PCOS Symptoms, Causes, Diagnosis & Treatment (Now Renamed PMOS)

In short: Polycystic ovary syndrome is a common hormonal disorder that affects ovulation, seen in 5–10% of women. It is linked to heredity and, in more than half of cases, to high insulin. Symptoms include irregular periods, weight gain, excess hair, acne and poor ovulation. Treatment starts with lifestyle changes, then medication such as metformin and ovulation induction; ovarian drilling may be used, with a success rate of 50–70%.

PCOS is a common condition affecting the ovaries, disrupting normal ovulation due to a hormonal imbalance. Some women experience several symptoms together — this pattern is known as polycystic ovary syndrome. These symptoms may include irregular periods, weight gain, and coarse hair growth in different areas of the body. In some cases, PCOS causes no noticeable symptoms at all and is discovered only during a routine ultrasound or check-up.

How common is PCOS? It is one of the most common gynecological conditions affecting women. Rates vary from country to country, with an overall estimated occurrence of around 10–13% of women of reproductive age, and this appears to be rising, though the exact reasons are not fully understood.

What causes PCOS?

The exact cause of PCOS is still not fully known. Researchers believe there is a strong genetic component involving many genes, and in some families it has been linked to early male-pattern baldness in male relatives. However, the precise genetic inheritance pattern has not yet been identified. PCOS most often becomes noticeable during adolescence, a time of rapid weight changes and hormonal shifts.

Some research also points to a connection between insulin function and PCOS-like symptoms, and certain medications — such as some treatments for epilepsy — have been associated with similar symptoms in some patients.

Symptoms of PCOS

As mentioned, PCOS symptoms can vary widely, and the condition is sometimes found incidentally during a routine exam. Ultrasound of the ovaries may show 20 or more small follicles (2–9 mm) in each ovary, often arranged around the edge, or an enlarged ovary; a raised AMH blood test can be used instead of ultrasound in adults. In teenagers, ultrasound is not used for diagnosis.

Other common symptoms include:

1- Menstrual cycle changes, ranging from missed periods to infrequent cycles. This can appear as primary or secondary amenorrhea, depending on severity.

2- Irregular or absent ovulation, which can make it harder to conceive and may contribute to primary or secondary infertility.

3- Weight gain, often concentrated around the abdomen (central obesity), although many women with PCOS have a normal weight. This is linked to insulin resistance and imbalances in body fat regulation.

4- Coarse hair growth in areas such as the chin, upper lip, lower abdomen, and chest, related to elevated male hormone levels.

5- A higher likelihood of acne and oily skin.

6- A possibly higher risk of miscarriage, mainly related to excess weight and insulin resistance rather than PCOS itself.

7- An association with high blood pressure and diabetes risk.

8- A possible link to depression or other emotional challenges.

What causes these symptoms?

The hormonal changes behind PCOS are not fully understood, but elevated insulin levels appear to play a role in more than half of cases. Insulin is produced by the pancreas and normally helps carry glucose from the blood into cells, where it is used for energy and metabolism.

In PCOS, cells may not respond to insulin as effectively, even though insulin still attaches normally to the cell surface. This prompts the pancreas to release even more insulin to compensate, raising overall insulin levels in the body.

This can affect the ovaries in two main ways:

1- The ovaries may not respond normally to hormonal signals from the brain that guide egg development, causing eggs to stop maturing and remain in the ovary as small, closely packed follicles.

2- The ovaries may produce more male hormones, and body tissues may become more sensitive to these hormones.

Diagnosing PCOS

Diagnosis is usually straightforward today: it requires two of three features — irregular or absent ovulation, signs or blood tests showing raised male hormones, and polycystic ovaries on ultrasound (or a raised AMH) — after other causes are excluded. The evaluation includes:

First: A physical examination and review of symptoms as described above.

Second: Laboratory tests, which may show:

1- Elevated LH hormone levels

2- Elevated insulin levels despite normal blood sugar, due to reduced insulin sensitivity

3- Elevated testosterone levels

4- Normal prolactin and thyroid levels, which are checked to exclude other causes of irregular periods

5- Elevated estradiol and estrone levels

6- Lower levels of sex hormone-binding globulin

7- If prolactin or thyroid levels are abnormal, these conditions are treated first, because they can cause irregular periods themselves.

Third:

Ultrasound is useful for evaluating the ovaries, although it is not needed if irregular cycles and raised male hormones are already present, and it is not used for diagnosis in teenagers. A vaginal ultrasound is generally preferred for its greater accuracy compared to an abdominal scan. The typical finding is 20 or more small follicles, usually 2–9 mm in size, in each ovary, often arranged in a ring pattern described as a “string of pearls,” and/or an enlarged ovary (volume 10 mL or more).

Treating PCOS

PCOS treatment focuses on managing symptoms, since there is currently no outright cure.

First — Menstrual irregularities: These are often managed with regular use of birth control pills or progesterone, sometimes combined with metformin at a dose suited to the patient’s weight, continued until hormone levels stabilize.

Second — Coarse hair growth: Anti-androgen medications can help, though it may take 6–8 months to notice a difference in hair thickness. In the meantime, hair removal methods such as laser treatment or topical products are often recommended.

Third — Weight gain: Weight and PCOS are closely linked, each one able to worsen the other — excess weight can contribute to hormonal imbalance, and hormonal imbalance can contribute to weight gain. A tailored diet and exercise plan is strongly encouraged to help restore hormonal balance.

