Polycystic Ovary Syndrome (PCOS): What It Really Means

What is Polycystic Ovary Syndrome?

Polycystic Ovary Syndrome is a hormonal condition in which several regulatory processes in the body fall out of balance. It affects not only the ovaries, but also hormone levels and sugar metabolism.

Despite the name, PCOS does not actually involve true cysts on the ovaries. What appears in an ultrasound are small follicles – egg sacs that have not developed fully. This is an important distinction, because some women show this pattern on ultrasound without having PCOS, while others have PCOS without any visible changes in the scan.

What matters is always the overall picture: cycle patterns, symptoms, and hormone levels taken together.

How is PCOS diagnosed?

PCOS is not a diagnosis that can be made at a glance. Before it can be confirmed, other possible causes for similar symptoms must be ruled out – for example, thyroid conditions or other hormonal changes.

The diagnosis is based on three characteristic features. If at least two of them are present, PCOS may be the cause:

• Irregular or absent ovulation
• Elevated male hormones – visible, for instance, as acne or increased body hair
• A typical appearance of the ovaries on ultrasound

Not every woman has all three features. A thorough assessment therefore includes a detailed conversation about cycle history, skin changes, weight, and any plans for pregnancy – alongside blood tests and an ultrasound examination. Particularly for younger women, it is important to take the time to carefully evaluate the situation rather than draw conclusions too quickly.

If you suspect PCOS may be behind your symptoms, a hormone consultation with Elisa Mahlberg offers a good starting point for individual assessment.

PCOS and insulin resistance: the metabolic connection

According to current medical understanding, reduced insulin sensitivity – known as insulin resistance – plays a significant role in most women with PCOS. This applies even to women who are not overweight.

Insulin is a hormone that regulates blood sugar. When the body responds poorly to it, more insulin is produced to compensate. Elevated insulin levels can in turn promote the production of male hormones and worsen cycle irregularities. This is why PCOS is not purely a hormonal question – it is closely linked to metabolism as well.

An assessment of sugar metabolism is therefore part of a complete evaluation.

What you can influence yourself

Even though PCOS is a hormonal condition, lifestyle factors can positively influence its course. This is not about perfection or strict rules, but about realistic changes that are sustainable in everyday life.

Nutrition: A balanced, regular diet can help stabilise sugar metabolism. Avoiding sharp blood sugar fluctuations – through regular meals, sufficient protein, and fibre-rich foods – can make a meaningful difference. There is no specific PCOS diet. What matters is finding an approach that fits your life.

Physical activity: Regular movement can improve insulin sensitivity and have a positive effect on both cycle regularity and general wellbeing. Even moderate activity can be beneficial.

Weight: PCOS is not caused by excess weight. Being overweight can intensify symptoms, but it does not need to be present. Women at a healthy weight can have PCOS too, and benefit from individual support.

Treatment options for PCOS

PCOS cannot be fully eliminated, but it can be managed very well. The goal is to reduce symptoms, stabilise the cycle, and lower long-term risks. Which measures are appropriate depends on each individual situation.

If there is currently no wish to conceive and cycle irregularities or symptoms related to elevated male hormones are the primary concern, hormonal therapy may be a sensible option. The aim is to regulate the cycle and ensure the uterine lining is regularly shed. A useful guideline is that a bleed should occur at least every three to four months – whether spontaneously or supported by targeted treatment.

Whether a medication such as metformin – a substance originally developed for diabetes that can improve insulin sensitivity in PCOS – is appropriate depends on the individual situation. This decision is always made together and with ongoing medical support.

You can find more information about PCOS treatment with Elisa Mahlberg on the dedicated service page.

PCOS and fertility

PCOS can make conceiving more difficult – but it does not mean that pregnancy is unlikely. PCOS is one of the most common and, at the same time, one of the most treatable causes of unmet fertility wishes.

Many women become pregnant with the right kind of support. What matters most is individual assessment, patience, and care that is tailored to your personal circumstances.

If having a child is something you are thinking about, the fertility consultation offers a good first step for an initial conversation.

Why long-term care matters

Untreated PCOS can, over time, increase the risk of metabolic conditions, high blood pressure, and changes in blood lipid levels. When periods are very infrequent, changes to the uterine lining may also occur.

Regular check-ups help to identify and reduce these risks at an early stage. Good ongoing care is therefore valuable even when there are no acute symptoms at present.

As part of the gynaecological care at Elisa Mahlberg in Dormagen, PCOS can be accompanied individually and over the long term.

Conclusion: PCOS is individual – and manageable

Polycystic Ovary Syndrome presents differently in every woman. There is no single therapy that works for everyone. What matters is finding an approach together that fits your individual life situation – with realistic goals and care that responds to your specific needs.

If you have questions about PCOS or would like a thorough assessment, you are welcome to book an appointment at any time.

References

• Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG): Guideline on Polycystic Ovary Syndrome, AWMF Registration No. 015-088
• Teede HJ et al.: Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction, 2018; 33(9): 1602–1618
• European Society of Human Reproduction and Embryology (ESHRE): PCOS Guideline, 2023. Available at: www.eshre.eu