Polycystic ovary syndrome: Symptoms and treatment

Estimated reading time: 8 minutes 20 seconds

What you need to know about polycystic ovary syndrome

When you experience menstrual irregularities, increased facial or body hair, acne, or difficulty becoming pregnant, there may be various underlying causes. However, when several of these findings occur together, an evaluation for polycystic ovary syndrome may be necessary. Although it is common, this condition does not progress in the same way in every patient and can affect not only the ovaries but also metabolic health, reproductive plans, and quality of life.

Polycystic ovary syndrome, commonly known as PCOS, is one of the most common hormonal and metabolic conditions among women of reproductive age. The duration and severity of symptoms vary from person to person. Therefore, diagnosis and treatment are not based solely on an ultrasound image or a single blood test. When determining the diagnosis and treatment plan, a specialist evaluates the patient’s symptoms, findings observed during the examination, stage of life, and pregnancy plans together.

What is polycystic ovary syndrome?

In PCOS, the ovulation cycle may become irregular, and the effects of hormones known as androgens may increase above normal levels. As this suggests, androgens are naturally present in everyone’s body; however, increased androgen activity can lead to symptoms such as excess hair growth, acne, and thinning hair. In some people, insulin resistance may also accompany this condition. Insulin resistance means that the body does not respond to insulin as expected, which can make weight management more difficult.

The term “polycystic” in the name of the condition is often misunderstood by people encountering PCOS for the first time:

• The structures seen on ultrasound in PCOS are usually not true cysts but small ovarian follicles that have remained at a particular stage of development.
• Having a polycystic ovarian appearance on ultrasound alone is not sufficient to diagnose the syndrome.
• Conversely, some people who are diagnosed with PCOS may not have typical polycystic ovarian findings on ultrasound.

Which symptoms may suggest polycystic ovary syndrome?

One of the most common reasons people seek medical care for this condition is infrequent, irregular, or prolonged menstrual cycles. When ovulation is irregular, periods may be delayed. As a result of these delays, the number of menstrual periods occurring throughout the year may decrease, meaning the intervals between periods become longer. In some people, even when the menstrual cycle appears regular, ovulation may not occur every month.

Some of the other main symptoms that may suggest polycystic ovary syndrome include:

• Noticeable hair growth on the face, chin, chest, abdomen, or back
• Acne that persists into adulthood
• Thinning around the hairline
• Weight gain
• Delayed pregnancy due to irregular ovulation in people who are trying to conceive

However, none of these symptoms is specific to PCOS alone. Thyroid disorders, elevated prolactin levels, adrenal gland disorders, certain medications, and some rarer hormonal conditions may cause similar symptoms. Therefore, if you have these complaints, it is advisable to undergo a comprehensive medical evaluation rather than attempting to diagnose yourself or acting on unverified information.

How is polycystic ovary syndrome diagnosed?

International diagnostic criteria are used when confirming a diagnosis of PCOS. In general, the presence of at least two of the following is evaluated: irregular or infrequent ovulation, clinical or laboratory evidence of excess androgen activity, and a polycystic ovarian appearance on ultrasound. However, before making this assessment, other conditions that may cause similar findings need to be ruled out.

The main factors considered during the medical evaluation include:

• Menstrual cycle pattern
• Onset of excess hair growth and acne
• Changes in weight
• Medications being used
• Family history
• Pregnancy plans
• Accompanying medical conditions

Following a physical examination, blood tests may be recommended to assess hormone levels, blood glucose, and blood lipid levels. Ultrasound can help evaluate the structure of the ovaries and investigate other possible conditions involving the uterus.

Why is evaluation different during adolescence?

Menstrual irregularities and acne are common during the early years of adolescence. Therefore, directly applying the diagnostic approach used in adults to adolescents may not be appropriate. Particularly during the first years after menstruation begins, the duration and severity of symptoms are monitored carefully. Rather than assigning an unnecessary diagnosis, ongoing evaluation by an experienced medical team may provide a safer approach.

Polycystic ovary syndrome treatment is planned individually

There is no single treatment for PCOS that is suitable for everyone. The treatment plan is developed according to the person’s main concerns and priorities. For example, regulating menstrual cycles, reducing excess hair growth and acne, managing metabolic risks, or achieving pregnancy may each require different approaches.

When the intervals between menstrual periods are prolonged, regularly protecting the lining of the uterus becomes important. Depending on the patient’s medical history and pregnancy plans, the physician may evaluate hormonal treatment options. Combined hormonal methods may help some people regulate their menstrual cycles and manage acne and excess hair growth. However, factors such as the risk of blood clots, type of migraine, blood pressure, smoking status, and other health conditions must be taken into consideration when selecting treatment.

