Polycystic ovary syndrome: a practical guide to understanding and managing it

A common misunderstanding about diagnosis

Many women are told they have polycystic ovaries based on an ultrasound image alone. That is not sufficient. A polycystic appearance on ultrasound occurs in a proportion of women who do not have the syndrome.

Diagnosis combines three strands: ovulatory disturbance, clinical or laboratory signs of raised androgens, and ovarian appearance. One criterion alone is not enough.

The distinction matters practically, because an inaccurate diagnosis means unnecessary treatment or a different cause of symptoms being missed.

Insulin resistance: the missing piece

A large proportion of women with the syndrome have insulin resistance. The body produces more insulin, and raised insulin stimulates the ovary to produce more androgens, worsening symptoms.

This explains why weight loss is harder, and why cycles and symptoms improve noticeably as insulin sensitivity improves, even before significant weight is lost.

This is why lifestyle change is a core treatment rather than general advice offered at the end of a visit.

Treatment follows the goal

If the goal is regulating cycles and protecting the endometrium, the plan differs entirely from one aimed at pregnancy. Some medications that regulate cycles also prevent pregnancy, and this must be clear from the outset.

If the goal is pregnancy, the focus is ovulation induction with ultrasound monitoring.

If the goal is controlling hirsutism and acne, the plan combines hormonal therapy with topical treatment and laser sessions, and needs months before it can be judged.

Beyond the visible symptoms

The syndrome is not only a cosmetic or fertility matter. The raised risk of type 2 diabetes and lipid disorders warrants periodic monitoring even after symptoms settle.

Long absent periods also mean the endometrium is not shedding regularly, which needs medical follow-up and should not be ignored simply because absent periods feel convenient.

Realistic expectations about time

Improvement in cycles may take months. Improvement in acne takes a similar period. Hirsutism is the slowest, because it is tied to the hair growth cycle itself.

Anyone expecting results within weeks stops treatment early and concludes it failed. Understanding the realistic timeline is part of the plan succeeding.

This article relates to pcos & hormonal treatment at My Clinic. For an assessment, book an appointment or message us on WhatsApp.