presence of numerous immature follicles, visible on ultrasound, are often observed. These follicles, small sacs filled with fluid, each containing an egg, do not reach maturity and are not released, leading to oligo-ovulation or anovulation. The hormonal imbalance specific to PCOS involves hyperandrogenism (excess androgens, hormones also present in women), often associated with insulin resistance. This endocrine context disrupts the hypothalamic-pituitary-ovarian axis, which is responsible for regulating folliculogenesis and ovulation.

The clinical signs of PCOS vary in intensity and combination. They can affect the menstrual cycle, physical appearance, weight, and fertility.
Menstrual disorders are common, ranging from irregular periods to amenorrhea (absence of periods), or even prolonged bleeding when periods do occur. Depending on the frequency of the cycles, this is referred to as oligoovulation or anovulation.
Hyperandrogenism manifests itself as excessive hair growth (hirsutism) on the face, chest, abdomen, or back, persistent acne in adulthood, and androgenetic alopecia (male-pattern hair loss).
Obesity, being overweight, or difficulty controlling weight gain affects between 40 and 80% of women with the condition. Other symptoms include darkening of certain areas of the skin (acanthosis nigricans) or the presence of small skin growths (skin tags).

The exact cause of PCOS remains unknown. However, research agrees that it has multiple causes. Genetic, hormonal, metabolic, and environmental factors seem to interact to promote the onset of the syndrome. Hyperandrogenism plays a central role by disrupting follicular growth and selection. Insulin resistance, which is frequently associated with PCOS, contributes to increased ovarian androgen production via compensatory hyperinsulinism. This vicious cycle perpetuates ovulatory and metabolic abnormalities.

Several factors can increase the likelihood of developing PCOS. Genetic predisposition is one of them. It is common to see several cases in the same family, suggesting a hereditary component. Studies have highlighted the involvement of certain genes linked to LH receptors, insulin, or folliculogenesis.
Being overweight or obese is also an aggravating factor. Approximately 75% of patients with PCOS have a high body mass index. This condition increases insulin resistance and exacerbates hormonal disorders.
Finally, certain environmental factors (unbalanced diet, sedentary lifestyle, pollution, endocrine disruptors) as well as the gut microbiota are mentioned in recent literature as potential influences on the development of PCOS.

The diagnosis of PCOS is based on an analysis of symptoms, biological tests, and a pelvic ultrasound. According to the Rotterdam criteria, the syndrome is confirmed if two of the following three elements are present:

• irregular or absent menstrual cycles;
• clinical or biological signs of hyperandrogenism (acne, excessive hair growth, alopecia);
• a typical ovarian image on ultrasound (increased number of follicles or ovarian volume).

Blood tests complete the assessment to evaluate hormone levels, glucose, and lipids. Pelvic ultrasound allows visualization of the ovaries and exclusion of other pathologies.
In adolescents, diagnosis requires caution, as some signs of PCOS may be normal during puberty. Long-term monitoring is therefore essential.

The treatment of PCOS depends on the predominant symptoms and plans for pregnancy. There is no cure, but the solutions offered can improve quality of life in the long term, prevent complications and, where appropriate, promote fertility. Treatment is based primarily on lifestyle and dietary measures: regular physical activity and a balanced diet can improve ovulation, regulate cycles and reduce androgen levels.
In addition, drug treatments are offered depending on the objectives: antiandrogens (spironolactone, cyproterone acetate, finasteride) to combat hirsutism, hair loss, and acne; metformin to correct insulin resistance; or ovulation inducers if pregnancy is desired. If these treatments fail, surgery on the ovaries may be considered.

PCOS is a chronic, progressive condition with repercussions that go beyond fertility.
Without appropriate treatment, it increases the risk of metabolic complications: type 2 diabetes, dyslipidemia, high blood pressure, metabolic syndrome. The low-grade chronic inflammation associated with PCOS contributes to these risks.
PCOS also promotes the development of endometrial hyperplasia, which can lead to uterine cancer, particularly in patients with infrequent or absent cycles who are not receiving hormone treatment.
Psychologically, the impact can be considerable: body image issues, anxiety, depression, and eating disorders are frequently reported. Finally, obstetric complications are more common.

There is no way to prevent the onset of PCOS, but certain measures can reduce the risks. A healthy lifestyle (healthy diet, regular physical activity, maintaining a stable weight) helps prevent insulin resistance, one of the drivers of the syndrome. For women at risk (family history, early puberty, overweight), regular medical monitoring allows for early intervention.

Medical advice is recommended as soon as any of the following signs appear: persistent irregular menstrual cycles, prolonged absence of periods, resistant acne, unexplained weight gain, excessive hair growth in unusual areas, or difficulty conceiving a child. A consultation is also necessary when the diagnosis has already been made and symptoms worsen or new complications arise (chronic fatigue, pelvic pain, mood disorders, etc.).

Is PCOS a rare condition?

No, it is a common disorder. It affects between 10 and 15% of women of childbearing age.

Is it possible to have PCOS without being overweight?

Yes. Although being overweight exacerbates the symptoms, some slim women have PCOS, sometimes in a more subtle form.

Does PCOS disappear after menopause?

The symptoms related to menstrual cycles diminish, but the metabolic risks (diabetes, cardiovascular disease) persist. Medical follow-up is still recommended.

Can you get pregnant with PCOS?

Yes. Although ovulation is irregular, treatments exist to stimulate ovulation and improve fertility. Lifestyle and weight loss play a key role.

What tests are used to diagnose PCOS?

The diagnosis is based on clinical signs, hormone tests, and a pelvic ultrasound.

Is PCOS linked to an unbalanced diet?

Not directly. But an unbalanced diet can aggravate the metabolic disorders associated with PCOS.