Polycystic ovary syndrome
### Key Facts
- **Prevalence**: Polycystic ovary syndrome (PCOS) affects 8–13% of reproductive-aged women globally, but up to 70% remain undiagnosed.
- **Infertility**: PCOS is the most common cause of anovulation and a leading cause of infertility.
- **Long-Term Health Issues**: PCOS is associated with various long-term health problems affecting both physical and emotional well-being.
- **Genetic and Ethnic Factors**: PCOS often runs in families, with ethnic variations influencing how the condition manifests and affects individuals.
### Overview
PCOS is a common hormonal disorder that primarily affects women of reproductive age. It often begins during adolescence and can cause a range of symptoms, including hormonal imbalances, irregular periods, elevated androgen levels, and cysts in the ovaries. PCOS is a leading cause of infertility and is a chronic condition without a cure, though symptoms can be managed through lifestyle changes, medications, and fertility treatments. The exact cause of PCOS is unknown, but risk factors include family history and type 2 diabetes.
### Scope of the Problem
PCOS is a significant public health issue and one of the most common hormonal disorders among women of reproductive age. It affects an estimated 8–13% of women in this group, with up to 70% remaining undiagnosed. The condition's prevalence varies among different ethnic groups, with some experiencing more severe complications, particularly metabolic issues. The condition's impact on obesity, body image, and infertility can also lead to mental health challenges and social stigma.
### Symptoms
PCOS symptoms vary widely among individuals and may change over time. Common symptoms include:
- **Menstrual Irregularities**: Heavy, long, intermittent, unpredictable, or absent periods.
- **Infertility**: Difficulty becoming pregnant due to lack of ovulation.
- **Skin and Hair Issues**: Acne, oily skin, excessive hair growth (hirsutism) on the face or body, and male-pattern baldness or hair thinning.
- **Weight Gain**: Particularly around the abdominal area.
PCOS is also associated with an increased risk of other health conditions, such as type 2 diabetes, hypertension, high cholesterol, heart disease, and endometrial cancer. Mental health issues, including anxiety, depression, and negative body image, are also common and can be exacerbated by social stigma related to infertility, obesity, and unwanted hair growth.
### Diagnosis
PCOS is diagnosed based on the presence of at least two of the following criteria:
1. **Hyperandrogenism**: Signs or symptoms of high androgen levels, such as unwanted hair growth, hair loss, or acne.
2. **Menstrual Irregularities**: Irregular or absent menstrual periods.
3. **Polycystic Ovaries**: Presence of cysts on an ultrasound scan.
Blood tests may be used to identify characteristic hormone changes, such as elevated testosterone, estrogen, luteinizing hormone (LH), insulin, and anti-Müllerian hormone (AMH) levels. Diagnosis also considers factors such as puberty, menopause, family history of PCOS or type 2 diabetes, and the clarity of ultrasound results.
### Treatment
While there is no cure for PCOS, treatments are available to manage symptoms:
- **Lifestyle Changes**: Healthy diet and regular exercise can help with weight management and reduce the risk of type 2 diabetes.
- **Medications**: Birth control pills can regulate menstrual cycles and reduce symptoms. Other medications may address acne and unwanted hair growth.
- **Fertility Treatments**: For infertility, treatment options include lifestyle changes, medications, or surgery to stimulate ovulation. In-vitro fertilization (IVF) may be used in some cases but carries certain risks.
### WHO Response
The World Health Organization (WHO) collaborates with member states and partners to improve women's health and reproductive well-being, including addressing PCOS. WHO works to raise public awareness about PCOS, develop guidelines for healthcare providers, and promote research into effective prevention, diagnosis, and treatment strategies for PCOS-related infertility. Additionally, WHO supports the collection of data on infertility and its causes, including PCOS, and encourages member states to integrate infertility care into national health policies, services, and financing to ensure accessible care for all.
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