Polycystic Ovary Syndrome (PCOS)

Dr. Wei-Wei Wee-Stekly

Senior Consultant Obstetrician & Gynaecologist

MBBS (London), MRCOG (United Kingdom), MMed (O&G) (Singapore), FAMS (Singapore), FRCOG (United Kingdom)

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders affecting women of reproductive age. Yet despite its prevalence, many women remain undiagnosed or confused by its wide range of symptoms. PCOS can affect more than just your menstrual cycle — it can impact your skin, weight, fertility, and even long-term health.

Dealing with irregular periods, unwanted hair growth, or difficulty conceiving can be frustrating and emotionally draining. The good news is, with the right diagnosis and a personalised treatment plan, PCOS can be effectively managed.

What Is PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal condition in which the ovaries produce excess androgens — male hormones that are normally present in small amounts. This hormonal imbalance disrupts the regular ovulation process, which can lead to missed or irregular periods, and the development of small fluid-filled sacs (follicles) around the ovaries.

Despite the name, you do not need to have “cysts” on your ovaries to be diagnosed with PCOS. It is a syndrome — a collection of symptoms and signs — and diagnosis is based on a combination of factors including irregular periods, elevated male hormone levels, and specific ultrasound findings.

What Are the Symptoms of PCOS?

PCOS presents differently in every woman, and symptoms can range from mild to more disruptive. Common symptoms include:

• Irregular or absent periods
• Difficulty conceiving (infertility) due to lack of ovulation
• Excess facial or body hair (hirsutism), especially on the chin, chest, or abdomen
• Oily skin or acne, particularly around the jawline
• Thinning scalp hair or hair loss (androgenic alopecia)
• Weight gain or difficulty losing weight, especially around the abdomen
• Darkened skin patches (acanthosis nigricans), often on the neck or underarms
• Fatigue, mood changes, or low energy levels

Symptoms may worsen with weight gain or may fluctuate with changes in lifestyle or stress.

What Causes PCOS?

The exact cause of PCOS is not fully known, but several contributing factors are believed to play a role:

• Insulin resistance: Most women with PCOS have some degree of insulin resistance, which causes the body to produce more insulin. High insulin levels can stimulate the ovaries to produce more androgens, disrupting ovulation.
• Genetics: PCOS often runs in families, suggesting a genetic component.
• Hormonal imbalance: Elevated luteinising hormone (LH) or androgen levels interfere with the natural menstrual cycle.
• Low-grade inflammation: Women with PCOS may have chronic low-grade inflammation, which contributes to ovarian dysfunction.

How Is PCOS Diagnosed?

There is no single test for PCOS. Diagnosis is usually based on the Rotterdam criteria, which require two of the following three features:

1. Irregular or absent ovulation (resulting in irregular periods)
2. Clinical or biochemical signs of high androgen levels (e.g., hirsutism, acne, blood test results)
3. Polycystic ovaries on ultrasound (ovaries appearing enlarged or with multiple small follicles)

Your doctor may also perform:

• Blood tests to measure hormone levels, insulin, glucose, and cholesterol
• Pelvic ultrasound to assess ovarian appearance
• Thyroid and prolactin tests to rule out other causes of irregular periods

When Should You See a Gynaecologist About PCOS?

You should seek medical advice if you:

• Have irregular or missed periods
• Struggle with acne, excess facial/body hair, or hair loss
• Are trying to conceive without success
• Experience unexplained weight gain or fatigue
• Have a family history of PCOS or related symptoms

Early diagnosis and proactive management can significantly improve symptoms and prevent long-term health issues.

Can PCOS Affect Fertility?

Yes, PCOS is one of the leading causes of female infertility due to irregular or absent ovulation. However, many women with PCOS can conceive — either naturally or with the help of ovulation induction medications or fertility treatments.

With early diagnosis and a treatment plan that supports regular ovulation and hormonal balance, chances of conceiving are significantly improved. Weight management, healthy lifestyle changes, and targeted medical support are often the first steps.

How Is PCOS Treated?

There is no “cure” for PCOS, but symptoms can be managed effectively with a combination of lifestyle changes and medical treatment. Your treatment will depend on your symptoms and goals — for example, whether you're trying to conceive or simply manage hormone-related symptoms.

1. Lifestyle Changes

• Healthy diet: A balanced, low-sugar, low-GI diet can improve insulin sensitivity.
• Regular exercise: Helps reduce insulin resistance and support healthy weight.
• Weight management: Even a slight reduction in weight can sometimes restore ovulation and improve hormone levels.

2. Medications

• Hormonal birth control pills: Help regulate periods, reduce androgens, and improve skin symptoms.
• Progestin therapy: Promotes regular shedding of the uterine lining to prevent endometrial thickening.
• Anti-androgen medications: Such as spironolactone, may help reduce unwanted hair growth.
• Ovulation induction agents: Such as clomiphene citrate or letrozole for women trying to conceive.

3. Fertility Treatments

• Ovulation induction with medication
• Intrauterine insemination (IUI)
• In-vitro fertilisation (IVF) in complex cases

Your gynaecologist will guide you through the most appropriate options based on your individual needs and health status.