Polycystic ovary syndrome, known as PCOS, is the most common hormonal disorder in women of reproductive age. It shows up as a combination of irregular or infrequent periods, signs of excess male hormones such as acne and excess hair, and sometimes difficulty conceiving and a tendency to gain body mass. Many women live for years with the symptoms without connecting them, and reach a diagnosis only when they try to become pregnant. It is worth seeing a gynecologist when periods come more than thirty-five days apart or fewer than eight times a year, when acne and excess hair appear and do not clear, or when pregnancy is delayed beyond a year of trying.
What happens in the body in polycystic ovary syndrome
In every cycle one follicle in the ovary is meant to mature and release an egg. In this syndrome the hormonal balance is disturbed: the ovaries produce more male hormones than usual, ovulation does not happen regularly, and many follicles stall at an early stage of their development. These small follicles are the “cysts” that give the syndrome its name, although they are not cysts in the usual sense and do not need to be removed.
A central factor in many women is insulin resistance: the body responds less to the hormone that regulates sugar, the pancreas secretes more of it, and the high insulin levels increase the production of male hormones in the ovary. This creates a cycle that also explains the tendency to gain body mass and the increased risk of diabetes later in life. The tendency to the syndrome runs strongly in families.
The common symptoms
The picture differs from woman to woman, and not all the symptoms need to appear together:
- Irregular periods: cycles longer than five weeks, no period for months, or unexpected bleeding.
- Persistent acne, mainly along the lower jaw, the neck and the back, that does not respond to the usual treatment.
- Excess hair on the face, chest, abdomen and back, and sometimes thinning hair on the scalp in a male pattern.
- Gain in body mass, mainly around the abdomen, and difficulty losing it.
- Dark, velvety patches on the skin of the neck, armpits or groin, a sign of insulin resistance.
- Difficulty conceiving because of infrequent ovulation.
- Low mood, anxiety and sleep problems, which are more common in women with the syndrome.
Some women with the syndrome are slim and have almost regular periods, and in them the syndrome is discovered during a fertility work-up or because of stubborn acne. The absence of excess body mass does not rule out the diagnosis.
The symptoms also change over life: in teenagers acne and irregularity stand out, in the twenties and thirties difficulty conceiving joins them, and later the metabolic risks move to the fore. The same woman may therefore need different treatment at each stage.
How the syndrome is diagnosed
There is no single test that establishes the diagnosis. The doctor relies on a combination of three elements: infrequent or absent ovulation that shows up as irregular periods, clinical or laboratory signs of excess male hormones, and a typical appearance of the ovaries on ultrasound. Two of the three are enough, once other causes of a similar picture have been ruled out, such as a thyroid disorder, excess of the hormone prolactin or a disorder of the adrenal gland.
The work-up therefore includes blood tests for hormones, taken at a particular time in the cycle, and a pelvic ultrasound to which the doctor refers as needed. In teenage girls in the first years after their first period the doctor is cautious with the diagnosis, because irregular periods and ovaries with many follicles are normal at that age.
When to see a gynecologist
It is worth booking a visit with a private gynecologist in Modi’in in these situations:
- Periods that come more than thirty-five days apart, or fewer than eight times a year.
- No period for three months or more, when you are not pregnant.
- Acne that does not improve after standard skin treatment, especially when it comes with excess hair.
- New or worsening excess hair on the face and body, or thinning hair on the scalp.
- Difficulty conceiving after a year of trying, or after six months over the age of thirty-five.
- Rapid gain in body mass together with irregular periods.
- Dark patches on the skin of the neck or the armpits.
- A family history of the syndrome or of diabetes, together with one of the symptoms.
Very heavy or prolonged menstrual bleeding, sharp pain in the lower abdomen or a missed period with a positive pregnancy test require prompt medical attention, regardless of the syndrome.
What the gynecologist checks
The visit begins with a detailed conversation: the pattern of your periods since puberty, changes in body mass, acne and hair, plans for pregnancy, medicines and family history. Then a physical examination that includes blood pressure, waist measurement and an assessment of signs of excess male hormones.
