Polycystic Ovary Syndrome (PCOS) is a common endocrine and metabolic disorder primarily affecting women of reproductive age. Its features include hormonal imbalance, ovarian dysfunction, and metabolic abnormalities. This condition not only impacts reproductive health but can also lead to long-term metabolic issues such as diabetes and cardiovascular disease. Therefore, early diagnosis and treatment are crucial.
According to statistics, approximately 5-10% of women of reproductive age worldwide are affected by this condition. However, clinical presentations are diverse, often leading to misdiagnosis or delayed treatment. This article provides a comprehensive overview of PCOS, covering causes, symptoms, diagnosis, treatment, and prevention, to help readers develop an accurate understanding of the disease.
The etiology of PCOS is complex, involving interactions among genetic, hormonal, and metabolic factors. Studies show that genetic predisposition accounts for about 70% of the risk. Individuals with a family history of PCOS have a significantly higher chance of developing the condition. Hormonal factors often include excessive androgen production, which prevents normal ovulation and leads to the accumulation of immature follicles in the ovaries, forming the characteristic 'polycystic' appearance.
Besides genetics, insulin resistance is a key trigger. About 60-70% of patients exhibit insulin resistance, leading to abnormal glucose metabolism and stimulating the adrenal glands to produce more androgens. Other risk factors include obesity, poor dietary habits, and lack of exercise, which can exacerbate metabolic abnormalities and create a vicious cycle. Recent research also suggests that chronic inflammation and gut microbiota imbalance may be related to symptom development.
Symptoms of PCOS are highly variable. Typical features include menstrual irregularities, such as cycles longer than 35 days, amenorrhea, or irregular bleeding. About 70% of patients exhibit hyperandrogenic symptoms, including hirsutism (excess hair growth around the lips and on the trunk), acne, or male-pattern hair loss. Some patients may show ovarian ultrasound features with more than 12 small cysts in the ovaries.
Metabolic symptoms include weight gain, abdominal obesity, and skin darkening (such as neck and armpit pigmentation). Severe cases may also have lipid abnormalities, such as elevated LDL cholesterol or triglycerides. Approximately 30-50% of patients have insulin resistance, which increases their risk of developing type 2 diabetes by 5-10 times.
Notably, about 20-30% of patients present with atypical symptoms, such as mild menstrual irregularities or slight hirsutism, making early diagnosis more challenging. Mild symptoms may lead to delayed medical attention and increased risk of metabolic complications.
Diagnosis of PCOS requires an integration of clinical symptoms, laboratory tests, and imaging results. According to the internationally accepted "Rotterdam criteria," at least two of the following three features are required: 1. Menstrual irregularity (anovulation or oligo-ovulation); 2. Hyperandrogenism or related symptoms (such as hirsutism); 3. Polycystic ovarian morphology on ultrasound.
Blood tests are essential for diagnosis, including measuring androgen levels (such as testosterone), the ratio of luteinizing hormone (LH) to follicle-stimulating hormone (FSH), elevated LH/FSH ratio, and markers of insulin resistance such as fasting blood glucose and insulin levels. Ultrasound should reveal a "pearl necklace" appearance of the ovaries or more than 12 small follicles (2-9mm) in one or both ovaries.
Other conditions with similar symptoms, such as congenital adrenal hyperplasia, Cushing's syndrome, or androgen-secreting tumors, should be excluded. For suspected cases, advanced tests like 24-hour urinary free cortisol or adrenal stimulation tests may be performed to ensure accurate diagnosis.
Management of PCOS should be personalized based on age, symptom severity, and reproductive goals. First-line treatment often involves lifestyle modifications, including a low-GI diet (increased fiber, reduced refined sugars) and regular aerobic exercise (recommended 150 minutes per week), which can improve insulin resistance and reduce symptoms.
Pharmacological treatments include oral contraceptives (combination estrogen and progestin pills) to regulate androgen levels and improve hirsutism and menstrual regularity. For patients seeking pregnancy, ovulation induction agents (such as clomiphene citrate) can promote ovulation. For severe insulin resistance, metformin may be prescribed to restore cellular sensitivity to insulin and reduce androgen secretion.
