What Is Polycystic Ovary Syndrome (PCOS)? Symptoms, Treatment, and Effects on Pregnancy

Polycystic Ovary Syndrome (PCOS) occurs in women of reproductive age and affects not only the ovaries; It is a condition that can also affect menstrual regularity, hormones, ovulation and metabolic health.

When PCOS is mentioned, "cysts in the ovaries" often come to mind. However, the term polycystic in the name of the syndrome may be a bit misleading. The small structures seen on ultrasound are mostly follicles in the early stages of development, not true ovarian cysts.

For this reason, the appearance of polycystic ovaries on ultrasound does not alone mean a diagnosis of PCOS.

One of the most important features of PCOS is that it does not occur in the same way in every woman. While the main problem in one patient may be menstrual irregularity and hair growth, in another patient the first symptom may be difficulty in achieving pregnancy. Some women may be diagnosed with PCOS with normal weight and very mild symptoms.

For this reason, treatment must be planned individually.

Short Answer

Polycystic Ovary Syndrome (PCOS) is a common hormonal-metabolic syndrome that can affect ovulation, androgen hormones, and the metabolic system.

Among the most common symptoms:

• Menstrual irregularity
• Infrequent or irregular ovulation
• Increased hair growth
• Acne
• Thinning of hair
• Difficulty achieving pregnancy

may take place.

PCOS does not mean infertility. Many PCOS patients can get pregnant naturally. For women with ovulation problems, the chance of pregnancy can be increased with lifestyle adjustments and, when necessary, treatments that support ovulation.

Highlights

• PCOS is a hormonal-metabolic syndrome common in women of reproductive age.
• Not every patient has the same symptoms.
• The appearance of polycystic ovaries on ultrasound does not alone diagnose PCOS.
• In PCOS, ovulation may become rare or may not occur in some periods.
• Insulin resistance may be found in some patients, but not in all PCOS patients.
• AMH level may be high in PCOS.
• PCOS does not mean infertility.
• PCOS can also be seen in women of normal weight.
• Not every PCOS patient needs in vitro fertilization treatment.
• Treatment should be planned according to the woman's desire for pregnancy and basic complaints.

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic Ovary Syndrome is a complex syndrome that can affect ovulatory function and androgen hormones in women and may be accompanied by metabolic features.

It is called PCOS (Polycystic Ovary Syndrome) in the international medical literature. In Türkiye, the abbreviations PKOS or PCOS may be used.

In PCOS, many small follicles can be seen in the ovaries. However, these are not ovarian cysts in the classical sense.

This distinction is important because the phrase “polycystic ovary” may cause unnecessary anxiety in some women.

Many small follicles seen with ultrasound in the ovary do not by themselves mean disease. Diagnosis; Menstrual pattern, androgen excess findings, laboratory results and, when necessary, ultrasound evaluation are discussed together.

What Causes PCOS?

There is no single cause of PCOS.

It is thought that genetic, hormonal and metabolic factors play a role in the development of the syndrome.

Especially:

• Genetic predisposition
• Increase in the effect of androgen hormones
• Insulin resistance
• Metabolic factors
• Changes in ovarian functions

It may play a role in the emergence of PCOS.

The occurrence of PCOS in more than one woman in the same family supports the importance of genetic predisposition. However, having PCOS in the family does not necessarily mean that a woman will develop PCOS.

What are the Symptoms of PCOS?

The symptoms of PCOS may vary from person to person.

The most common symptoms are:

• Infrequent menstruation
• Absence of menstruation for a long time
• Irregular ovulation
• Difficulty achieving pregnancy
• Increased facial and body hair growth
• Acne
• Oily skin
• Thinning of hair or male pattern hair loss
• Tendency to gain weight
• Difficulty losing weight

However, not every PCOS patient needs to have all of these symptoms.

For example, a woman of normal weight who does not have significant hair growth but has irregular menstrual periods may also be diagnosed with PCOS.

Is Menstrual Irregularity a Symptom of PCOS?

Yes. One of the most characteristic features of PCOS is ovulation and associated menstrual irregularity.

In a normal menstrual cycle, one of the follicles in the ovaries develops and reaches the ovulation stage.

In PCOS, follicle development and ovulation patterns may be disrupted.

As a result:

• Menstrual intervals may become longer.
• The number of pieces per year may decrease.
• Some women may not have a menstrual period for months.
• Ovulation may not occur every month.

