PCOS

The exact cause of PCOS is not fully understood, but it involves differences in the hormones that regulate ovarian function. Many people with PCOS have higher-than-expected levels or activity of androgens, sometimes referred to as male hormones, although these hormones are naturally present in everyone. Increased androgen activity can interfere with the normal development and release of eggs from the ovaries, resulting in irregular or absent ovulation. This can lead to irregular periods and difficulty conceiving and may also contribute to symptoms such as excess facial or body hair, acne and scalp hair thinning.

Insulin resistance is another important feature in many cases of PCOS. Insulin helps the body’s cells use glucose for energy. When cells become less responsive to insulin, the body may compensate by producing more of it. Higher insulin levels can encourage the ovaries to produce more androgens, potentially making hormonal and ovulatory symptoms more pronounced. Insulin resistance can occur regardless of body size, although excess weight can worsen it in some people. PCOS is also associated with an increased long-term risk of metabolic problems such as type 2 diabetes, making broader health assessment important alongside management of reproductive symptoms.

Genetics also appear to influence PCOS, as the condition frequently occurs within families, although no single gene explains every case. Despite its name, PCOS does not simply mean having ovarian cysts. Ultrasound may show ovaries containing many small, immature follicles — the structures in which eggs develop — but these are not the same as typical ovarian cysts. Some people with PCOS do not have this ovarian appearance at all. Diagnosis therefore considers a combination of menstrual or ovulatory patterns, signs or blood-test evidence of increased androgen activity and, where relevant, ovarian appearance, while excluding other conditions that can produce similar symptoms.