Overview

PCOS is a hormonal condition affecting women of reproductive age. It disrupts ovulation, raises androgen levels, and affects physical and emotional wellbeing. It affects 8–13% of women globally, and rates in the GCC may be even higher.

Symptoms

• Irregular or missed periods
• Excess facial/body hair (hirsutism)
• Persistent acne
• Hair thinning or loss on the scalp
• Weight gain, especially around the abdomen
• Darkened skin patches (acanthosis nigricans)
• Difficulty getting pregnant
• Mood changes, anxiety, depression

Causes & Risk Factors

• Insulin resistance (up to 70% of cases)
• Hormonal imbalance — elevated LH and androgens
• Genetics — runs in families
• Obesity and sedentary lifestyle
• Vitamin D deficiency

Complications

• Infertility — number one cause of anovulatory infertility
• Type 2 diabetes (3–4× higher risk)
• Cardiovascular disease
• Endometrial cancer from irregular periods
• Depression and anxiety

Diagnosis

Rotterdam Criteria: 2 of 3 — ovulatory dysfunction, excess androgens, polycystic ovary morphology or elevated AMH. Blood tests and pelvic ultrasound complete the evaluation.

Treatment

• Lifestyle changes — even 5–10% weight loss restores ovulation
• Combined oral contraceptives — for cycle regulation
• Metformin — for insulin resistance
• Letrozole — first-line ovulation induction (2023 guideline)
• Gonadotropin injections — if oral agents fail
• IVF — when other treatments have not succeeded