What is PCOS (polycystic ovarian syndrome)?

hormone health pcos Aug 19, 2021
What is PCOS treatment

Polycystic Ovarian Syndrome (aka PCOS) is a complex condition characterized by hormonal imbalance. It is the most common cause of chronic anovulation and infertility. It affects up to 6%-10% of reproductive age women. There are differences in opinion on the diagnostic criteria for PCOS. Let’s go over the three main different diagnostic criteria put forth by three separate research groups. 

In 1990, the National Institute of Health (NIH), defined PCOS as requiring three criteria: 

  1. Delayed ovulation or periods (aka oligomenorrhea or amenorrhea)
  2. Presence of excess androgens from clinical signs (acne, hirsutism, male pattern hair loss) or from blood work showing excess androgens
  3. Other conditions that would create similar symptoms have to be ruled out

In 2003, the European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine Rotterdam consensus (ESHRE/ASRM) developed the Rotterdam criteria which added polycystic ovarian morphology on ultrasound as a new criterion. For diagnosis of PCOS, they required two out of the following three features:

  1. Delayed ovulation or periods (aka oligomenorrhea or amenorrhea)
  2. Presence of excess androgens from clinical signs (acne, hirsutism, male pattern hair loss) or from blood work showing excess androgens
  3. Polycystic ovarian morphology (PCOM) seen on ultrasound

Finally in 2006, the Androgen Excess Society defined PCOS as hyperandrogenism with ovulatory dysfunction or polycystic ovaries. The Androgen Excess Society (AES) considered that androgen excess is the central event in the development of polycystic ovary syndrome. For diagnosis of PCOS, they required:

  1. Presence of excess androgens from clinical signs (acne, hirsutism, male pattern hair loss) or from blood work showing excess androgens


  1. Delayed ovulation or periods (aka oligomenorrhea or amenorrhea)


  1. Polycystic ovarian morphology (PCOM) seen on ultrasound

Possible Symptoms of PCOS and Related Health Risks

Many women with PCOS will have irregular cycles, most commonly long, anovulatory cycles (anovulatory meaning no ovulation). They may also have no period for a long time (aka amenorrhea). On ultrasound, they may have enlarged ovaries or ovaries with a high number of follicles that look like multiple small cysts on the ovaries (hence the name Polycystic Ovary Syndrome). The lack of ovulation may lead to infertility (or subfertility). Other symptoms relating to excess androgens include acne, hirsutism (male pattern hair growth), or hair loss. Symptoms relating to insulin resistance include obesity and carbohydrate intolerance. Note: you do not have to be obese to meet the criteria for PCOS and lean women with PCOS may still have insulin resistance. 

PCOS is not an “all or nothing” condition. It can be mild for some women and severe for other women. It can be severe for one woman in her 20’s and become mild in her 30’s. There can be times when a woman with PCOS will ovulate more regularly and other times when she won’t ovulate at all. She can have PCOS and be lean and not have hirsutism. She can also have PCOS with or without infertility. There is a wide range of symptoms experienced in PCOS. It’s no wonder that it often takes a long time for women to be diagnosed with PCOS. 

Bottom line is, there is a spectrum of PCOS and one can go in and out of different phases of PCOS depending on lifestyle factors, age, environment, stress, etc. 

Why does it matter?

It is important to diagnose and treat PCOS because this condition is associated with other medical conditions and up to 70% of women with PCOS have insulin resistance. Insulin resistance is linked to an increased risk for several disorders, including type 2 diabetes, hypertension, dyslipidemia (low high-density lipoprotein cholesterol and high triglycerides), and heart disease. This clustering of abnormalities with insulin resistance has been termed metabolic syndrome which is a major cardiac risk factor. Other health related issues include higher risk for depression, cardiovascular disease, elevated cholesterol, and autoimmune thyroid disease.

There is good news though! PCOS responds to lifestyle changes and self care. We will go over some key strategies for self care with PCOS in another blog post. 

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Bani Mohammad, M., & Majdi Seghinsara, A. (2017). Polycystic Ovary Syndrome (PCOS), Diagnostic Criteria, and AMH. Asian Pacific Journal of Cancer Prevention: APJCP, 18(1), 17-21. https//doi.org/10.22034/APJCP.2017.18.1.17.

Briden, L. (2018). Period repair manual: Natural treatment for better hormones and better periods. Greenpeak Publishing. 

Diamanti-Kandarakis, E., Baillargeon, J.-P., Iuorno, M. J., Jakubowicz, D. J., & Nestler, J. E. (2003). A modern MEDICAL quandary: Polycystic OVARY Syndrome, insulin resistance, and oral contraceptive pills. The Journal of Clinical Endocrinology & Metabolism, 88(5), 1927–1932. https://doi.org/10.1210/jc.2002-021528 

McCulloch, F. (2016). 8 Steps to reverse your PCOS: A Proven program to reset your hormones, repair your metabolism and restore your fertility. Greenleaf Book Group Press. 

Shannon, M. M. (2019). Chapter 9: Polycystic Ovary Syndrome (PCOS) & Overweight without PCOS163. In Fertility, cycles & nutrition: Self-care for improved cycles and fertility-- naturally (pp. 163–175). essay, Couple to Couple League International. 

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