Why does polycystic ovary syndrome occur and how is it detected

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age.
According to statistics, this condition is diagnosed in 5–15% of women, but many are not even aware of having the problem.

At the ZDRAVO Medical Center in Mykolaiv, we regularly receive questions from patients about what PCOS is, why it occurs, and how to recognize it at an early stage.

WHAT IS POLYCYSTIC OVARY SYNDROME

PCOS is not just the presence of cysts on the ovaries, but a complex hormonal disorder that affects the entire female body.

MEDICAL DEFINITION OF PCOS

Polycystic ovary syndrome is an endocrine disorder characterized by:

• Ovulation disorders or complete absence of ovulation.
• Elevated levels of male sex hormones (androgens).
• Specific structural changes in the ovaries detected by ultrasound.
• Metabolic disorders (insulin resistance, excess body weight).

Unlike isolated functional cysts that may appear and disappear naturally, polycystic ovary syndrome is a chronic condition that requires medical monitoring and correction.

WHAT DO POLYCYSTIC OVARIES LOOK LIKE

During an ultrasound examination, the doctor may observe:

• Enlarged ovaries (volume over 10 cm³).
• Multiple small follicles (12 or more) measuring 2–9 mm.
• Thickened ovarian capsule.
• Increased density of stromal tissue.

It is important to understand that polycystic ovarian morphology on ultrasound is only one diagnostic criterion and not a definitive diagnosis.

CAUSES OF POLYCYSTIC OVARY SYNDROME

The exact causes of PCOS are not fully understood, but modern medicine identifies several key factors that influence its development.

GENETIC PREDISPOSITION

Studies show that the development of PCOS is often associated with heredity:

• If the mother has PCOS, the daughter’s risk increases by 50%.
• The syndrome is often observed in sisters.
• Certain genes that increase susceptibility to PCOS have been identified.

Genetic predisposition does not guarantee the development of the syndrome, but it requires greater attention to prevention and early diagnosis.

INSULIN RESISTANCE

One of the main mechanisms of PCOS development is impaired tissue sensitivity to insulin.

Mechanism of development:

• Cells become less sensitive to insulin.
• The pancreas compensates by producing more insulin.
• High insulin levels stimulate the ovaries to produce androgens.
• Excess androgens disrupt follicle maturation.
• Chronic anovulation develops.

Insulin resistance is diagnosed in 50–70% of women with PCOS, even in those with normal body weight.

HORMONAL IMBALANCE

Hormones affected in PCOS:

Increased levels:

• Testosterone (free and total)
• Androstenedione
• DHEA-S (dehydroepiandrosterone sulfate)
• LH (luteinizing hormone)
• Insulin
• Prolactin (in some cases)

Decreased levels:

• FSH (follicle-stimulating hormone)
• Progesterone (due to absence of ovulation)
• SHBG (sex hormone-binding globulin)

Disrupted ratio:

• LH/FSH greater than 2.5–3 (normal range: 1.5–2)

These hormonal changes create a vicious cycle that maintains the manifestations of the syndrome.

CHRONIC INFLAMMATION

Recent studies show that women with PCOS often have:

• Elevated C-reactive protein levels.
• Increased pro-inflammatory cytokines.
• Markers of chronic low-grade inflammation.

This inflammation can be both a cause and a consequence of hormonal disorders.

STRESS AND LIFESTYLE

Triggering factors for PCOS development include:

• Chronic stress and sleep disturbances.
• Sedentary lifestyle.
• Excessive physical activity (especially in professional athletes).
• Unbalanced diet with a predominance of simple carbohydrates.
• Vitamin D deficiency.

POLYCYSTIC OVARY SYNDROME: SYMPTOMS AND MANIFESTATIONS

Symptoms of PCOS can be diverse and not always obvious. Many women remain unaware of the condition for years.

MENSTRUAL CYCLE DISORDERS

The most common reproductive signs of PCOS include:

Oligomenorrhea (infrequent menstruation):

• Menstrual cycles longer than 35 days.
• 8 or fewer menstrual periods per year.
• Irregular and unpredictable cycles.

Amenorrhea (absence of menstruation):

• Primary — menstruation has not started before the age of 16.
• Secondary — absence of menstruation for more than 3–6 months after cycles were established.

Uterine bleeding:

• Heavy and prolonged menstruation.
• Intermenstrual bleeding.
• Irregular spotting.

These disorders are associated with absence of ovulation and insufficient progesterone production.