The benefits of weight loss can include:

• Reduced insulin resistance
• Reduced risk of heart disease
• Reduced risk of uterine cancer
• More regular menstrual cycles
• Improved chances of pregnancy
• Reduced acne and excess hair growth
• Improved mood.

Fourth — Infertility: Fertility treatment for PCOS generally falls into two categories:

1- Medication 2- Surgical treatment

Medication for PCOS-related infertility:

Medication options are also divided into two types:

The first is metformin, which can help regulate hormones and improve how the ovaries respond to fertility treatment. It may also help reduce the risk of ovarian hyperstimulation during IVF. Continuing metformin in pregnancy to prevent miscarriage is not recommended, because studies have not shown a benefit.

The second involves ovulation-inducing medications: letrozole tablets are now the first choice, with Clomid as an alternative and FSH injections as the next step, combined with ultrasound monitoring of the ovaries to pinpoint ovulation and avoid multiple pregnancy. When ovulation is achieved, the chance of pregnancy is around 15–20% per cycle, and about half of women conceive within six ovulatory cycles, though individual results vary.

Surgical treatment for PCOS:

Older surgical techniques involved removing part of the ovary through open abdominal surgery. This approach carried a risk of scar tissue (adhesions), which could itself contribute to infertility, and it is no longer used in modern practice.

Today, when tablets do not restore ovulation, laparoscopic ovarian drilling (a few small punctures in the ovary through keyhole surgery) may be offered as a second-line option; it can restore ovulation in about half of women and avoids the risk of multiple pregnancy, but it should be done carefully to protect the ovarian reserve.

Long-term health considerations with PCOS:

1. Diabetes.

2. Uterine cancer.

3. High blood pressure.

4. Certain cardiovascular conditions.

5. Lipid disorders and excess body fat.

What can be done to reduce long-term health risks?

• Adopt a healthy lifestyle (a balanced diet, regular exercise, and gradual weight loss).
• Schedule regular medical checkups to help monitor for conditions such as diabetes, high blood pressure, and endometrial changes.
• The New Revolution in Women’s Health 2026-May

Goodbye PCOS… Hello PMOS

After more than 90 years, the medical community has agreed that the term “Polycystic Ovarian Syndrome” was somewhat misleading. In May 2026, following a decision by 56 international medical organizations published in The Lancet, the name was officially updated to:

Polyendocrine Metabolic Ovarian Syndrome (PMOS).

Why this change now?

Because focusing on “cysts” was misleading — what shows up on ultrasound are not true cysts, but small follicles that stopped developing. More importantly, PMOS is now understood as more than an ovarian issue alone; it is a broader, whole-body condition affecting ovulation, the reproductive system, insulin and metabolism, skin, and emotional wellbeing.

The Four Dimensions of PMOS: What Does the Patient Experience?

We look at the condition through four connected lenses:

Reproductive: Irregular egg maturation can delay pregnancy and disrupt menstrual cycles.

Metabolic: Around 70% of patients experience insulin resistance, which is associated with a higher risk of developing diabetes over time.

Endocrine: Elevated male hormones (androgens) can contribute to hirsutism and acne.

Psychological: Because PMOS can be linked with increased anxiety and low mood, we believe compassionate, supportive care is an essential part of treatment.

How is PMOS diagnosed?

Modern diagnosis doesn’t require every symptom to be present. Instead, doctors typically look at criteria such as:

Menstrual irregularities (fewer than 8 periods per year).

Signs of elevated male hormones, such as resistant cystic acne or unwanted hair growth.

Polycystic ovaries on modern ultrasound (20 or more follicles in at least one ovary, or ovarian volume of 10 mL or more), or a raised AMH blood test in adults.

Treatment Roadmap: An Individualized, Goal-Based Approach

Every patient’s situation is different, so treatment plans at our clinic are tailored around your health goals and age:

Lifestyle modification (the cornerstone): We usually begin with a personalized lifestyle plan. Research suggests that losing just 5–10% of body weight can help restore ovulation in many patients, and can meaningfully improve insulin sensitivity.

Cycle regulation and endometrial protection: Combined oral contraceptives or cyclical progesterone may be used to help regulate cycles and reduce the risk of future endometrial changes.

**Ovulation induction for patients trying to conceive: Letrozole is the first-line ovulation-stimulating medication, followed by other tablets or injections if needed, at doses tailored to each individual case.

**Managing insulin resistance: Metformin (commonly 1500–2000 mg daily) may be used to support metabolic health, help with weight and cycle regularity, and lower diabetes risk; it is not recommended as a treatment to prevent miscarriage.

Women with PCOS who are concerned about this subject can find more background in our article on repeated pregnancy loss.

Skin and hair concerns: Hirsutism and acne can be managed with anti-androgen medications that work by blocking hormone receptors, supporting healthier skin over time. Our goal is always to protect your long-term health.

The renaming of PCOS to PMOS reinforces the importance of the long-term, follow-up-focused approach we have long believed in. Our ongoing follow-up plan typically includes:

Regular glucose and lipid testing to help protect heart health and support metabolic balance.

Endometrial ultrasound assessment if periods have been absent for more than 3 months.

Ongoing psychological support, because we believe emotional wellbeing plays an important role in hormonal balance.

PMOS represents more than a name change — it reflects a commitment to deeper, more comprehensive care. If you have questions about PCOS/PMOS or would like to discuss your situation, the team at Dr. Najeeb Layyous’s clinic is here to help guide you through your options with care and clarity.

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

Consultant Obstetrician, Gynecologist and Infertility Specialist