Polycystic ovaries – PCOS (polycystic ovary syndrome)

Polycystic ovaries are one of the most common hormonal disorders in women. Many women experience symptoms for years that affect their physical health, appearance, and emotional well-being, without realizing they stem from this syndrome. Irregular menstrual cycles, skin changes, difficulties with fertility, or sudden changes in body weight are often attributed to other causes, which can delay diagnosis. Timely recognition of symptoms and consulting a doctor allow for better management of the condition and a reduced risk of long-term health complications.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a hormonal disorder in women of reproductive age that affects ovarian function and the process of ovulation. In this condition, there is an increased production of androgens, male sex hormones, which can cause a range of changes in the menstrual cycle, skin, hair, and fertility.

The term “polycystic” comes from the appearance of the ovaries, which in many women contain multiple small follicles visible on ultrasound, although their presence is not required for diagnosis. A typical ultrasound image may show a row of small follicles (“string of pearls”) located just beneath the surface of the ovaries or an ovarian volume greater than 10 cm³. In women with PCOS, follicles often stop developing in the early stage of maturation (preantral phase), which leads to the absence of ovulation and irregular menstruation.

Causes of polycystic ovaries

The exact cause of polycystic ovary syndrome (PCOS) is not fully understood, but research suggests it results from a combination of genetic, hormonal, and metabolic factors. In most women with PCOS, a hormonal imbalance is observed, which includes elevated levels of androgens and disturbances in insulin regulation.

The most commonly recognized risk factors include:

• Genetic predisposition – higher likelihood of occurrence in women whose mothers or sisters have PCOS.
• Insulin resistance – the body’s reduced response to insulin, which can lead to elevated blood sugar and increased androgen production.
• Disorders of the hypothalamus and pituitary gland – organs that regulate hormones involved in ovulation.
• Excess body weight – can worsen symptoms and further disrupt hormonal balance.

Symptoms of PCOS

The symptoms of polycystic ovary syndrome can vary in severity and combination for each woman. The most common include:

• Irregular or absent menstrual cycle – a result of irregular or absent ovulation.
• Excess hair growth (hirsutism) – elevated androgens can cause the growth of dark, coarse hair on the face, chest, abdomen, or back.
• Skin changes – acne and increased oiliness of the skin, especially on the face, chest, and upper back.
• Difficulty conceiving – PCOS is a common cause of infertility in women of reproductive age.
• Weight gain – often accompanied by problems with appetite regulation and metabolism.
• Insulin resistance – reduced sensitivity of the body to insulin, which increases the risk of developing type 2 diabetes.

Complications of untreated PCOS

If polycystic ovary syndrome is not recognized and treated in time, it can lead to various health problems that develop gradually.

• Infertility – as a result of chronic lack of ovulation.
• Type 2 diabetes – due to prolonged insulin resistance and elevated blood sugar.
• Hypertension – increased risk of high blood pressure, especially in overweight women or during pregnancy.
• Blood lipid disorders (dyslipidemia) – elevated LDL and reduced HDL cholesterol, raising the risk of atherosclerosis.
• Cardiovascular diseases – heart and blood vessel conditions occur more often, with a higher risk of stroke and heart attack.
• Sleep apnea – interruptions in breathing during sleep, more common in overweight women, increasing the risk of heart disease and diabetes.
• Endometrial hyperplasia – thickening of the uterine lining, which can increase the risk of endometrial cancer.
• Miscarriage and preterm birth – higher risk during pregnancy.
• Mental health disorders – anxiety, depression, and low self-esteem occur more frequently.

PCOS diagnoses

PCOS is identified through several medical procedures that allow for an accurate diagnosis and a personalized approach to treatment.

• Gynecological examination – taking a medical history and performing a physical exam, including a pelvic exam to assess the condition of the ovaries and other reproductive organs.
• Ovarian ultrasound – visualization of the ovaries to detect cysts or other changes; most commonly a transvaginal scan to evaluate ovarian volume and endometrial thickness.
• Laboratory tests, which may include:
  • complete blood count,
  • analysis of sex hormones (testosterone, progesterone, estrogen – LH, FSH, estradiol, prolactin),
  • analysis of ovarian tumor markers (CA125, HE4, ROMA index),
  • blood sugar testing,
  • thyroid hormones (TSH, T3, fT3, T4, fT4).
• Endocrinologist consultation – evaluation of possible endocrine disorders, including insulin resistance, and further guidance for treatment.

How PCOS is treated

Treatment is tailored to the needs of each patient and depends on whether the goal is to regulate the cycle, relieve symptoms, plan pregnancy, or reduce metabolic risk.

• Lifestyle changes – a balanced diet with limited intake of sugar and refined carbohydrates, regular physical activity, and maintaining a healthy body weight.
• Medication therapy – drugs to regulate menstruation, treatments to lower androgen levels in order to reduce acne and excessive hair growth, and metformin for insulin resistance.
• Fertility support – ovulation stimulation for women who want to become pregnant, monitoring ovulatory cycles, and providing guidance for conception planning.
• Additional therapeutic options – supplements such as vitamin D, omega-3 fatty acids, and myo-inositol, as well as relaxation techniques and stress management methods.

Regular checkups and therapy adjustments allow for long-term control of symptoms and reduce the risk of complications.

Polycystic ovaries and pregnancy

Polycystic ovary syndrome can make conception more difficult, but with proper treatment and monitoring, many women are able to become pregnant and carry a pregnancy to term successfully. Hormonal imbalance and irregular ovulation are the main reasons for reduced fertility in this condition.

• Ovulation difficulties – absence or irregularity of ovulation lowers the chances of natural conception.
• Increased pregnancy risks – women with PCOS have a higher likelihood of developing gestational diabetes, high blood pressure, and preeclampsia.
• Fertility improvement options – ovulation stimulation with medication, lifestyle changes, and treatment of insulin resistance can increase the chances of pregnancy.
• Monitoring during pregnancy – regular checkups and an individualized care plan help protect the health of both mother and baby.

With proper preparation and professional support, pregnancy in women with PCOS can progress without complications and result in the birth of a healthy child.

Outlook and next steps for PCOS

Polycystic ovaries don’t have to define your quality of life, but they can affect how you care for your health. Knowing your body, tracking changes, and openly communicating with your doctor help you stay actively involved in your treatment. Small, consistent lifestyle changes and regular health checkups can bring long-term results. Timely and accurate diagnostics are the first step toward better symptom control — for this, IntroLab in Belgrade can assist you, where all necessary tests for assessing hormonal status and overall health can be performed. Every woman with polycystic ovaries has her own unique journey, and with the right support and accurate information, it is possible to live a fulfilling, healthy, and high-quality life.