However, regular menstruation does not completely exclude PCOS in all cases. Diagnosis is not made just by looking at menstrual cycle.

Why Does Hair Growth Increase in PCOS?

In PCOS, an increase in the level or effect of hormones called androgens may be observed.

This may lead to male pattern hair growth called hirsutism.

Especially:

• Chin
• Upper lip
• Chest circumference
• Abdomen
• Back

Dark and thick hairs may be seen in areas such as:

Androgen excess may also be associated with acne, oily skin, and thinning of hair at the crown in some women.

However, PCOS is not the only reason for increased hair growth. Other hormonal causes may need to be investigated for significant or rapid-onset hair growth.

What is the Relationship Between PCOS and Insulin Resistance?

Insulin resistance may be observed in some women with PCOS.

Insulin is the hormone that helps cells use glucose in the blood. When insulin resistance develops, the body's response to normal insulin levels may decrease and the pancreas may secrete more insulin to compensate.

High insulin levels may contribute to the hormonal features of PCOS by affecting androgen production in the ovaries.

Insulin resistance in some patients:

• Weight gain
• Fat around the waist
• Blood sugar disorders
• Increase in metabolic risks

Can be seen together with

But there is an important point:

Not every PCOS patient has insulin resistance, and PCOS is not a disease caused solely by insulin resistance.

Is PCOS Only Seen in Overweight Women?

No.

PCOS may be seen with more pronounced metabolic problems in overweight or obese women, but it can also occur in women of normal weight.

This condition is sometimes referred to as “weak PCOS.”

In normal weight PCOS patients:

• Menstrual irregularity
• Ovulation disorder
• Acne
• Pillification
• Difficulty achieving pregnancy

can be seen.

Therefore, PCOS cannot be diagnosed or excluded just by looking at body weight.

How is PCOS Diagnosed?

PCOS is not diagnosed with a single blood test or ultrasound image.

Basically for evaluation:

• Ovulation and menstrual cycle
• Clinical or biochemical findings of androgen excess
• Ultrasound features of the ovaries

may be taken into consideration.

In addition, other conditions that may cause similar symptoms must be excluded.

According to the patient's characteristics:

• Thyroid functions
• Prolactin
• Androgen hormones
• Glucose metabolism
• Other necessary hormonal tests

Can be evaluated.

For this reason, it is not correct to make a definitive diagnosis of PCOS just by writing "polycystic ovary appearance" in the ultrasound report.

Is Polycystic Ovary Appearance the Same Thing as PCOS?

No.

This distinction is one of the most important points about PCOS.

In some women, many small follicles may be seen in the ovaries during ultrasound.

But the same woman:

• If her periods are regular
• If her ovulation is normal
• If there are no signs of androgen excess

Diagnosing PCOS based on ultrasound appearance alone may not be accurate.

In other words:

Polycystic ovary morphology is an ultrasound finding; Polycystic Ovary Syndrome is a clinical syndrome.

Why Can AMH Be High in PCOS?

AMH, or Anti-Müllerian Hormone, is produced by small developing follicles in the ovaries.

As the number of small antral follicles may be high in women with PCOS, the AMH value may also be high.

However, there is a common interpretation mistake here:

High AMH does not necessarily mean that fertility is high.

In PCOS, there may be many follicles in the ovaries, but there may be problems in their regular development and reaching ovulation.

Therefore, the appearance of a high number of eggs is not the same as regular ovulation every month.

Does PCOS Increase ovarian reserve?

AMH and antral follicle count may be high in women with PCOS.

However, it is not correct to interpret this as "my ovarian reserve is very good, so I can get pregnant easily at an older age."

As women get older, age-related changes in egg quality are also valid for women with PCOS.

For this reason, high AMH should not be considered as an assurance to postpone having children for many years.

Does PCOS Prevent Getting Pregnant?

PCOS does not completely prevent pregnancy.

One of the main mechanisms that make pregnancy difficult in PCOS is irregular or infrequent ovulation.

For example, a woman who ovulates regularly has more pregnancy opportunities per year, while the number of opportunities for natural pregnancy may decrease in a woman with PCOS who ovulates only a few times a year.

However, the possibility of pregnancy does not depend solely on PCOS.

In evaluation:

• Woman's age
• Ovulation frequency
• Whether the tubes are open
• Uterine structure
• Sperm characteristics
• Infertility duration

They should be considered together.

Does PCOS Mean Infertility?

No.

