Polycystic ovary syndrome is the most common hormonal condition in women of reproductive age. Its symptoms cluster in three groups, and which group yours fall into determines what treatment helps.
Cycle and ovulation signs such as cycles over 35 days or fewer than eight periods a year; androgen signs such as jawline acne, coarse hair growth and scalp thinning; and metabolic signs such as central weight gain, cravings, energy crashes and dark velvety skin patches.
Follicles stall before ovulation, so there is no progesterone phase and bleeding becomes unpredictable. Higher insulin drives ovarian testosterone production and lowers sex-hormone-binding globulin, which produces the androgen symptoms.
Two of three criteria are required: irregular ovulation, clinical or biochemical androgen excess, and polycystic ovarian morphology on ultrasound, with thyroid, prolactin and adrenal causes excluded first. Ultrasound is not used in adolescents.
Thyroid disease, raised prolactin, non-classic adrenal hyperplasia, hypothalamic amenorrhoea and perimenopause all overlap and are distinguished by specific tests and features.
Cycle regulation protects the womb lining, ovulation induction addresses fertility, anti-androgen treatment addresses skin and hair over three to six months, and exercise, protein-forward meals and where indicated metformin improve insulin sensitivity.