polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, marked by a combination of androgen excess, irregular or absent ovulation, and ovaries that often contain many small underdeveloped follicles. It sits at the crossroads of reproductive and metabolic endocrinology, which is part of why it is so common yet so varied in presentation.

The hormonal picture typically involves elevated androgens, which cause acne, excess facial or body hair, and sometimes scalp hair thinning, together with cycles that are long, unpredictable, or missing because ovulation fails. A central player is insulin resistance: high insulin levels stimulate the ovarian theca cells to make more androgens and reduce the liver's production of SHBG, raising free androgen even further. This links PCOS to a higher long-term risk of type 2 diabetes.

Diagnosis usually rests on meeting two of three criteria — clinical or biochemical androgen excess, irregular ovulation, and polycystic-appearing ovaries on ultrasound — after excluding other causes. A crucial caveat: the polycystic ovaries are not truly cysts but arrested small follicles, and the name overemphasizes the ovarian appearance; many experts argue the metabolic and androgen features matter more. Management targets the dominant problem, whether irregular cycles, fertility, excess hair, or metabolic risk, rather than a single cure.