PCOS Explained: Symptoms, Causes, and What You Can Do About It

If you've been told you have PCOS, or you're wondering whether your symptoms point to it, you're not alone. Polycystic Ovary Syndrome (a hormonal condition where your ovaries produce too many androgens, which are male-type hormones) affects roughly 4 to 18 percent of women of reproductive age worldwide. That's millions of women, from Lagos to London, from Nairobi to New York.

Let's break it all down in plain language.

What is PCOS, really?

PCOS stands for Polycystic Ovary Syndrome. Despite the name, it's not actually about "cysts" on your ovaries. The word "polycystic" refers to the many small fluid-filled sacs (called follicles) that can develop on the ovaries. These follicles are actually eggs that didn't mature properly.

At its core, PCOS is a hormonal imbalance. Your body produces higher-than-normal levels of androgens (hormones typically associated with male development, like testosterone). This throws off your menstrual cycle, can affect your skin and hair, and may make it harder to get pregnant.

What are the symptoms?

PCOS shows up differently in different women, but common signs include:

• Irregular periods, your cycle may be longer than 35 days, or you might skip periods altogether
• Excess hair growth, also called hirsutism, meaning thicker hair on your face, chest, or back
• Acne and oily skin, especially along the jawline, chin, and cheeks
• Weight gain, particularly around the midsection, and difficulty losing weight
• Thinning hair, hair on your head may thin out, even while body hair increases
• Dark patches of skin, around the neck, armpits, or under the breasts (called acanthosis nigricans)
• Difficulty getting pregnant, PCOS is one of the leading causes of infertility in women

You don't need to have all of these symptoms to have PCOS. Some women have just one or two.

What causes PCOS?

Doctors don't know the exact cause, but several factors play a role:

1. Insulin resistance

Up to 70% of women with PCOS have insulin resistance. Insulin helps your body use sugar for energy. When your cells don't respond well to it, your body makes more, and high insulin levels can trigger your ovaries to produce more androgens. This is also why PCOS is closely linked to type 2 diabetes.

2. Genetics

PCOS tends to run in families. If your mother, sister, or aunt has it, your chances are higher.

3. Inflammation

Women with PCOS often have higher levels of chronic low-grade inflammation, which can also stimulate the ovaries to produce more androgens.

How is PCOS diagnosed?

There's no single test. Your doctor will usually ask about your symptoms and menstrual history, do a physical exam, order blood tests to check hormone levels (including testosterone, insulin, and thyroid hormones), and possibly do an ultrasound to look at your ovaries.

To be diagnosed, you typically need to meet at least two of these three criteria (the Rotterdam criteria):

1. Irregular or absent periods
2. Signs of high androgen levels (like excess hair or acne), or high androgen levels in blood tests
3. Polycystic ovaries on an ultrasound

Treatment and management

There's no cure for PCOS, but there are many ways to manage it effectively.

Lifestyle changes (the foundation)

• Regular exercise, even 30 minutes of moderate activity most days can improve insulin sensitivity and help with weight management
• Balanced eating, focus on whole foods; reducing refined sugars and processed carbs can make a big difference in blood sugar
• Weight management, losing even 5 to 10% of your body weight (if overweight) can significantly improve symptoms and restore regular ovulation

Medical treatments

• Hormonal birth control, can regulate your period, reduce acne, and lower androgen levels
• Metformin, helps your body use insulin more effectively and can help restore regular periods
• Anti-androgen medications, drugs like spironolactone can reduce excess hair growth and acne
• Fertility treatments, if you're trying to conceive, medications like letrozole or clomiphene can stimulate ovulation

Mental health support

Living with PCOS can take a toll on your mental health. Anxiety, depression, and low self-esteem are more common in women with PCOS. Don't hesitate to seek support, whether that's a therapist, an online community, or someone you trust.

PCOS in Africa: what you should know

PCOS affects women of all backgrounds, but awareness and diagnosis rates vary widely. In many parts of Nigeria, Kenya, and South Africa, women may go years without a diagnosis because symptoms are dismissed, access to specialists is limited, and stigma around infertility makes it hard to seek help.

If you suspect you have PCOS, advocate for yourself. Ask your doctor about hormone testing. You deserve answers.

The bottom line

PCOS is common, it's manageable, and it is not your fault. With the right combination of lifestyle changes, medical treatment, and support, you can live a full, healthy life with PCOS.