For people with insulin resistance, prediabetes, or an increased risk of diabetes, lifestyle changes are one of the fundamental components of treatment. In some cases, medications that support insulin sensitivity may also be prescribed by a physician. Another important point that should be emphasized is that medications used in PCOS treatment are not suitable for everyone. They should not be used indiscriminately by people whose only goal is to lose weight.

For excess hair growth and acne, dermatological procedures, laser hair removal, or different medication options may be considered in addition to hormonal treatments. It is important to understand that achieving a noticeable reduction in unwanted hair may take several months. Consistent follow-up and adherence to treatment help ensure that expectations are managed realistically.

Why are lifestyle changes important?

Nutrition and physical activity should not be considered solely in terms of weight loss. Regular physical activity, adequate sleep, a sustainable eating pattern, and stress management can have positive effects on blood sugar balance, cardiovascular health, and overall well-being. In people who are overweight, even modest weight loss may improve menstrual regularity and metabolic indicators.

However, PCOS does not occur only in people who are overweight. Insulin resistance or hormonal symptoms may also occur in people of normal weight. Therefore, expecting the condition to disappear completely after losing weight is not realistic. The goal is to create a sustainable health plan that is compatible with the person’s physical characteristics, cultural eating habits, and everyday life.

The role of nutrition and diet in PCOS management

Nutrition plays a critical role in reducing the metabolic burden associated with polycystic ovary syndrome. Choosing foods with a low glycemic index to support better insulin sensitivity may help prevent sudden fluctuations in blood sugar and the sugar cravings that can follow. It is also important to include high-fiber vegetables, whole grains, and healthy fats such as olive oil, avocado, and nuts in the diet instead of processed carbohydrates and foods containing added sugars.

Adopting a diet rich in antioxidants may also help support the management of chronic inflammation in the body. For long-term success, it is important that your dietary approach is not based on strict restrictions but instead follows a sustainable pattern that can be integrated into everyday life.

Approach for people planning pregnancy

A diagnosis of PCOS does not mean that pregnancy is impossible. The process may take longer because of irregular ovulation, but with appropriate evaluation and treatment, many women can become pregnant. In the first stage, medications that support ovulation may be planned after considering factors such as the person’s age, ovarian reserve, condition of the fallopian tubes, and evaluation of the partner.

Before pregnancy, it may be useful to review blood sugar levels, blood pressure, weight status, and medications currently being used. People with PCOS may have an increased risk of gestational diabetes and high blood pressure during pregnancy. This does not mean that complications will necessarily occur; it simply means that pregnancy follow-up may need to be individualized.

Long-term health monitoring

PCOS should not be evaluated solely in terms of menstrual irregularities and excess hair growth. Particularly in people with insulin resistance, the risk of type 2 diabetes, abnormal blood lipid levels, high blood pressure, and cardiovascular disease may be increased. Symptoms of sleep apnea, depression, and anxiety may also occur more frequently in some people.

During regular follow-up, it is important to assess blood pressure, blood glucose, and blood lipid levels, discuss psychological well-being, and monitor menstrual patterns. Medical evaluation should not be delayed in cases of prolonged absence of menstruation, unusually heavy bleeding, sudden or rapidly progressing excess hair growth, deepening of the voice, or severe pelvic pain.

The most appropriate approach to PCOS management is to avoid dismissing symptoms while also ensuring that the condition does not become the single defining aspect of a person’s life. Open communication, regular follow-up, and an individualized treatment plan can help address both current symptoms and future health goals more safely.

Recommendations and warnings from Aktif International doctors

During this process, it is also important for patients to know what they should pay attention to and what they should avoid. We asked the specialist physicians in the Obstetrics and Gynecology Department at Aktif International Hospital for their recommendations and compiled their responses for you.

• Do not use medications based on unverified information: Never use medications or supplements you have heard about from others or seen online without consulting your physician in an attempt to reduce PCOS symptoms or lose weight quickly.
• Do not neglect regular follow-up for early detection: Do not postpone evaluation of menstrual irregularities or sudden skin changes by assuming that they will simply go away. Early medical assessments can help identify and manage metabolic risks that may develop over time.
• Do not focus only on the number on the scale: The goal of PCOS management is not simply to lose weight but also to improve body composition and support metabolic balance. Even if you are at a normal weight, regular exercise and a healthy diet remain important.
• Be patient during treatment: Restoring hormonal balance and improving symptoms such as acne and excess hair growth may take several months. Do not discontinue treatment prematurely, and do not neglect your medical follow-up appointments.
• Prioritize your overall health: PCOS can affect not only reproductive health but also mood and sleep quality. If you experience depression, anxiety, or sleep problems, do not hesitate to seek support from appropriate healthcare professionals.