Surgical options are typically reserved for severe cases unresponsive to medication. Laparoscopic ovarian drilling can improve ovulation but carries risks such as infection or adhesion formation. Emerging therapies include GLP-1 receptor agonists or SGLT2 inhibitors, which can simultaneously improve metabolic abnormalities and symptoms.
While genetic factors cannot be changed, lifestyle modifications can effectively reduce symptom severity. Maintaining a healthy weight (BMI 18.5-24.9) significantly improves insulin sensitivity. The "Mediterranean diet," rich in whole grains, high-quality proteins, and unsaturated fats, is recommended. Regular exercise enhances mitochondrial function and improves cellular response to insulin.
Routine metabolic screening is vital for preventing complications. Annual measurements of fasting blood glucose, HbA1c, and lipid profile are advised. Those with a family history should start monitoring menstrual cycles after age 18. Avoiding exposure to endocrine disruptors (such as BPA in plastics and cosmetics) may help reduce symptom triggers.
Psychological support is equally important, as physical changes can cause anxiety or self-esteem issues. Professional counseling can help patients develop a positive outlook. Traditional Chinese medicine approaches like acupuncture and herbal therapy may serve as adjuncts but should be supervised by a healthcare professional.
If you experience the following symptoms, seek medical attention promptly: menstrual cycles longer than 35 days, persistent acne or skin darkening, unexplained weight gain or abdominal obesity, signs of masculinization (such as a prominent Adam's apple or abnormal hair distribution). If pregnancy attempts are unsuccessful over a long period or blood glucose levels are abnormal (e.g., fasting glucose ≥100 mg/dL), medical consultation is recommended.
Screening is advised for individuals with: a family history of PCOS, BMI over 27 with irregular menstruation, unexplained hirsutism, or other related symptoms. Early diagnosis through medication and lifestyle changes can effectively control symptoms and delay metabolic complications.
If severe complications occur, such as worsening dysmenorrhea, ovarian cyst enlargement, or diabetic retinopathy, urgent evaluation by obstetrics and gynecology or endocrinology specialists is necessary. Regular follow-up helps adjust treatment plans timely and prevent symptom progression.
It is recommended to adopt a low-carbohydrate, high-fiber diet, and choose low-GI foods to control blood sugar fluctuations. Increasing intake of fatty fish, nuts, and leafy greens, while limiting refined sugars and processed foods, can improve insulin resistance. Consulting a nutritionist for a personalized diet plan is advised.
What are the differences between aerobic exercise and resistance training in managing PCOS?Aerobic exercise effectively reduces body fat and improves insulin sensitivity; it is recommended to perform 150 minutes of moderate-intensity activity per week (such as jogging or swimming). Resistance training increases muscle mass and basal metabolic rate; 2-3 sessions per week are suggested. Combining both types of exercise provides a more comprehensive improvement in metabolic abnormalities.
What are the potential risks of long-term oral contraceptive use for PCOS?Long-term use of oral contraceptives may slightly increase the risk of blood clots. Regular monitoring of blood coagulation parameters is recommended. Some patients may experience elevated blood pressure or lipid abnormalities; health checks every 3-6 months and discussions with a healthcare provider are advised.
Will PCOS symptoms naturally improve with age?Some hyperandrogenic symptoms may diminish with age and hormonal changes, but insulin resistance and metabolic issues may persist. Continued monitoring of weight, blood sugar, and metabolic indicators, along with maintaining a healthy lifestyle, is recommended to prevent complications.
What are the chances of natural conception for women with PCOS?About 70% of women can conceive naturally after lifestyle adjustments and ovulation induction treatments, primarily by restoring regular ovulation cycles. Doctors may recommend ovulation-stimulating medications or lifestyle modifications (such as weight control). Early and proactive treatment improves the likelihood of successful pregnancy.
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