Polycystic ovary syndrome (PCOS): understanding, diagnosing, treating

It is a hormonal and metabolic disorder: the ovaries ovulate little or irregularly, and the body produces an excess of hormones called androgens ("male" hormones). The "cysts" of polycystic ovaries are not true cysts to be operated on: they are small immature follicles that build up because ovulation does not take place.

They vary a great deal from one woman to another:

• long cycles (over 35 days) or absent periods;
• acne, oily skin;
• more or thicker hair (face, chin, abdomen);
• hair loss;
• weight gain, especially around the abdomen, and difficulty losing weight;
• difficulty conceiving;
• tiredness, sometimes anxiety or low mood.

It is generally based on two criteria out of three, once other causes are excluded:

• irregular or absent ovulation;
• signs of excess androgens, visible or measured by a blood test;
• ovaries that look polycystic on ultrasound.

Having ovaries that look polycystic on ultrasound is not enough to speak of PCOS: it is common in women with no disorder at all. In adolescents, the diagnosis is made more cautiously.

The doctor examines you, measures weight and blood pressure, and looks for signs of excess androgens. A pelvic ultrasound, often endovaginal, studies the ovaries and uterus. A hormone blood test (androgens, thyroid, prolactin, depending on the case) rules out other causes, and a metabolic check (blood sugar, lipids) assesses the associated risk.

Beyond the daily discomfort, PCOS has consequences worth knowing:

• on fertility, because ovulation is irregular;
• on metabolic health: a higher risk of type 2 diabetes, cholesterol and blood pressure problems;
• on the uterus: when periods are very rare, the lining can thicken, hence the value of regulating the cycle;
• on mood and self-confidence.

It is personalised, according to your symptoms, your age and your plans for pregnancy:

• lifestyle: a balanced diet, regular physical activity; modest weight loss often improves cycles and ovulation;
• regulating the cycle and protecting the uterine lining, with a pill or a progestogen;
• treating the signs of excess androgens (acne, hair), with certain pills or specific treatments, never during pregnancy;
• in some cases, a medicine that improves sensitivity to insulin;
• regular metabolic follow-up.

Ovulation can be stimulated with medicines, with ultrasound monitoring to avoid excessive stimulation and multiple pregnancies. The couple's work-up is carried out in parallel. If these measures are not enough, other assisted reproduction techniques may be offered, the laboratory steps being done in a specialised centre with which follow-up is coordinated.

PCOS is the result of no fault of yours. It is a chronic disorder, but its signs can be well controlled and change with age. Regular follow-up, clear information and, if needed, psychological support make it possible to live with it calmly.