PCOS and infertility are not the same thing.

PCOS may be one of the important causes of infertility due to ovulation disorder. However, many women diagnosed with PCOS can become pregnant naturally.

For some women, it may be difficult to achieve pregnancy because ovulation is very rare.

Treatments aimed at regulating ovulation can be applied to these patients.

Is Natural Pregnancy Possible in PCOS?

Yes.

A woman with PCOS can become pregnant naturally during the periods when she is ovulating.

Especially:

• Young age
• Tubes are open
• Normal sperm characteristics
• Ovulation occurs from time to time

In this case, natural pregnancy may be possible.

For some women who are overweight, weight loss and lifestyle adjustments may also help ovulation become more regular.

How is PCOS Treated?

There is no single treatment protocol for PCOS that can be applied to everyone.

Treatment is primarily shaped according to the following question:

What is the patient's main goal?

For example:

• Wanting to regulate their menstruation
• Those suffering from hair growth and acne
• Those with metabolic problems
• Wanting pregnancy

The treatments for four different PCOS patients may differ from each other.

Main goals in treatment:

• Maintaining menstrual regularity
• Protecting the inner lining of the uterus
• Reducing androgen symptoms
• Managing metabolic risks
• To ensure ovulation when necessary
• Helping to achieve pregnancy

It can be listed as follows.

Treatment for PCOS Patients Who Do Not Want Pregnancy

One of the main goals for women who do not plan pregnancy is to maintain menstrual regularity and protect the inner lining of the uterus due to prolonged absence of ovulation.

Hormonal treatments can be evaluated depending on the patient's condition.

If acne or hair growth is a significant complaint, additional treatments can be planned for these.

Also:

• Body weight
• Blood pressure
• Blood sugar
• Lipid profile
• Other metabolic risks

It should be evaluated when necessary.

Treatment for PCOS Patients Wanting Pregnancy

The approach is different for PCOS patients who want to become pregnant.

First of all, the couple should be evaluated together instead of focusing only on the woman's ovulation.

Because even if PCOS is present, it may be accompanied by another factor that prevents pregnancy.

When necessary:

• Sperm analysis
• Evaluation of tubes
• Uterus evaluation
• Ovulation status

Can be examined.

If the main problem is ovulation disorder, drug treatments that enable or support ovulation can be used.

If pregnancy does not occur despite treatment, assisted reproductive methods such as insemination or in vitro fertilization may be considered.

Does In Vitro Fertilization Require for Every Patient with PCOS?

No.

The diagnosis of PCOS does not directly mean in vitro fertilization treatment.

Many patients:

• Lifestyle adjustments
• Ovulation treatments
• IUI in appropriately selected situations

Pregnancy can be achieved through methods such as

In vitro fertilization is usually brought to the agenda by evaluating other factors and the results of previous treatments.

Is Losing Weight Helpful in PCOS?

Weight management may be an important part of PCOS treatment in overweight women.

Even relatively limited weight loss in some women:

• Improved insulin sensitivity
• Makes menstruation more regular
• Improvement of ovulation function

can contribute.

However, it is not right to reduce the entire PCOS treatment to a "lose weight" recommendation.

Normal-weight women also have PCOS, and PCOS is not the cause of menstrual irregularity in every overweight woman.

How to Eat in PCOS?

There is no single specific diet proven to eliminate PCOS.

Sustainable and balanced nutrition approach is more important.

In general:

• Adequate consumption of vegetables and fruits
• Include foods rich in fiber
• Intake of appropriate amount of protein
• Preferring whole grains
• Limiting ultra-processed foods
• Reducing sugary drinks
• Nutrition appropriate to the person's energy needs

May support metabolic health.

It is more appropriate to personalize the nutrition plan according to the person's weight, metabolic status and accompanying diseases.

Is Exercise Beneficial in PCOS?

Yes.

Regular physical activity is especially important for metabolic health.

Exercise:

• It may improve insulin sensitivity.
• It may help with weight control.
• May support cardiovascular health.
• May contribute to reducing overall metabolic risks.

A combination of aerobic and resistance exercises appropriate to the person's health condition may be considered.

Are Insulin Resistance Drugs Used in PCOS?

It can be used in suitable patients.

However, it is not right to automatically start insulin resistance medication for every PCOS patient.

Treatment decision:

• Metabolic status
• Glucose values
• Body weight
• Pregnancy plan
• Other clinical features

It should be evaluated and given.