HIRSUTISM AND OTHER MANIFESTATIONS OF HYPERANDROGENISM

Symptoms related to elevated male hormones include:

Hirsutism — excessive hair growth in a male pattern:

• Face (upper lip, chin, cheeks).
• Chest and abdomen (along the midline).
• Back and buttocks.
• Inner thighs.

Skin manifestations:

• Acne on the face, back, and chest.
• Oily skin and seborrhea.
• Darkening of the skin in natural folds (acanthosis nigricans).

Alopecia:

• Hair loss on the scalp in a male pattern.
• Thinning of hair in the temporal and parietal areas.

WEIGHT-RELATED PROBLEMS

Metabolic symptoms of PCOS include:

• Overweight or obesity (40–60% of cases).
• Abdominal (central) obesity.
• Difficulty losing weight even with dieting.
• Rapid weight gain.

Important: about 30–40% of women with PCOS have normal body weight, so the absence of excess weight does not exclude the diagnosis.

INFERTILITY AND CONCEPTION PROBLEMS

PCOS is one of the leading causes of anovulatory infertility:

• Inability to conceive after one year of regular unprotected intercourse.
• Rare ovulation (2–3 times per year instead of 12–13).
• Increased risk of early miscarriage.
• Pregnancy complications (gestational diabetes, preeclampsia).

PSYCHOLOGICAL AND EMOTIONAL SYMPTOMS

Nervous system manifestations of PCOS include:

• Depressive states.
• Increased anxiety.
• Mood swings.
• Decreased self-esteem due to appearance changes.
• Sleep disturbances.
• Chronic fatigue syndrome.

These symptoms are partly related to hormonal imbalance and partly to psychological stress caused by other manifestations.

ADDITIONAL SYMPTOMS

Other possible manifestations include:

• Lower abdominal pain (not always).
• Painful menstruation (if present).
• Increased appetite and cravings for sweets.
• Dark skin patches.
• Multiple skin tags.

HOW TO RECOGNIZE POLYCYSTIC OVARY SYNDROME

Early recognition of PCOS is crucial for timely treatment and prevention of complications.

EARLY WARNING SIGNS

Pay attention to the following changes:

In adolescence:

• Delayed onset of menstruation (after 15–16 years).
• Irregular cycles for 2–3 years after menarche.
• Sudden onset of acne resistant to standard treatment.
• Rapid weight gain without obvious cause.
• Appearance of dark fine hair above the upper lip.

In reproductive age:

• Gradual increase in intervals between menstruations.
• Changes in hair growth pattern.
• Weight problems.
• Unsuccessful attempts to conceive.

WHEN TO SEE A GYNECOLOGIST

Do not wait for severe symptoms.

Urgent reasons for consultation:

• Absence of menstruation for more than 3 months.
• Sudden changes in menstrual patterns.
• Uterine bleeding.
• Inability to conceive for one year.

Planned consultation is recommended in case of:

• Irregular cycles (longer than 35 days or shorter than 21 days).
• Appearance of hirsutism.
• Progressive acne in adulthood.
• Rapid weight gain without dietary changes.
• Hair loss.

At the ZDRAVO Medical Center in Mykolaiv, you can receive a gynecologist consultation, where the doctor will conduct an initial examination, take medical history, and prescribe necessary tests.

HOW PCOS IS DIAGNOSED

Diagnosis of PCOS requires a comprehensive approach and is based on criteria approved by international medical organizations.

ROTTERDAM DIAGNOSTIC CRITERIA

According to the Rotterdam criteria, a diagnosis of PCOS requires at least 2 of the following 3 criteria:

• Oligo-ovulation or anovulation (irregular or absent menstruation).
• Clinical or laboratory signs of hyperandrogenism (hirsutism, acne, elevated androgen levels).
• Polycystic ovaries on ultrasound (12 or more follicles measuring 2–9 mm in one ovary or ovarian volume greater than 10 cm³).

Other conditions with similar symptoms must be excluded (hyperprolactinemia, congenital adrenal hyperplasia, tumors).

ULTRASOUND DIAGNOSIS

Ultrasound examination is a key visualization method.

The ultrasound specialist evaluates:

• Ovarian size (volume, length, width, thickness).
• Number of antral follicles.
• Follicle distribution (peripheral or diffuse).
• Thickness of the ovarian capsule.
• Stromal echogenicity.
• Endometrial condition.

Optimal timing for ultrasound: days 3–5 of the menstrual cycle (with regular cycles).

