Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a hormonal condition that affects women of reproductive age, often leading to irregular menstrual cycles, elevated androgen levels, and multiple small ovarian cysts. It can impact metabolism and increase the risk of long-term health issues, including diabetes, cardiovascular disease, and fertility challenges.

Dr. Harvard Lin

Obstetrician & Gynaecologist

MBBS (SG) | MRCOG (UK) | MMed (OBGYN) (SG)

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of PCOS

PCOS symptoms vary among individuals, with some experiencing mild effects and others more pronounced changes.

Irregular Menstrual Cycles

Periods may be infrequent (fewer than eight times per year), absent for several months, or highly unpredictable due to disrupted ovulation.
Excess Hair Growth

Dark, coarse hair may develop on the face, chest, back, or other areas where men typically grow hair, caused by elevated androgen levels.
Acne

Persistent acne on the face, chest, and upper back may be resistant to standard treatments due to increased oil production from hormonal imbalances.
Weight Changes

Weight gain, especially around the midsection, is common and often difficult to manage with conventional weight-loss methods due to insulin resistance.
Hair Loss

Thinning hair or male-pattern baldness on the scalp may occur as a result of elevated androgen levels, often progressing over time.
Skin Darkening

Dark, velvety patches of skin, known as acanthosis nigricans, may appear in body folds, particularly around the neck, groin, and under the breasts, often linked to insulin resistance.

Causes and Risk Factors

Multiple factors contribute to the development of PCOS, often interacting to disrupt hormonal balance and metabolic function.

Genetic Predisposition

A family history of PCOS or type 2 diabetes increases susceptibility, suggesting a hereditary component in hormone regulation and insulin function.

Insulin Resistance

A reduced ability of the body to respond to insulin leads to elevated blood sugar and insulin levels. This can stimulate excess androgen production and disrupt ovulation.

Chronic Inflammation

Persistent low-grade inflammation may contribute to increased androgen levels, further affecting ovarian function and metabolic health.

Excess Androgen Production

Overproduction of androgens by the ovaries interferes with ovulation, leading to irregular periods, excess hair growth, and acne.

Diagnostic Methods

Physical Examination: Includes measuring blood pressure, BMI, and waist circumference while assessing visible signs such as excess hair growth, acne, or skin changes. This helps establish a baseline health status and identify common PCOS symptoms.
Blood Tests: Analyse hormone levels, including testosterone, DHEA, FSH, LH, and prolactin, to detect imbalances. Additional tests evaluate insulin resistance, cholesterol levels, and thyroid function to rule out other conditions with similar symptoms.
Pelvic Ultrasound: Evaluates ovarian appearance and uterine lining thickness. The scan detects multiple small follicles and increased ovarian volume, which are key indicators of PCOS.
Medical History Review: Examines menstrual patterns, weight fluctuations, and family history of PCOS or related conditions to track symptom progression and identify potential risk factor.

Treatment Options

PCOS management is personalised to address symptoms, restore hormonal balance, and support long-term health.

Non-Surgical Treatment

Lifestyle Modifications: Regular physical activity and a well-balanced diet help regulate blood sugar levels, manage weight, and improve insulin sensitivity. These changes can promote hormonal balance, regulate menstrual cycles, and reduce symptoms such as excess hair growth and acne.

Hormonal Medications: Birth control pills or progestin therapy help stabilise hormone levels, regulate menstrual cycles, and lower androgen production. This can lead to improved skin health, reduced hair growth, and a lower risk of endometrial issues associated with irregular periods.

Insulin-Sensitising Medications: Metformin may be prescribed to improve insulin resistance, a common feature of PCOS. It helps regulate blood sugar levels, supports weight management, and in some cases, restores ovulation, improving fertility outcomes.

Surgical Treatment

Ovarian Drilling: This laparoscopic procedure involves creating small punctures in the ovaries using heat or laser to reduce androgen production. By lowering androgen levels, ovarian drilling may help restore regular ovulation in women who have not responded to medication. While effective for some, the benefits are not permanent, and the procedure is generally reserved for those with fertility challenges.

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Prevention and Management

While PCOS cannot be prevented, proper management reduces complications and improves quality of life. Regular monitoring of blood sugar, blood pressure, and cholesterol levels helps detect potential health issues early. A combination of consistent medication use, regular physical activity, and a balanced diet maintains symptom control. Working with healthcare providers to adjust treatment plans ensures optimal management of the condition.

Frequently Asked Questions (FAQ)

Does PCOS increase cancer risk?

Women with PCOS have a higher risk of endometrial cancer due to irregular periods and prolonged exposure to unopposed oestrogen. Regular monitoring and appropriate treatment help reduce this risk.

Will PCOS symptoms improve after menopause?

Symptoms like irregular periods and fertility issues naturally resolve after menopause. However, metabolic aspects of PCOS may continue and require ongoing management to prevent cardiovascular complications.

Is PCOS the same as having ovarian cysts?

No, PCOS is a hormonal disorder, while ovarian cysts can occur for various reasons in women without PCOS. The term “polycystic” refers to the small, fluid-filled follicles seen on the ovaries during an ultrasound, but not all women with PCOS develop these cysts.

Dr. Harvard Lin

Obstetrician & Gynaecologist

MBBS (SG)|MRCOG (UK)|MMed (OBGYN) (SG)

Dr. Lin has a clinical focus on female pelvic medicine and reconstructive surgery, encompassing the management of urinary incontinence, overactive bladder, and prolapse.

Dr. Lin completed his medical training at the National University of Singapore and obtained advanced certifications in Obstetrics and Gynaecology. He is a Member of the Royal College of Obstetricians and Gynaecologists in the UK.
Dr. Lin serves as a clinical tutor at NUS and contributes to laparoscopic and pelvic floor workshops. His research includes stem cell therapy, synthetic meshes, and translational medicine, with publications in peer-reviewed journals and textbooks.

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