Your skin is covered in acne despite your 28 years, your periods arrive when they want (or not at all), and your gynecologist talks about "polycystic ovaries" without really explaining. Polycystic ovary syndrome (PCOS) affects between 8 and 13% of women of reproductive age, and yet 70% of them remain undiagnosed.
It's not a rare condition. It's the leading cause of female infertility worldwide. And no, it's not just irregular periods. PCOS is a complex hormonal imbalance that can impact your weight, fertility, skin, mood, and long-term health. This article separates the facts from the fiction, backed by scientific data, and provides concrete answers to the questions you're asking.
The main thing to remember
- What's this ? A hormonal imbalance that creates an excess of androgens (male hormones)
- Prevalence : 8-13% of women, but up to 70% are undiagnosed
- Diagnosis : 2 out of 3 criteria (ovulation disorders + hyperandrogenism + polycystic ovaries)
- Variable symptoms : irregular periods, acne, hirsutism, weight gain, but not all are present
- Fertility : 50% primary infertility, but 74% get pregnant naturally with appropriate monitoring
- no healing, but effective management through lifestyle, treatments and supplements
- Psychological impact : anxiety, depression and negative body image common
PCOS: Definition & Mechanisms
Polycystic ovary syndrome is an endocrine disorder, not an ovarian disease per se. The name is misleading: these "cysts" are not cysts in the medical sense, but rather follicles that have not fully matured.
Clear
Your ovaries produce too many male hormones (androgens, including testosterone). This overproduction disrupts the normal functioning of your cycles: ovulation becomes rare or nonexistent, and many follicles remain stuck at an immature stage in your ovaries, hence the "polycystic" appearance on ultrasound.
The Two Main Mechanisms
The pathophysiology of PCOS remains partly mysterious, but two mechanisms are at the heart of the problem.
1. Hyperandrogenism (excess male hormones)
The pituitary gland (a gland in the brain) produces too much LH (luteinizing hormone) compared to FSH (follicle-stimulating hormone). This imbalance causes the ovaries to produce more testosterone than normal. The result: acne, excessive hair growth, disrupted cycles, and blocked ovulation.
2. Insulin resistance
About 70% of women with PCOS have insulin resistance, even if they're not overweight. Your pancreas produces too much insulin to compensate for this resistance, and this hyperinsulinemia stimulates even more androgen production. It's a vicious cycle that promotes weight gain, makes weight loss difficult, and increases the risk of type 2 diabetes.
Causes of PCOS
The exact cause of PCOS is unknown. Research points to a combination of genetic, epigenetic, and environmental factors.
- Heredity : If your mother or sister has PCOS, you have a 30% increased risk of developing it. Several genes are involved, but no single one is responsible.
- Endocrine disruptors : Suspected but not formally proven. Chemical substances (plastics, cosmetics, pesticides) could play a role
- In utero development : Exposure to high levels of androgens during pregnancy may increase the risk
- Chronic inflammation : Women with PCOS often have elevated inflammatory markers, but it is unclear whether this is a cause or a consequence.
Symptoms of PCOS
PCOS is a chameleon. Two women diagnosed with PCOS can have radically different clinical presentations. Some symptoms are very debilitating, others almost imperceptible.
The most common symptoms
- Menstrual cycle disorders (present in 70-85%) : Long cycles (more than 35-40 days), irregular, unpredictable, or complete absence of periods (amenorrhea)
- Hirsutism (50-60%) : Excessive hair on the face (mustache, beard), chest, back, stomach. This is the most visible and socially stigmatizing symptom.
- Persistent acne (20-40%) : Hormonal acne that does not go away after adolescence, located on the lower face, jaw and neck
- Androgenic alopecia (10-20%) : Hair loss at the top of the head or at the temples, as in men
- Weight gain and difficulty losing weight (40-60%) : Overweight or obesity, often located in the abdominal area, resistant to conventional diets
- Acanthosis nigricans (10-30%) : Dark, thick spots on the back of the neck, under the arms, and inside the thighs, a sign of insulin resistance
Lesser Known But Very Real Symptoms
Beyond the "classic" symptoms, PCOS is often accompanied by less documented but equally impactful disorders.
- Chronic fatigue and lack of energy, sometimes linked to insulin resistance or sleep apnea
- Sleeping troubles, in particular obstructive sleep apnea (risk multiplied by 5-10)
- Emotional hypersensitivity, anxiety and depression (40-60% increased risk)
- Persistent swollen belly, often confused with simple bloating but linked to inflammation and metabolic imbalance
- Troubles digestifs, including irritable bowel syndrome, which is more common in women with PCOS
Important : You probably won't have all of these symptoms. Some women only have irregular cycles, while others have acne, hirsutism, and excess weight. There isn't one PCOS, but several phenotypes with varying presentations.
How to Diagnose PCOS
PCOS diagnosis is based on the Rotterdam criteria, established in 2003 and updated in 2023. You must have at least 2 of the following 3 criteria.
The Concrete Diagnostic Course
If you suspect PCOS, consult your gynecologist, primary care physician, midwife, or endocrinologist. Diagnosis generally follows these steps.
1. Medical interview
Your doctor will ask you about your menstrual cycles, your symptoms (acne, hair growth, weight gain), your family history, and your current treatments.
2. Physical examination
Measurement of weight, taille, around taille. Observation of hairiness, acne, acanthosis nigricans. BMI calculation.
3. Hormonal assessment (blood test)
To be performed between the 2nd and 5th day of the cycle. If you do not have a period, a progestin treatment may be prescribed to induce it. Dosages include:
- FSH and LH (to see the inversion of the LH/FSH ratio)
- Total and free testosterone
- DHEA-S (androgen produced by the adrenal glands)
- 17-hydroxyprogesterone (to exclude congenital adrenal hyperplasia)
- TSH and prolactin (to rule out other causes)
- AMH (anti-Müllerian hormone, often very high in PCOS)
4. Metabolic assessment
- Fasting blood glucose and glycated hemoglobin (HbA1c)
- Fasting insulin levels (to assess insulin resistance)
- OGTT (oral glucose tolerance test) if necessary
- Lipid profile (cholesterol, triglycerides)
5. Pelvic ultrasound
Transvaginal ultrasound to visualize the ovaries and count follicles. Note: Not all polycystic ovaries mean PCOS. Approximately 20-30% of women without PCOS have ovaries that appear polycystic on ultrasound.
Diagnoses to Exclude
PCOS is a diagnosis of exclusion. Other conditions can mimic its symptoms and must be ruled out.
- Hypothyroidism : May cause irregular cycles, weight gain, fatigue
- hyperprolactinemia : Excess prolactin which blocks ovulation
- Congenital adrenal hyperplasia : Excessive production of androgens by the adrenal glands
- Cushing's syndrome : Excess cortisol
- Androgen-secreting ovarian or adrenal tumors (rare but to be excluded if severe and rapid hyperandrogenism)
PCOS & Fertility: Your Real Chances of Pregnancy
PCOS is the leading cause of female infertility worldwide. But infertility does not mean sterility. A crucial nuance.
The good news
About 74% of women with PCOS manage to conceive naturally, according to a study published in Human Reproduction. Many even have above-average ovarian reserve, despite hormonal imbalances. Anovulation makes conception longer, but not impossible.
Impact on Design
PCOS complicates pregnancy in several ways.
- Anovulation or irregular ovulation : If you don't ovulate, or only a few times a year, you automatically have fewer conception windows.
- Variable oocyte quality : Excess androgens and inflammation can affect egg maturation
- Luteal insufficiency : Insufficient production of progesterone after ovulation, making implantation of the embryo more difficult
- Slightly increased risk of miscarriage (20-30% vs 15-20% in the general population)
Infertility figures in PCOS
- 50% of women with PCOS have primary infertility (have never been able to get pregnant)
- 25% have secondary infertility (difficulty conceiving after having one or more children)
- 25% do not encounter any difficulties and get pregnant without any problems
How to Get Pregnant with PCOS
There are several approaches to improving your chances of pregnancy, from the least invasive to the most medicalized.
1. Healthy lifestyle and weight loss
If you are overweight, losing just 5 to 10 percent of your weight can restore ovulation in 50 to 70 percent of cases. This simple, cost-free approach often works better than medical treatments.
- Anti-inflammatory diet (Mediterranean, low-carb, or ketogenic depending on the case)
- Regular physical activity (reduced insulin resistance)
- Stress management (cortisol further disrupts ovulation)
2. Ovulation induction (Clomid or Letrozole)
Clomiphene citrate (Clomid) is the first-line treatment for stimulating ovulation. It works in 60-80% of cases. Letrozole (an aromatase inhibitor) shows similar or even higher success rates, with a lower risk of multiple pregnancies.
Disadvantage Clomid dries out cervical mucus, which can ironically reduce the chances of conception. Your gynecologist can help you optimize this aspect.
3. Metformin (prescription)
Metformin improves insulin sensitivity and may restore ovulation in some women. Its use as a first-line treatment for infertility is controversial: recent studies show that it is no more effective than Clomid alone and should no longer be routinely prescribed in this setting.
4. Ovarian drilling (laparoscopic surgery)
When oral treatments fail, ovarian drilling involves puncturing the surface of the ovaries to stimulate ovulation. This technique restores normal cycles in approximately 50% of cases and has the advantage of avoiding the risk of multiple pregnancies associated with gonadotropins.
5. PMA (Medically Assisted Procreation)
As a last resort: artificial insemination or IVF (in vitro fertilization). Women with PCOS often have an excellent response to ovarian stimulation, but are at greater risk of hyperstimulation.
IVF success rates are comparable to, or even higher than, those of the general population thanks to good ovarian reserve.
PCOS and Pregnancy: The Risks
Once pregnant, PCOS increases certain risks of pregnancy complications. This doesn't mean you'll have them, but increased monitoring is recommended.
- Gestational Diabetes (risk multiplied by 3-4)
- Preeclampsia (hypertension during pregnancy)
- Premature delivery
- Excessive weight gain during pregnancy
- Cesarean section more frequent
🤰 Protocols & Testimonials Getting Pregnant with PCOS →
How to Treat PCOS
There is no cure for PCOS. PCOS cannot be cured; it must be managed. Treatment is symptomatic and should be continued until menopause.
Hygiene of Life: The Incompressible Basis
All specialists agree: changing one's lifestyle is the first line of treatment, well before medication.
Diet adapted to PCOS
The goal is twofold: to reduce chronic inflammation and stabilize blood sugar levels to improve insulin sensitivity.
- Favor : Green vegetables, low-glycemic fruits, lean proteins, oily fish (omega-3), whole grains, legumes, olive oil, oilseeds
- Limit strongly : Refined sugars, ultra-processed products, saturated fats, dairy products (controversial, some women react badly), alcohol
- Effective approaches : Mediterranean diet (most studied), low-carb, ketogenic (under supervision), or anti-inflammatory
Please note : Restrictive diets and diet culture can worsen eating disorders (EDs), which are already more common in women with PCOS. Seek professional support from a nutritionist if needed, not Instagram.
Physical activity
Regular exercise improves insulin sensitivity, reduces inflammation, promotes weight loss, and regulates hormones. You don't have to run a marathon.
- Recommendation : 150 minutes of moderate activity per week (brisk walking, cycling, swimming)
- Musculation : Very effective in improving insulin resistance (2-3 sessions/week)
- HIIT (high intensity interval training): Excellent results on metabolism in a short time
Drug Treatments
Treatments vary depending on your main symptoms and your life plan.
Dietary Supplements for PCOS
Some supplements have been shown to be scientifically effective in improving PCOS symptoms. Please note that they are not a substitute for a healthy lifestyle or medical monitoring.
The most studied supplements
Myo-inositol (+ D-chiro-inositol) : The most effective and most studied. Improves insulin sensitivity, regulates cycles, improves oocyte quality. Recommended dose: 4g/day. Interesting alternative to metformin with fewer side effects.
NAC (N-acetyl-cysteine) : Powerful antioxidant that improves oocyte quality, reduces inflammation and insulin resistance. Dose: 600-1800mg/day.
Vitamin D : Often deficient in PCOS women. Supplementation improves hormonal regulation and fertility.
Magnesium : Improves insulin sensitivity and reduces anxiety.
Omega-3 (EPA/DHA) : Reduce chronic inflammation and improve metabolic markers.
Berberine : Comparable to metformin for improving insulin sensitivity. Dose: 500mg 2-3 times/day.
Specialized PCOS brands : Sova and Zytolia (formerly Hollis) offer formulas specifically designed for PCOS, with tailored dosages and optimized inositol combinations. These products are popular with many users but remain supplements, not miracle treatments.
📋 Sample 7-Day Menu & Anti-Inflammatory PCOS Recipes →
The Psychological Impact of PCOS
Living with PCOS carries an invisible mental burden. Beyond the physical symptoms, the syndrome profoundly affects mental health and quality of life.
Mental health figures in PCOS
- Anxiety : Risk increased by 40-60% compared to the general population
- Depression : Risk multiplied by 2-3, particularly in cases of infertility or hirsutism
- Body image disorders : Very common, linked to weight gain, acne and hirsutism
- Eating disorders : More frequent (orthorexia, hyperphagia, restriction cycles)
- suicidal thoughts : Risk up to 7 times higher according to some studies
Why PCOS Has Such a Bad Impact on Morale
Psychological distress isn't "just in your head." It results from a tangle of biological, social, and emotional factors. Several mechanisms are intertwined.
- Social stigma Hirsutism, acne, and being overweight are socially judged. Hurtful remarks, stares, and intrusive questions ("but why do you have a mustache?") are a daily occurrence.
- Diagnostic wandering : On average, 7 years and 5 consultations before diagnosis. During this time, you hear "it's normal", "it's in your head", "go on a diet"
- Infertility For those who want a child, the absence of periods and the difficulties in conceiving generate enormous stress.
- Invisible mental load : Managing pain, treatments, daily hair removal, medical appointments, restrictive diets, guilt about not "doing it right"
- Direct hormonal imbalance : Androgens and insulin resistance directly influence brain function and emotional regulation
Recurring testimony
"The day I was diagnosed, I cried. Even though it didn't change anything about my condition, putting what I was going through into words was a real shock. No one had taken me seriously before. I felt both relief and anger. All those years of feeling guilty, thinking it was my fault."
Taking Care of Your Mental Health
PCOS can also be managed through psychological support. It's not a luxury, it's a necessity.
- Consult a psychologist or psychiatrist if you experience anxiety, depression, dark thoughts
- Join a community : Patient associations (Asso'SOPK, SOPK Europe), forums, Facebook groups. You are not alone.
- Stress management techniques : Yoga, meditation, cardiac coherence, behavioral therapies
- Refuse guilt : You are not responsible for your PCOS. It is not a personal failure, it is a chronic illness.
Living with PCOS on a Daily Basis
PCOS is a chronic illness. There's no cure; you learn to live with it. Here are some practical strategies to make your daily life easier.
Managing Hirsutism
This is the most visible and stigmatizing symptom. Several options exist, none of which are miraculous.
Laser or pulsed light hair removal : Effective but requires several sessions (10-15), does not guarantee a definitive result, and is expensive
Classic hair removal : Tweezers, razor, hair removal cream, wax. Temporary but accessible
Vaniqa Cream (eflornithine) : Slows down facial hair growth. Moderate effectiveness, apply twice a day.
Hormonal treatments : Anti-androgens (Androcur, Aldactone) gradually reduce hair growth over 6-12 months
Reduce Endocrine Disruptors
Although their role in PCOS is not fully proven, limiting your exposure can improve your overall hormonal balance.
In the kitchen : Replace plastic with glass or stainless steel (water bottles, food containers)
In the bathroom : Use clean cosmetics (applications like Yuka, INCI Beauty to scan your products)
For cleaning : Prefer natural products (white vinegar, baking soda, black soap)
On the plate : Choose organic foods, at least for the most processed fruits and vegetables (strawberries, apples, grapes, spinach)
⚖️ Understanding & Managing Weight Gain with PCOS →
Taking Back Control, One Step at a Time
Polycystic ovary syndrome affects 1 in 10 women but remains largely underdiagnosed. It's not just a problem with irregular periods; it's a complex hormonal and metabolic disorder that impacts fertility, weight, skin, mood, and long-term health.
Diagnosis is based on two of the three Rotterdam criteria (ovulation disorders + hyperandrogenism + polycystic ovaries). There is no cure, but effective management combining lifestyle, targeted medical treatments, and dietary supplements can significantly improve symptoms.
The majority of women with PCOS manage to get pregnant, either naturally or with proper medical care. The psychological impact of the syndrome is real and deserves to be taken seriously. Join a community, consult a professional, and reject the guilt.
If you recognize these symptoms, seek medical help. Diagnosis can take time, but putting words to what you're experiencing is the first step toward regaining control.
Sources & Scientific References
This article is based on recent scientific studies and international evidence-based recommendations.
International recommendations and diagnostic criteria
- Teede HJ, et al. (2023). Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Hum Reprod. DOI: 10.1093/humrep/dead156
- Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks associated with polycystic ovary syndrome. Fertile Sterile. DOI: 10.1016/j.fertnstert.2003.10.004
- Stener-Victorin E, Teede H, Norman RJ, et al. (2024). Polycystic ovary syndrome. Nat Rev Dis Primers. DOI: 10.1038/s41572-024-00511-3
Prevalence and epidemiology
- Bozdag G, Mumusoglu S, Zengin D, et al. (2016). The prevalence and phenotypic characteristics of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. DOI: 10.1093/humrep/dew218
- Lizneva D, Suturina L, Walker W, et al. (2016). Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertile Sterile. DOI: 10.1016/j.fertnstert.2016.05.003
Pathophysiology and mechanisms
- Yildiz BO, Bolour S, Woods K, et al. (2024). Polycystic ovary syndrome as a metabolic disease. Nat Rev Endocrinol. DOI: 10.1038/s41574-024-01057-w
- Diamanti-Kandarakis E, Dunaif A. (2012). Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. DOI: 10.1210/er.2011-1034
Fertility and pregnancy
- Christ JP, Gunning MN, Meun C, et al. (2019). Pre-conception characteristics predict obstetrical and neonatal outcomes in women with polycystic ovary syndrome. J Clin Endocrinol Metab. DOI: 10.1210/jc.2018-01787
Treatments and myo-inositol
- Unfer V, Carlomagno G, Dante G, Facchinetti F. (2012). Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials. Gynecol Endocrinol. DOI: 10.3109 / 09513590.2012.662882
- Costantino D, Minozzi G, Minozzi E, Guaraldi C. (2009). Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. Eur Rev Med Pharmacol Sci. PMID: 19499845
Mental health and quality of life
- Yadav S, Narasimhan S, Channaveerappa D, et al. (2023). Direct economic burden of mental health disorders associated with polycystic ovary syndrome: systematic review and meta-analysis. eLife. DOI: 10.7554/eLife.85338
Official French resources
- Ameli.fr. Symptoms, diagnosis and progression of polycystic ovary syndrome. Ameli Link
- Inserm. Polycystic ovary syndrome (PCOS). Inserm link
- WHO. (2025). Polycystic ovary syndrome. WHO Link
Footnotes : DOIs allow direct access to original scientific publications.
Medical warning : This article is for informational purposes only and is not a substitute for professional medical advice. For diagnosis and treatment tailored to your situation, consult a gynecologist, endocrinologist, midwife, or general practitioner.