At ZDRAVO, pelvic ultrasound is performed using modern equipment, providing detailed information about the reproductive system.

LABORATORY TESTS FOR SUSPECTED PCOS

Laboratory tests are an essential part of the diagnostic process.

Mandatory hormonal tests include:

At ZDRAVO, all necessary tests can be performed at a convenient time, with results available as quickly as possible.

ADDITIONAL EXAMINATIONS

To obtain a complete diagnostic picture, the following may be required:

Instrumental studies:
• Thyroid ultrasound.
• Adrenal ultrasound (in case of elevated DHEA-S).
• Pituitary MRI (in case of elevated prolactin).

Consultations with related specialists:

• Endocrinologist — for metabolic disorders.
• Dermatologist — for severe acne.

WHAT TO DO AFTER DIAGNOSIS CONFIRMATION

Treatment of PCOS is individualized and depends on symptoms, age, and pregnancy plans.

MAIN TREATMENT DIRECTIONS

1. Lifestyle modification:
   • Weight normalization (even a 5–10% reduction improves symptoms).
   • Regular physical activity.
   • Balanced nutrition.
   • Stress management.

2. Medication therapy:
   • Combined oral contraceptives (for cycle regulation).
   • Metformin (for insulin resistance).
   • Antiandrogens (for hirsutism and acne).
   • Ovulation induction medications (when planning pregnancy).

3. Symptomatic treatment:
   • Cosmetic procedures for hirsutism correction.
   • Dermatological treatment of acne.
   • Psychological support.

DIET FOR POLYCYSTIC OVARY SYNDROME

Diet plays a key role in symptom control.

Dietary principles:

• Low glycemic index foods.
• Limitation of simple carbohydrates.
• Adequate protein intake.
• Healthy fats (omega-3).
• High fiber intake.

Recommended foods:

• Lean meat and fish.
• Vegetables (except potatoes).
• Whole grains.
• Legumes.
• Nuts and seeds.
• Avocado.

Foods to limit:

• White bread and pastries.
• Sweets and confectionery.
• Sugary drinks.
• Fast food.
• Saturated fats.

CAN PCOS BE CURED

PCOS is a chronic condition that cannot be completely cured.
However, symptoms can be successfully controlled.

With proper management:

• Quality of life remains high.
• Many women with PCOS successfully conceive and give birth to healthy children.

Effective PCOS control includes:

• Regular follow-up with a gynecologist-endocrinologist.
• Adherence to lifestyle recommendations.
• Ongoing medication therapy when indicated.
• Monitoring of metabolic indicators.
• Prevention of complications (diabetes, cardiovascular diseases).

POSSIBLE COMPLICATIONS OF PCOS

Without proper control, PCOS may lead to serious consequences.

Metabolic complications:

• Type 2 diabetes mellitus (4 times higher risk).
• Metabolic syndrome.
• Non-alcoholic fatty liver disease.
• Cardiovascular diseases.
• Arterial hypertension.

Reproductive complications:

• Infertility.
• Recurrent pregnancy loss.
• Pregnancy complications.
• Endometrial hyperplasia.
• Increased risk of endometrial cancer.

Psychological consequences:

• Depression.
• Eating disorders.
• Social isolation.
• Reduced quality of life.

PREVENTION AND PROGNOSIS

RISK GROUPS

Special attention is required if you have:

• Relatives with PCOS.
• Overweight or obesity.
• Family history of diabetes.
• Irregular menstruation since adolescence.

PREVENTIVE MEASURES

• Maintaining a healthy weight.
• Regular physical activity.
• Balanced diet.
• Stress control.
• Regular preventive gynecological examinations.

PROGNOSIS

With timely diagnosis and appropriate treatment, the prognosis is favorable:

• Symptoms are successfully controlled.
• Most women can conceive (sometimes with medical assistance).
• The risk of complications is minimized.
• Quality of life remains high.

Conclusion

Polycystic ovary syndrome is not a sentence, but a manageable condition that requires attention and the right approach. Understanding what polycystic ovary syndrome is, how PCOS develops, and how to recognize it at early stages will help you seek medical care in time and avoid complications.
Modern medicine offers effective tools for managing PCOS. The key is not to ignore symptoms and to undergo regular examinations.

At the ZDRAVO Medical Center in Mykolaiv, we are ready to support you at every stage — from initial diagnosis to the development of an individualized treatment plan.
Remember: early detection and proper treatment of PCOS allow women to lead full lives, successfully conceive, and maintain good health for many years.