How to Treat Ovulation in PCOS?

Drugs to stimulate ovulation can be used in patients who want pregnancy and do not ovulate regularly.

During treatment, the goal is not always to develop as many eggs as possible.

The development of an excessive number of follicles, especially during IUI or scheduled intercourse treatments, may increase the risk of multiple pregnancy.

For this reason, it is important that the treatment be carried out under the supervision of a physician and with ultrasound monitoring when necessary.

Can IUI Be Done in PCOS?

Yes in some patients.

IUI can be considered after appropriate follicle development is achieved through ovulation treatment.

However, in the decision to perform IUI:

• Woman's age
• Tubes are open
• Sperm characteristics
• Infertility duration
• Previous treatments

Factors such as should be taken into consideration.

When May In Vitro Fertilization Be Necessary in PCOS?

Not every PCOS patient requires in vitro fertilization.

In vitro fertilization treatment especially:

• Failure to achieve pregnancy despite other treatments
• Advanced female age
• Problem with tubes
• Accompaniment of male factor
• Long-lasting infertility
• There is another indication for in vitro fertilization

It can be evaluated in certain situations.

Since the ovaries are likely to respond strongly to stimulant medications in patients with PCOS, it is important to carefully plan the treatment protocol.

Is There a Relationship Between PCOS and OHSS Risk?

In some women with PCOS, the ovaries may respond strongly to in vitro fertilization medications.

The risk of ovarian hyperstimulation syndrome (OHSS) may increase if many follicles develop.

Today, this risk can be managed significantly with strategies such as appropriate drug protocols, dose adjustments and freezing of embryos in necessary patients.

For this reason, it is important to personalize the in vitro fertilization protocol, especially in PCOS patients with high AMH and antral follicle count.

What is the success of IVF in PCOS?

Due to the high ovarian reserve in women with PCOS, many eggs can be obtained during in vitro fertilization.

However, the number of eggs alone does not mean success.

On success:

• Woman's age
• Egg quality
• Sperm characteristics
• Embryo development
• Intrauterine conditions
• Accompanying metabolic problems

Many factors such as play a role.

Therefore, high AMH or obtaining a large number of eggs does not guarantee a live birth.

Does PCOS pose a risk during pregnancy?

The majority of women with PCOS can have healthy pregnancies.

However, the likelihood of certain complications during pregnancy may increase in some patients, especially those with obesity, insulin resistance or other metabolic problems.

These include:

• Gestational diabetes
• Hypertensive disorders in pregnancy

may take place.

Therefore, before pregnancy:

• Body weight
• Blood pressure
• Glucose metabolism
• General health status

Can be evaluated.

Does PCOS Increase the Risk of Miscarriage?

The relationship between PCOS and miscarriage cannot be explained by a single mechanism.

Low risk of miscarriage:

• Woman's age
• Obesity
• Metabolic health
• Chromosomal characteristics of the embryo
• Other accompanying diseases

It also affects.

For this reason, it is not correct to automatically attribute the loss to PCOS in a PCOS patient who has previously experienced a miscarriage.

Is it harmful to not have a period for a long time in PCOS?

In women who do not ovulate for a long time, the uterine lining may not receive enough of the regulatory effect of progesterone.

Therefore, it is important to evaluate women who have not had a menstrual period for months.

Long-term irregular or infrequent menstruation may pose a risk for excessive thickening of the endometrium in some patients.

Therefore, the aim of the treatment is not only to "induce menstruation" but also to protect the health of the uterine lining in the long term.

Is PCOS Completely Gone?

PCOS is a syndrome that can have chronic features.

Severity of symptoms over time:

• Live
• Weight changes
• Lifestyle
• Hormonal changes
• The treatments used

It may differ depending on the situation.

The goal of treatment is to control existing complaints, support reproductive goals, and reduce long-term metabolic risks, rather than a one-time “destroy PCOS” approach.

Does PCOS Continue Until Menopause?

The clinical features of PCOS may change with age.

During the reproductive period:

• Menstrual irregularity
• Ovulation problem
• Pregnancy desire

Topics such as these may lose their importance over time.

However, issues such as glucose metabolism and cardiometabolic health may require follow-up at later ages.

For this reason, PCOS should not be considered only as a "pregnancy problem".

Assoc. Prof. Dr. What Does Nurettin Türktekin Look at in PCOS Evaluation?

It is not enough to just look at the ultrasound image or AMH result in the evaluation of PCOS.

