Polycystic Ovary Syndrome (PCOS)
Overview
Polycystic Ovary Syndrome (PCOS) is a hormone signaling condition that can affect ovulation, metabolism, and long-term health. While it is often diagnosed during the reproductive years, PCOS is not limited to fertility concerns alone.
PCOS is best understood as a condition involving disrupted communication between hormones, particularly insulin, ovarian hormones, and androgens, which can interfere with normal follicle development and ovulation.
At Reproductive Health Medicine & Gynecology (RHM), we approach PCOS through the Restorative Reproductive Medicine approach. Our focus is on understanding and addressing underlying contributors to hormone disruption rather than suppressing symptoms. We do not provide IVF or IUI.
Quick Answers About PCOS
What is PCOS?
PCOS is a hormonal condition involving altered hormone signaling that often affects ovulation and metabolic regulation.
Can you have PCOS without ovarian cysts?
Yes. Polycystic ovaries on ultrasound are not required for a diagnosis of PCOS.
Does PCOS always cause infertility?
No. Many women with PCOS ovulate intermittently or respond well when underlying contributors are addressed.
Is PCOS only a reproductive condition?
No. PCOS can influence metabolic, cardiovascular, and long-term health beyond the reproductive years.
What Are the Symptoms of PCOS?
Because PCOS is a syndrome, symptoms vary from person to person and may change over time. Common patterns include:
Irregular or absent menstrual cycles (oligo-ovulation or anovulation)
Difficulty identifying ovulation
Excess hair growth (hirsutism), often on the face, chest, or inner thighs
Acne or oily skin
Thinning hair or male-pattern hair loss
Changes in weight distribution, often with increased central adiposity
Difficulty conceiving
Fatigue, mood changes, and blood sugar instability
Not all individuals experience the same symptoms, and symptom severity does not always reflect underlying hormone disruption.
How Is PCOS Diagnosed?
PCOS is diagnosed clinically, based on a combination of menstrual cycle patterns, hormone levels, and imaging when appropriate.
A diagnosis typically requires two of the following three criteria:
Irregular or absent menstrual cycles due to oligo- or anovulation
Elevated androgens (such as testosterone or DHEA), which may present as acne, excess hair growth, or hair thinning
Polycystic ovarian morphology on ultrasound, reflecting multiple small follicles that have not progressed to ovulation
Diagnosis is individualized and should account for age, clinical presentation, and exclusion of other conditions that can mimic PCOS.
Why Does PCOS Develop?
PCOS is multifactorial and develops due to a combination of hormonal, metabolic, genetic, and environmental influences. Common contributors include:
Insulin resistance, which can stimulate excess androgen production and impair ovulation
Elevated androgens, which interfere with normal follicle maturation
Chronic low-grade inflammation, which can disrupt hormone signaling
Stress-related hormone changes, including altered cortisol rhythms
Genetic predisposition, which influences susceptibility
These factors often interact rather than acting in isolation, which is why PCOS can look different from one person to another.
Long-Term Health Considerations in PCOS
PCOS can be associated with long-term health considerations, particularly when ovulation is absent for extended periods. These may include:
Challenges with ovulation and fertility
Insulin resistance and Type 2 diabetes
Cardiometabolic risk factors
Mood disorders such as anxiety or depression
Endometrial overgrowth when estrogen is unopposed by regular ovulation
Understanding PCOS as a whole-body condition - not only a reproductive one - allows for more comprehensive and forward-looking care.
Our Restorative Approach to PCOS
Our approach to PCOS centers on restoring healthy hormone communication and ovulation rather than suppressing symptoms.
Care is guided by careful evaluation of:
Menstrual cycle patterns and ovulatory function
Metabolic health and insulin regulation
Thyroid function
Inflammatory patterns
Sleep and stress physiology
Because PCOS is heterogeneous, care is individualized and timelines vary. Our goal is to seek understanding first, then intervene thoughtfully and proportionately.
PCOS Resources
We regularly update this page as new educational resources are published.
What we mean by hormone reset
PCOS and inflammation
PCOS and sleep
Thyroid health and PCOS
Restorative fertility care in PCOS
PCOS across midlife: perimenopause and menopause
Frequently Asked Questions
Can PCOS improve over time?
Hormone patterns can change over time, especially when contributing factors are identified and addressed.
Do I need to be trying to conceive to address PCOS?
No. PCOS care is important for overall health, regardless of pregnancy intentions.
Does birth control treat PCOS?
Hormonal suppression may manage certain symptoms but does not address underlying hormone signaling or restore ovulation.
Is PCOS something I will always have?
PCOS reflects a tendency toward certain hormone patterns. With appropriate care, many individuals experience meaningful improvement in symptoms and cycle function.
References: