Polycystic Ovary Syndrome : Too many Eggs spoil the basket!

Polycystic Ovary Syndrome: Too Many Eggs Spoil the Basket!

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders affecting women of reproductive age — estimated to affect 1 in 10 women worldwide, and up to 20% of Indian women. Despite its prevalence, PCOS remains widely misunderstood and underdiagnosed.

What is PCOS?

PCOS is characterised by a combination of hormonal imbalances, irregular menstrual cycles, and the presence of multiple small follicles (cysts) on the ovaries. The name is somewhat misleading — the “cysts” are actually immature follicles that failed to release an egg, not true cysts.

Key Features of PCOS

• Irregular or absent periods — due to infrequent or absent ovulation

• Hyperandrogenism — elevated male hormones causing acne, excess facial/body hair (hirsutism), and scalp hair thinning

• Polycystic ovaries — multiple small follicles visible on ultrasound

• Insulin resistance — present in 70–80% of PCOS cases, driving weight gain and increasing diabetes risk

• Infertility — PCOS is the leading cause of anovulatory infertility

The Genetic Basis of PCOS

PCOS has a strong hereditary component — women with a first-degree relative with PCOS have a significantly elevated risk. Research has identified several genetic associations:

• The DENND1A gene variant (DENND1A.V2) has been identified as a crucial factor in excess androgen production in theca cells

• Northwestern University identified 11 PCOS susceptibility regions in the genome, including genes for LH and FSH receptors

• Variants in insulin signalling genes (INSR, IRS-1) contribute to insulin resistance in PCOS

While the genetic factors are strongly supported, the full picture — including lifestyle, environmental, and epigenetic contributions — remains an active area of research.

Management of PCOS

PCOS has no cure, but symptoms can be effectively managed through:

• Lifestyle modification: Even a 5–10% reduction in body weight can restore ovulation and improve hormonal balance in overweight women with PCOS

• Diet: Low-glycaemic index diets reduce insulin resistance and androgen levels

• Exercise: Regular physical activity improves insulin sensitivity and reduces androgen levels

• Medications: Metformin (for insulin resistance), oral contraceptives (for cycle regulation), and clomiphene/letrozole (for fertility)