The patient:

• Age
• Menstrual pattern
• Ovulation status
• Pilling and acne symptoms
• Weight and body composition
• Hormone results
• Metabolic properties
• Ultrasound findings
• Pregnancy desire

They should be evaluated together.

In patients who want to become pregnant:

• Sperm analysis
• Condition of tubes
• Infertility duration

Factors such as are also added.

This approach is important not only for diagnosing PCOS but also for determining what treatment the patient really needs.

How can there be a road map for a PCOS patient who wants to become pregnant?

In the patient planning pregnancy, firstly the age and how long the pregnancy has been tried are evaluated.

Then, the ovulation pattern and other infertility factors of the couple are examined when necessary.

If the main problem is ovulation disorder, the first goal in suitable patients is to ensure ovulation.

The next stage of the treatment is:

• Age
• Response to treatment
• Sperm characteristics
• Tubes
• Infertility duration

It is determined according to factors such as.

Therefore, instead of going directly from PCOS diagnosis to in vitro fertilization, a stepwise and personalized approach may be more accurate.

When to Consult a Doctor?

It is useful to consult a gynecologist and obstetrician in the following cases:

• Persistently irregular menstrual periods
• Noticeable lengthening of menstrual intervals
• No menstruation for months
• Significant hair growth
• Severe or persistent acne
• Significant thinning of hair
• Difficulty achieving pregnancy
• Detection of polycystic ovary appearance on ultrasound
• Finding a high AMH result

Evaluation should not be delayed, especially in women who want to become pregnant, taking into account age and other risk factors.

Common Mistakes

“If there are many follicles on ultrasound, there is definitely PCOS.”

Wrong. Polycystic ovary morphology alone is not a diagnosis of PCOS.

“A woman with PCOS cannot get pregnant.”

Wrong. Many PCOS patients can achieve pregnancy naturally or with treatment.

“PCOS is only seen in overweight women.”

Wrong. PCOS can also be seen in normal weight women.

“If there is PCOS, there is definitely insulin resistance.”

Wrong. Insulin resistance may be common but is not found in all patients.

“If AMH is high, fertility is very high.”

Wrong. High AMH does not mean regular ovulation or high egg quality.

“If there is PCOS, in vitro fertilization is definitely required.”

Wrong. In many patients, simpler treatments may be sufficient.

“The birth control pill completely cures PCOS.”

Wrong. Hormonal treatments may control some symptoms, but they do not permanently eliminate all features of the syndrome.

Assoc. Prof. Dr. Nurettin Türktekin's Evaluation

One of the most important points when evaluating Polycystic Ovary Syndrome is that the diagnosis is not made only based on ultrasound image or AMH level. PCOS is a syndrome with hormonal and metabolic aspects that can occur with different characteristics in different women.

It should be emphasized that the diagnosis of PCOS does not directly mean in vitro fertilization, especially in women who want to become pregnant. If the main problem is ovulation disorder, pregnancy can be achieved in many patients with appropriate lifestyle adjustments and ovulation-oriented treatments.

However, by focusing only on PCOS, the tubes or the male factor should not be overlooked. The couple should be considered together in the evaluation of infertility.

The purpose of treatment is not to give the same medicine to all patients; It is to apply the right treatment at the right time according to the patient's age, metabolic status, symptoms and pregnancy plan.

Conclusion

Polycystic Ovary Syndrome (PCOS) is a common syndrome that can have effects on ovulation, hormone balance, and metabolic health.

It can cause symptoms such as menstrual irregularity, hair growth, acne, thinning of hair and difficulty in achieving pregnancy. However, not every woman has to have the same symptoms, and only the appearance of polycystic ovaries on ultrasound is not sufficient for the diagnosis of PCOS.

Most importantly, PCOS does not mean infertility.

Many PCOS patients can achieve pregnancy naturally. In women with ovulation problems, ovulation can be achieved with lifestyle adjustments and appropriate medical treatments. Assisted reproductive methods such as insemination or in vitro fertilization are used only in necessary patients.

The treatment;

• Age of the woman
• Menstrual and ovulation patterns
• Androgen symptoms
• Metabolic state
• By body weight
• Pregnancy plan

It needs to be personalized accordingly.

A more accurate approach is to consider PCOS not as an ultrasound finding seen only in the ovaries, but as a multifaceted syndrome in which reproductive and metabolic health should be evaluated together.