PCOS in Quebec: Symptoms, Diagnosis, and Treatment

Polycystic ovary syndrome, known by the acronyms PCOS in English and SOPK in French, is one of the most common hormonal disorders in women of reproductive age. Despite its prevalence, it remains poorly understood—both by patients and the general public. This page will help you understand what PCOS is, how it manifests, how it is diagnosed, and what treatment options exist in Quebec.

What is PCOS?

PCOS is an endocrine (hormonal) disorder that affects ovarian function. It is characterized by a combination of three main elements: excessive production of androgens («male» hormones), irregular or absent menstrual cycles, and the presence of numerous small follicles on the ovaries during ultrasound (hence the term «polycystic»). The name can be confusing: these are not true cysts, but follicles that do not mature properly.

PCOS is associated with insulin resistance in a significant proportion of cases, making it a metabolic condition as well, not just a gynecological one. It has long-term health implications that extend beyond menstruation and fertility.

Who is affected by PCOS?

PCOS can manifest as early as the first menstruation (menarche), but it is often diagnosed in one's twenties or thirties, frequently when a woman seeks consultation for menstrual irregularity, difficulty conceiving, or symptoms such as acne or excessive hair growth.

The condition is not caused by a particular behavior. Genetic factors play a role—PCOS tends to run in families—but no single gene has been identified as responsible.

PCOS symptoms

PCOS doesn't present the same way in all women. Some have multiple pronounced symptoms, while others have few. Here are the most common manifestations:

Long cycles (over 35 days), infrequent (oligomenorrhea), or absent (amenorrhea) are characteristic of PCOS. These irregularities reflect disrupted or absent ovulation (anovulation).

Excess androgens can manifest as persistent acne (especially on the chin and jawline), increased hair growth on the face, abdomen, chest, or back (hirsutism), and sometimes male-pattern hair loss (androgenetic alopecia). These symptoms often have a significant psychological impact.

Insulin resistance, present in a significant proportion of people with PCOS, can lead to weight gain, especially in the abdominal area, and make weight loss more difficult. It also increases the long-term risk of developing type 2 diabetes and cardiovascular disease.

PCOS is the most common cause of ovulatory infertility. The absence or irregularity of ovulation makes conception more difficult, but not impossible. With appropriate management, many women with PCOS are able to conceive.

Sleep disturbances, fatigue, mood swings, and an increased risk of depression and anxiety are also associated with PCOS. Sleep apnea is more common in affected women, even in the absence of obesity.

How is PCOS diagnosed?

The diagnosis of PCOS is based on the Rotterdam criteria, which are widely used in clinical practice. According to these criteria, two of the following three elements must be present:

• Irregular menstrual cycles or absence of ovulation
• Clinical or biological signs of hyperandrogenism
• Ovaries with a polycystic appearance on ultrasound

Other causes that may explain these signs (hypothyroidism, hyperprolactinemia, congenital adrenal hyperplasia) must be ruled out beforehand.

A hormonal evaluation typically includes testosterone (total testosterone, DHEA-S), LH and FSH, prolactin, thyroid hormones, and sometimes 17-OH progesterone. A metabolic evaluation (blood glucose, insulin levels, lipid profile) is recommended to assess metabolic risk.

Transvaginal ultrasound can visualize the characteristic appearance of the ovaries (numerous small peripheral follicles, «string of pearls» appearance). It is not sufficient on its own to make the diagnosis.

PCOS Treatment Options

PCOS is a chronic condition that is managed, not cured. Treatment is tailored to the patient's priority goals: regulating cycles, treating symptoms of hyperandrogenism, improving fertility, or reducing long-term metabolic risk.

For women with PCOS and insulin resistance, lifestyle changes are the first line of intervention. A balanced low-glycemic diet, regular physical activity, and quality sleep can improve insulin sensitivity, regulate cycles, and reduce symptoms. These changes have a real effect even in the absence of significant weight loss.

Combined hormonal contraception (the pill) is often prescribed to regulate cycles and reduce symptoms of hyperandrogenism (acne, hirsutism). Other anti-androgen medications may be added as needed under medical supervision.

Metformin, a medication used in diabetology to improve insulin sensitivity, is sometimes prescribed for PCOS, particularly in women with insulin resistance or those seeking to improve their ovulatory regularity. Its use in this context is under medical prescription.

When pregnancy is the goal, medications like letrozole or clomiphene can be used to trigger ovulation. These treatments require strict medical supervision. Some women will resort to assisted reproductive technologies.

Dermatological support

Acne and hirsutism may require specific topical or systemic treatments, in addition to hormonal therapy.

PCOS and mental health

The symptoms of PCOS—acne, hirsutism, weight gain, menstrual irregularities, and difficulty conceiving—often have an underestimated impact on body image and psychological well-being. Studies show higher rates of depression and anxiety in women with PCOS compared to the general population.

If you notice changes in your mood, a feeling of discouragement, or anxiety related to your condition, speak to your doctor. Psychological support can be part of effective overall care. Mental health resources are available in Quebec, through in-person or online consultations.

PCOS evolves over time. Symptoms can change after menopause: cycles often become regular, but metabolic risks (type 2 diabetes, cardiovascular disease) persist and require long-term monitoring. Regular medical follow-up, even in the absence of acute symptoms, is recommended.

When to see a doctor

Make an appointment with a healthcare professional if you experience:

• Irregular, spaced, or absent menstrual cycles
• Persistent acne, especially after adolescence
• Excessive hair growth on the face or body
• Difficulty conceiving
• Unexplained weight gain, especially abdominal
• From chronic fatigue or sleep disorders

A simple hormonal assessment can help guide the diagnosis. The earlier PCOS is identified, the better the management can be adapted to protect your short- and long-term health.

Our doctors can evaluate your symptoms, order the appropriate tests, and help you understand and manage PCOS. A telemedicine consultation is available if you prefer to consult from home — our service points in Quebec offer flexibility adapted to your reality.

Teleconsultation in Quebec — Private Online Doctor | Omicron Clinic