PCOS FAQ: Answers to Your Questions About Polycystic Ovary Syndrome

In short: Polycystic ovary syndrome is not a single condition but a group of symptoms linked to a hormonal imbalance, and it can look different from one woman to another. This page answers the questions patients ask most often about it.

If you’ve been told you have polycystic ovary syndrome (PCOS), you probably have a lot of questions. PCOS isn’t just one condition — it’s a group of symptoms linked to a hormonal imbalance in the body, and it can look different from one woman to another. Below, we’ve answered some of the questions we hear most often from patients.

How common is Polycystic Ovary Syndrome?

PCOS affects around 10–13% of women of reproductive age worldwide, making it one of the leading causes of infertility.

What are the most important symptoms of Polycystic Ovary Syndrome?

Any of these symptoms can occur in this syndrome:

• • No periods or scanty periods.
• • Ovulatory disorders.
• • High testosterone level which leads to increase growth of hair over chin, chest and thighs.
• • Infertility due to disorders in ovulation.
• • The ovary on ultrasound has a larger size than normal ovary with multiple small follicles on its edge like a pearl necklace.
• • Over weight.
• • Insulin resistance which leads to increase insulin level although there is normal level of blood glucose.
• • Lipid profile disorder.
• • Elevated blood pressure.
• • Acne and oily skin.

What is the cause of Polycystic Ovary Syndrome?

The main cause is still unknown, but many studies point to a genetic link, since PCOS often runs in families.

• Other studies showed that there is a role for insulin receptors effectiveness.
• There is also a role for antiepileptic drugs in unmasking the symptoms of this disease.

Is there a definitive treatment for Polycystic Ovary Syndrome?

Not yet. Current treatments can help manage and reduce symptoms, but they don’t cure the underlying condition.

Is there a specific laboratory investigation should be done to diagnose Polycystic Ovary Syndrome?

No, there isn’t one specific test, because PCOS doesn’t have one single, specific cause.

How is the diagnosis made?

Diagnosis is based on a combination of clinical examination, ultrasound, and blood tests.

How is the diagnosis made by vaginal ultrasound?

On ultrasound, the ovaries often look like a string of pearls, with 20 or more small follicles (2–9 mm) in each ovary, and/or the ovaries are larger than normal (10 mL or more).

What is the laboratory test that should be done routinely?

• Fasting blood sugar and HbA1c, or preferably an oral glucose tolerance test (especially before pregnancy).
• Lipid profile.
• Thyroid stimulation hormone.

These tests should be done once a year at least.

Does every woman with PCOS experience infertility?

It depends on how severe the condition is — when it disrupts ovulation, it can lead to infertility.

Is it possible to have regular menses without ovulation?

Yes, but the ovulation depends on the period between two consecutive cycles.

Does the body temperature predict the time of ovulation in PCOS patients?

It depends on the severity of the disease.

Does clomid have a role in PCOS cases?

Yes, it can help induce ovulation and is used for up to about six cycles, but letrozole is now the first-choice tablet for women with PCOS because it gives a higher chance of live birth and fewer twins.

Does PCOS affect the quality of the oocyte?

Yes, this may be due to high insulin level, or due to delayed ovulation.

What is the role of cortisone treatment in addition to induction of ovulation?

Cortisone is not recommended as a routine part of ovulation induction in PCOS; it is used mainly when blood tests show a different condition of the adrenal gland (non-classic congenital adrenal hyperplasia), and it can worsen weight and insulin resistance.

Is it necessary to use progesterone in PCOS patients?

Women with PCOS who do not ovulate have low progesterone, so progesterone tablets are used to bring on a period and protect the lining of the womb; once ovulation is achieved with treatment, extra progesterone is usually not needed except in IVF cycles.

May we use oral hypoglycemic drugs with ovulation induction drugs?

Yes, this is possible. Metformin may be combined with letrozole or Clomid, especially in women who are overweight, and it is usually started a few weeks to months before ovulation induction, depending on your insulin levels.

Does PCOS carry a risk of ovarian hyper-stimulation syndrome?

Yes — because PCOS ovaries contain many small follicles, ovulation induction needs careful management to encourage the right follicles to grow without over-stimulating the others. Metformin may help lower this risk.

Is it necessary to take baby aspirin during induction of ovulation in PCOS patients?

No. Aspirin does not improve the results of ovulation induction; however, once pregnant, your doctor may recommend baby aspirin from 12 weeks if you are at higher risk of pre-eclampsia.

Is there a relationship between PCOS and endometriosis?

It is unknown, but if both diseases coincide with each other; there may be a genetic cause.

What is the surgical treatment for PCOS?

There are two types of surgery:

1- Partial oopherectomy, an older method performed through an abdominal incision. It can sometimes lead to adhesions, which may in turn affect fertility.

2- Laparoscopic ovarian drilling, performed using a laparoscope. Reported success rates vary widely (from around 25% up to 50-70%) depending on the surgeon’s experience and technique.

What is hyper-prolactinemia, and what is its treatment?

This is when prolactin levels in the blood are elevated, which can cause breast milk production or irregular periods. Common causes include some medications, an underactive thyroid, and a small benign pituitary tumor (prolactinoma), which is diagnosed with an MRI of the pituitary gland. In most cases, including when a prolactinoma is found, medication such as cabergoline is the first treatment and usually shrinks the tumor; surgery is needed only rarely.

Does the risk of miscarriage increase in cases of PCOS?

If this applies to you, our separate page on recurrent miscarriage covers the subject in greater depth.

Miscarriage rates may be somewhat higher in women with PCOS, mainly in those who are overweight or have insulin resistance, though the exact reason isn’t fully understood. Some researchers link this to elevated LH levels, while others point to higher insulin levels affecting embryo implantation and early development.

Does metformin reduce the risk of miscarriage?

Current evidence does not show that taking metformin during pregnancy reduces the risk of miscarriage, so it is not recommended for this purpose; improving weight and insulin resistance before pregnancy is more helpful.

Does a PCOS patient have a higher risk of developing diabetes later in life?

Yes, women with PCOS do have an increased long-term risk of developing diabetes, so regular monitoring is important.

Is there a hope for permanent cure for PCOS once pregnancy occurs?

There is no permanent cure for PCOS, but some women do notice hormonal shifts after pregnancy that lead to more regular cycles.

What are the drugs used for treatment of PCOS?

1- Oral contraceptive pills used to regulate the cycle.

2- Anti-androgenic drugs.

3- Acne treatment drugs.

What are the ways used to induce menstruation?

Oral contraceptive pills are commonly used; for patients who prefer not to take them, oral progesterone is another option.

If you have PCOS and are trying to conceive, or simply want personalized guidance on managing your symptoms, the team at Dr. Najeeb Layyous clinic is here to help you understand your options and plan the next step with confidence.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist