It is characterised by hormonal imbalances that may cause irregular menstrual periods, excess body or facial hair, acne and difficulty becoming pregnant. PCOS may also increase the risk of metabolic problems such as type 2 diabetes, high cholesterol, and high blood pressure.
Having polycystic ovaries means that an ultrasound shows many small cysts in the ovaries, but this does not always indicate PCOS. PCOS is a clinical diagnosis that requires at least two of the following: irregular periods, signs of excess androgens (such as excess hair or acne), and polycystic ovaries on ultrasound, according to the Rotterdam criteria recommended by the Endocrine Society.
Irregular menstruation (oligomenorrhoea, amenorrhoea)
Hyperandrogenism: hirsutism, acne, androgenic alopecia
Anovulatory infertility
Central obesity (not universal)
Acanthosis nigricans (marker of insulin resistance)
Metabolic disorders: dyslipidaemia, glucose intolerance, metabolic syndrome, hypertension
Increased risk of obstructive sleep apnoea, depression, anxiety, eating disorders and reduced quality of life.
PCOS is a heterogeneous and multifactorial condition, with genetic, epigenetic, and environmental contributions.
The underlying mechanisms include hypothalamic–ovarian dysfunction, insulin resistance, compensatory hyperinsulinemia, alterations in gonadotropin secretion (increased LH, decreased FSH), and excess ovarian and adrenal androgens.
Insulin resistance is present in 50–70% of patients, even in the absence of obesity. It enhances ovarian androgen production and reduces sex hormone–binding globulin (SHBG), thereby increasing the free fraction of testosterone.
Chronic low-grade inflammation. Some patients with PCOS show persistent markers of systemic inflammation, which may contribute to the hormonal imbalance observed in this condition.
PCOS can make pregnancy more difficult because many women do not ovulate regularly. However, most women with PCOS can become pregnant with appropriate treatment and lifestyle changes.
In some cases, due to age or the specific characteristics of PCOS, assisted reproductive treatments may be necessary to achieve pregnancy.
The available options range from medication to regulate the menstrual cycle to techniques such as artificial insemination or in vitro fertilisation.
It is essential to rely on a medical team experienced in PCOS, especially in controlled ovarian stimulation protocols, in order to minimise risks and carefully manage dosages and monitoring. In this way, complications such as ovarian hyperstimulation syndrome and others can be anticipated or avoided.
The absence of regular ovulation prevents the release of a mature egg in each cycle. Even when ovulation occurs, oocyte quality may be reduced, affecting embryo viability.
Not all patients with PCOS experience the same degree of reproductive impairment. Some may ovulate spontaneously and achieve pregnancy without assistance, while others require medical treatment from the outset.
For this reason, it is crucial to individualise both the diagnosis and the treatment plan, taking into account factors such as age, hormonal status, weight, family history, and ovarian reserve.
The fertility management of PCOS may include different strategies, ranging from lifestyle changes to advanced assisted reproduction techniques. The most common options include:
- Nutritional changes and weight management.
- Ovulation induction with hormonal medication.
- Artificial insemination (AI) in selected cases.
- In vitro fertilisation (IVF), especially if there is poor ovarian response or additional factors involved.
Since PCOS does not affect all women in the same way, the reproductive approach must be fully individualised. Some patients may benefit from lifestyle changes or simple ovulation induction, while others will require more advanced techniques such as in vitro fertilisation (IVF).
Comprehensive
management:
International guidelines recommend an
individualised approach, focused on the
patient’s goals (symptom control, fertility,
prevention of comorbidities):
a healthy diet and regular exercise form the basis of treatment and help improve symptoms and reduce long-term risks.
First-line option to regulate the menstrual cycle and treat excess androgens (excess hair, acne).
Particularly useful in cases of insulin resistance or metabolic disorders.
Prescribed and monitored by the gynaecologist to ensure treatment success.
Antiandrogens for resistant cases, hair-removal treatments (laser), and psychological support.
How is PCOS diagnosed at Equipo Juana Crespo?
The diagnosis of polycystic ovary syndrome cannot be based solely on an ultrasound or a single blood test. At Equipo Juana Crespo, we take a comprehensive approach, combining clinical examination, hormonal testing, metabolic evaluation, and advanced gynaecological imaging techniques. The aim is to provide an accurate diagnosis and a personalised plan, especially when the patient is trying to conceive.
The first step is a detailed medical interview, during which we gather information about menstrual cycles, personal and family history, presence of hormonal symptoms (such as acne, hirsutism, or hair loss), weight changes, difficulty conceiving, and possible metabolic disorders. This phase is essential to guide the complementary tests correctly.
We perform a high-resolution transvaginal ultrasound, which allows us to accurately observe ovarian morphology. In women with PCOS, it is common to find enlarged ovaries with multiple small follicles arranged around the periphery. However, the presence of polycystic ovaries alone is not sufficient to diagnose the syndrome; it must always be assessed within the clinical and hormonal context of each patient.
We request a complete hormonal profile, which may include levels of luteinising hormone (LH), follicle-stimulating hormone (FSH), androgens (total and free testosterone, DHEA-S), prolactin, TSH and other related hormones. In addition, we carry out a metabolic profile assessment, including fasting glucose, insulin, glycated haemoglobin, and lipids, among other parameters, as many patients with PCOS present insulin resistance or other associated metabolic disorders.
At Equipo Juana Crespo, the diagnosis of PCOS is not limited to meeting theoretical criteria; we perform a comprehensive assessment that may include input from specialists in endocrinology, gynaecology, assisted reproduction and nutrition, when necessary. This allows us to design a plan tailored to the clinical and reproductive profile of each woman, especially in complex cases or in patients who have not received a clear diagnosis in previous consultations.
Treatment for polycystic ovary syndrome must be tailored to each patient, according to her age, symptoms, reproductive goals, and hormonal-metabolic status. At Equipo Juana Crespo, we propose two complementary therapeutic approaches: one aimed at controlling general symptoms and another focused on improving fertility.
Combined hormonal contraceptives, which help regulate the cycle, reduce excess androgens (improving acne and hirsutism), and prevent endometrial thickening associated with prolonged amenorrhoea.
Antiandrogen treatment, such as spironolactone, in selected cases and always under medical supervision, to reduce androgen activity.
Metformin or other insulin sensitizers if insulin resistance or metabolic disorders are detected.
Nutritional guidance and regular physical exercise, especially strength training, which improves insulin sensitivity and helps restore ovulation in many patients.
This approach is also essential before starting fertility treatment, as optimising the hormonal and metabolic environment improves the response to reproductive treatments and reduces risks.
Reproductive approach:
treatment of PCOS in
women seeking pregnancy
In women with PCOS who wish to conceive,
treatment focuses on restoring ovulation and
facilitating fertilisation. The strategy depends
on the degree of anovulation, age, ovarian reserve,
and other associated factors:
Using medications such as clomiphene citrate or letrozole, indicated in mild cases, especially when the patient ovulates sporadically.
Combined with artificial insemination (AI), when induction alone is not sufficient or when other mild infertility factors are present.
In cases where pregnancy is not achieved with previous techniques, when there is severe anovulation, advanced age or poor oocyte quality.
In situations where oocyte quality is severely compromised or when there have been repeated implantation failures.
PCOS is a chronic condition that does not have a definitive “cure,” but it can be effectively managed with proper diagnosis, personalised treatment, and lifestyle changes.
Without treatment, PCOS may cause prolonged menstrual irregularities, difficulty conceiving, an increased risk of type 2 diabetes, cardiovascular disease, and emotional problems such as anxiety or depression.
Some women with PCOS ovulate irregularly but spontaneously and may become pregnant without treatment. However, many require medical assistance to regulate ovulation and optimise their chances.
PCOS does not damage ovarian structure or prematurely deplete ovarian reserve, but it may affect egg quality and ovarian function due to hormonal and metabolic imbalance. A persistent hyper oestrogenic state may affect uterine function.
Some supplements, such as inositol, may help improve insulin resistance and ovarian function, but they should always be prescribed and monitored by a specialist.
Maintaining a healthy weight, following a balanced diet, exercising regularly, and managing stress are the foundations for controlling PCOS and improving fertility.
