Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders in women of reproductive age, affecting 8–13% of women globally and roughly 15% of Jordanian women. It causes a spectrum of issues: irregular periods, acne, excess hair, weight gain, and delayed pregnancy. The ClinicsJo Editorial Team reviews symptoms and treatments.
What Is PCOS?
PCOS is a hormonal disorder characterized by three main features:
- Irregular ovulation: irregular or absent menstrual cycles.
- Elevated androgens: causing excess hair and acne.
- Polycystic ovaries: immature follicles visible on ultrasound.
Common Symptoms
- Irregular periods (>35 days) or absent for months.
- Difficulty or delay in conception.
- Excess facial, chest, and back hair (hirsutism).
- Scalp hair loss (androgenic alopecia).
- Severe acne, especially on the jaw and chin.
- Weight gain, especially around the belly.
- Difficulty losing weight.
- Dark skin in neck folds and armpits (acanthosis nigricans).
- Mood swings and depression.
- Chronic fatigue.
Causes and Risk Factors
- Insulin resistance: most common — elevated insulin stimulates ovaries to produce androgens.
- Genetics: 50% of patients have an affected relative.
- Obesity: worsens resistance.
- Chronic low-grade inflammation.
Diagnosis — Rotterdam Criteria
PCOS is diagnosed when two of three criteria are present:
- Irregular ovulation (cycle >35 days or <8 cycles per year).
- Signs of high androgens (clinical or biochemical).
- Polycystic ovaries on ultrasound (12+ follicles per ovary).
Required Tests
- Ovarian ultrasound (transvaginal preferred).
- Hormone tests: FSH, LH, testosterone, DHEAS, prolactin, TSH.
- Fasting glucose and HbA1c.
- Lipid panel.
- Liver function (to rule out fatty liver).
Long-Term Complications
- Type 2 diabetes (4–7x risk).
- Cardiovascular disease.
- High cholesterol and blood pressure.
- Metabolic syndrome.
- Fatty liver disease.
- Sleep apnea.
- Endometrial cancer (from irregular cycles).
- Depression and anxiety.
Treatment
1. Lifestyle Modification (Foundation)
Losing just 5–10% of body weight dramatically improves symptoms. Includes:
- Low glycemic index diet.
- Reducing refined carbs and sugar.
- Increasing protein and fiber.
- 150 minutes of exercise weekly.
- Strength training 2–3 times weekly.
- 7–8 hours of sleep.
2. Metformin
First-line for insulin resistance. Improves cycles, aids weight loss, and reduces diabetes risk. Dose: 500–2000 mg daily.
3. Combined Oral Contraceptives
For women not currently seeking pregnancy:
- Regulate cycles.
- Lower androgens — improve acne and excess hair.
- Protect the endometrium.
- Preferred types: containing drospirenone or cyproterone acetate.
4. Anti-Androgens
- Spironolactone: for excess hair and acne.
- Finasteride: occasionally for hair.
5. Fertility Treatments
For women wishing to conceive:
- Clomiphene (Clomid): first-line ovulation induction.
- Letrozole (Femara): better than Clomid in PCOS per recent studies.
- Metformin: with Clomid improves results.
- Gonadotropin injections: for resistant cases.
- Ovarian drilling: laparoscopic surgery.
- IVF: last resort.
6. Treating Acne and Excess Hair
- Topical creams.
- Oral isotretinoin.
- Laser hair removal.
- Topical eflornithine (Vaniqa).
7. Helpful Supplements
- Inositol (myo-inositol): improves ovulation and insulin resistance.
- Vitamin D.
- Omega-3.
- Chromium.
- Magnesium.
Medical tip: There's no magic pill for PCOS. Success comes from sustained lifestyle change + tailored medical treatment based on your goals (cycle regulation, pregnancy, or symptom control).
PCOS and Pregnancy
Many women conceive with PCOS, but complication rates are higher:
- Gestational diabetes.
- Pregnancy hypertension and preeclampsia.
- Early miscarriage.
- Preterm birth.
Careful monitoring and pre-pregnancy insulin resistance control significantly improves outcomes.
Recommended Diet in PCOS
- Leafy and colorful vegetables.
- Lean protein (chicken, fish, legumes).
- Whole grains (oats, quinoa, brown rice in moderate amounts).
- Healthy fats (olive oil, nuts).
- Anti-inflammatory spices (turmeric, cinnamon).
- Reduce whole-fat dairy and sugars.
For accurate assessment and a personalized plan, book an appointment with a gynecologist or endocrinologist on ClinicsJo.