It helps to come to the visit with a record of your period dates over the past months, which can be taken from a phone app, with results of previous blood tests and with a list of the medicines and supplements you take, including the pill. A record like this saves time and lets the doctor see the pattern over time instead of relying on memory.
The doctor refers you for hormonal blood tests and metabolic tests, including fasting sugar or a glucose tolerance test, blood lipids and thyroid function, and as needed for a pelvic ultrasound. The purpose of the work-up is twofold: to confirm the diagnosis and rule out other causes, and also to map the associated risks, mainly insulin resistance and prediabetes, which can be treated early. When necessary, the doctor involves an endocrinologist or a dermatologist in the care.
How the syndrome is treated
Treatment is tailored to the symptom that bothers you and to your stage of life, and there is no single medicine that suits everyone. For many women the foundation is a change of lifestyle: regular physical activity, a balanced diet with fewer simple sugars, and enough sleep. Even a moderate loss of body mass, when there is an excess, restores ovulation in many women and improves acne and the metabolic measures.
When pregnancy is not wanted at this stage, the combined pill regulates periods, protects the lining of the uterus and reduces acne and excess hair. For excess hair there are also medicines that block the action of male hormones, alongside hair removal. When there is insulin resistance, the doctor may suggest a medicine that improves sensitivity to insulin.
When the goal is pregnancy, treatment is aimed at inducing ovulation with medicines, with follicle monitoring, and most women with the syndrome succeed in conceiving with treatment of this kind. When pregnancy is still delayed, the work-up continues to a broader fertility evaluation of both partners.
Why diagnosis and follow-up matter even when the symptoms are tolerable
The syndrome is a condition of the whole body, not only of the ovaries. Women with the syndrome are at increased risk of diabetes, high blood pressure, a disturbance of blood lipids and fatty liver, and when periods are infrequent for many years the lining of the uterus does not shed as it should and may thicken. Periodic follow-up, even when the symptoms themselves are not bothersome, makes it possible to identify these risks early and treat them simply.
At EliteMed in the Ayala 360 complex in Modi’in you can book a visit with a specialist gynecologist without a referral, and the consultation can be held in English. If pregnancy is delayed, read our guide to fertility evaluation for couples in Israel. The information here is general and does not replace an examination and advice from a doctor.
Frequently asked questions
Can I become pregnant with polycystic ovary syndrome?
Yes. The syndrome is a common cause of delayed pregnancy because of infrequent ovulation, but most women with the syndrome succeed in conceiving, some after lifestyle changes alone and some with medicines that induce ovulation under a doctor’s supervision. When pregnancy is still delayed despite treatment, the work-up continues to a fertility evaluation of both partners.
Are the cysts on the ovaries dangerous and do they need to be removed?
No. The “cysts” in the syndrome are small follicles that stalled in their development, not tumours and not cysts that require surgery. They do not burst and do not cause pain, and treatment is aimed at the hormonal balance and the symptoms, not at removing the follicles.
Do only women with excess body mass have the syndrome?
No. A considerable share of women with the syndrome have a normal body mass, and in them the syndrome is usually discovered because of irregular periods, stubborn acne or during a fertility work-up. Excess body mass worsens the symptoms but is not a condition for the diagnosis.
Does the syndrome go away on its own with age?
The syndrome is a chronic condition, but its expression changes over life. In many women periods become more regular towards the age of forty, while the metabolic risk of diabetes and lipid disturbances remains and requires follow-up. So even when the gynecological symptoms settle, it is worth continuing with periodic check-ups.
What is the difference between ordinary irregular periods and the syndrome?
Irregular periods can result from stress, a sharp drop in body mass, strenuous exercise, a thyroid disorder or excess prolactin. In the syndrome the irregularity is joined by signs of excess male hormones or a typical appearance of the ovaries, once the other causes have been ruled out. The distinction is made with blood tests and an ultrasound to which the doctor refers.