Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a common hormonal and metabolic disorder affecting women of reproductive age, characterised by irregular ovulation, elevated androgen (male hormone) levels, and often multiple small follicles on the ovaries seen on ultrasound. It is one of the most common endocrine disorders in women, affecting an estimated 8-13% of women of reproductive age worldwide, and is the leading cause of anovulatory infertility. PCOS is increasingly diagnosed in Nigerian gynaecology clinics, though many women live with undiagnosed or under-treated symptoms for years, often dismissing irregular periods as normal. While there is no cure, PCOS is a manageable long-term condition, and most women achieve good symptom control and successful pregnancies with appropriate treatment.

PCOS symptoms vary widely in severity and combination. Diagnosis typically requires at least two of three Rotterdam criteria: irregular ovulation, clinical or biochemical signs of excess androgens, and polycystic ovaries on ultrasound. Reproductive symptoms: • Irregular, infrequent, or absent menstrual periods • Heavy or unpredictable bleeding when periods do occur • Difficulty conceiving due to infrequent or absent ovulation Hormonal and skin symptoms: • Excess facial or body hair (hirsutism), commonly on the chin, upper lip, chest, or back • Persistent acne, often along the jawline, that responds poorly to standard skincare • Thinning hair on the scalp (androgenic alopecia pattern) • Dark, velvety patches of skin at the neck, armpits, or groin (acanthosis nigricans), a sign of insulin resistance Metabolic symptoms: • Weight gain, particularly around the abdomen, or difficulty losing weight despite effort Psychological impact: • Anxiety and depression are significantly more common in women with PCOS, often linked to visible symptoms like acne, hirsutism, and weight changes

The exact cause of PCOS is not fully understood, but it centres on a cycle of insulin resistance and excess androgen production: • Insulin resistance: the body's cells respond poorly to insulin, so the pancreas produces more of it; high insulin levels stimulate the ovaries to produce excess androgens • Excess androgens: elevated male hormone levels disrupt the normal hormonal signalling required for follicles to mature and release an egg each month, leading to irregular or absent ovulation • Genetic predisposition: PCOS runs strongly in families; having a mother or sister with PCOS significantly raises risk • Low-grade inflammation: some studies link chronic low-grade inflammation to further stimulation of androgen production

• Family history of PCOS, type 2 diabetes, or insulin resistance • Obesity, particularly abdominal obesity (though PCOS also occurs in women of normal weight) • Sedentary lifestyle and diets high in refined carbohydrates • Pre-existing insulin resistance or metabolic syndrome

• Infertility from chronic anovulation • Type 2 diabetes and pre-diabetes: up to 50% of women with PCOS develop type 2 diabetes by age 40 • High blood pressure and abnormal cholesterol, raising cardiovascular disease risk • Endometrial hyperplasia and endometrial cancer, from prolonged unopposed oestrogen exposure due to infrequent shedding of the uterine lining • Pregnancy complications, including gestational diabetes and pre-eclampsia, when conception occurs • Sleep apnoea, more common in women with PCOS, particularly those with obesity • Anxiety and depression linked to the physical and fertility-related impact of the condition

PCOS itself cannot be prevented, as it has a strong genetic and hormonal basis, but its severity and complications can be significantly reduced: • Maintaining a healthy weight through regular exercise and a balanced, low-refined-carbohydrate diet improves insulin sensitivity and can restore more regular ovulation • Even a 5-10% reduction in body weight can meaningfully improve symptoms and fertility in women who are overweight • Regular follow-up allows early detection and management of diabetes, high blood pressure, and cholesterol Treatment: combined hormonal contraceptives regulate cycles and reduce androgen symptoms; metformin improves insulin sensitivity; letrozole or clomiphene are first-line for inducing ovulation in women trying to conceive; and targeted treatments (topical or oral) address acne and hirsutism.