Polycystic ovary syndrome is the most common cause of hormonal disorders in women of reproductive age. It affects between 8 and 13 % of this population in Canada, and yet many women wait years for a diagnosis (Society of Obstetricians and Gynecologists of Canada, 2023). The reason is often the same: the symptoms are varied, nonspecific, and easily attributed to other causes.
PCOS is not just a fertility problem. It is a metabolic and hormonal condition with implications for cardiovascular health, glucose metabolism, and mental health that extend far beyond the gynecological sphere.
What is PCOS
PCOS is an endocrine disorder characterized by excess androgens, ovulation abnormalities, and, in many cases, a polycystic appearance of the ovaries on ultrasound. These three elements are the Rotterdam diagnostic criteria, the most commonly used clinically, but two out of the three are sufficient to make the diagnosis.
Despite their name, ovarian cysts are not the central criterion for PCOS. What are called cysts in this context are actually small, immature follicles that fail to mature normally, reflecting ovulatory dysfunction rather than a cystic pathology.
Clinical manifestations
Irregular or absent periods are often the first sign. Anovulation, meaning the absence of ovulation, is the cause of infertility associated with PCOS. Hyperandrogenism, meaning an excess of male hormones, manifests as acne, hair growth in male-pattern areas, and sometimes androgenetic alopecia.
La résistance à l’insuline est présente chez environ 70 % des femmes avec un SOPK, indépendamment du poids. Elle contribue à l’hyperandrogénie, aux cycles irréguliers et augmente significativement le risque de diabète de type 2, d’hypertension et de maladies cardiovasculaires. La prise en charge métabolique fait donc partie intégrante du traitement du SOPK.
Diagnosis
The diagnostic workup includes a blood test to evaluate androgens, LH, FSH, prolactin, TSH, and fasting blood glucose, as well as a pelvic ultrasound to assess the ovaries. These tests also help exclude other conditions that can mimic PCOS, such as congenital adrenal hyperplasia, hyperprolactinemia, or an androgen-secreting tumor.
Support options
PCOS treatment depends on the woman's goals. For those who do not wish to conceive, combined hormonal contraceptives regulate cycles and reduce androgen manifestations. Metformin may be prescribed to improve insulin sensitivity, particularly in women with documented insulin resistance.
For women who wish to conceive, ovulation induction with medication is often effective. Lifestyle changes, including modest weight loss in overweight women, can restore spontaneous ovulation in a significant proportion of cases. Fertility clinic follow-up may be recommended depending on the situation.
Mental health deserves particular attention in PCOS. The risk of depression and anxiety is significantly increased, likely linked to hormonal imbalances and the condition's impact on body image and fertility.
Frequently Asked Questions about PCOS
Does PCOS disappear after menopause?
Gynecological symptoms like irregular cycles stop with menopause, but the metabolic components of PCOS, particularly insulin resistance and increased cardiovascular risk, persist. Metabolic monitoring remains indicated after menopause.
Can you get pregnant with PCOS?
Yes. PCOS is the most common cause of anovulatory infertility, but also the one that responds best to treatment. The majority of women with PCOS can conceive with appropriate management.
Does diet influence PCOS?
Yes. A diet with a low glycemic index, rich in fiber, and low in refined sugars improves insulin sensitivity and can improve cycles and reduce androgens. These dietary changes are complementary to medical treatments.
When to consult a healthcare professional
If you have irregular periods, signs of hyperandrogenism like acne or hirsutism, difficulty conceiving, or have been told your ovaries appear polycystic on an ultrasound, a medical consultation is necessary to assess the situation.
A doctor or specialized nurse practitioner can conduct the diagnostic assessment and refer you for care tailored to your goals. An in-person or teleconsultation at one of our Omicron Clinic in Quebec gives you immediate access.
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