Polycystic Ovaries (PCOS)

Polycystic ovary syndrome (PCOS) is the most common endocrinological and metabolic disorder in women of reproductive age, affecting between 10% and 15% of the female population. Although the name may sound alarming, polycystic ovaries are not actually a disease, but a complex syndrome that encompasses a range of reproductive, hormonal, and metabolic characteristics. At Palmotićeva Clinic, our approach is based on the latest 2023 ESHRE guidelines, providing integrated diagnostics and modern therapy tailored to your life goals, whether you are planning a pregnancy or seeking a better quality of life.

What is PCOS?

PCOS is a condition that affects how a woman's ovaries function. According to the current Rotterdam criteria, the diagnosis is confirmed if you have at least two of the following three signs (while excluding other conditions):

• Oligo/anovulation: Irregular menstruations or their complete absence, which is a sign of chronic lack of ovulation.
• Clinical and/or biochemical signs of hyperandrogenism: Elevated levels of male sex hormones (such as testosterone), which manifests through various symptoms.
• Polycystic appearance of ovaries on ultrasound: An increased number of small follicles in the ovaries and/or increased ovarian volume (most commonly detected using modern ultrasound).

Recognizing Key Symptoms

Symptoms of polycystic ovaries usually become apparent in the late teenage years or early twenties, and can significantly impact both physical health and psychological well-being.

• Irregular periods: Cycles longer than 35 days, very rare menstruations (fewer than 9 per year), or their complete absence.
• Aesthetic and skin changes: Excessive hair growth on the face, body, chest (hirsutism), persistent acne that responds poorly to treatments, and increased hair loss (similar to male pattern baldness).
• Metabolic issues: A tendency to gain weight easily (especially around the waist), insulin resistance, fatigue, and sudden energy crashes.
• Difficulty conceiving: PCOS is a leading cause of anovulatory infertility in women.
• Mental health: Increased frequency of mood swings, anxiety, and depression due to chronic symptoms.

Diagnostics at Palmotićeva Clinic

Precise diagnosis is a crucial first step. Because PCOS looks different in every woman (different phenotypes of the disorder are formed), a thorough approach is required:

• Expert gynecological ultrasound: Using transvaginal or transabdominal equipment, we carefully evaluate ovarian volume, antral follicle count, and endometrial thickness.
• Hormonal status and metabolic panel: Blood is usually sampled between the second and fifth day of the cycle to analyze sex hormones (FSH, LH, Estradiol, Progesterone, Free and total testosterone, DHEAS, SHBG).
• Insulin resistance assessment: When necessary, a specific OGTT with insulinemias is performed to evaluate the risk of early onset diabetes, which women with PCOS experience significantly more often.

Treatment Options: An Individualized Approach

PCOS therapy depends on what your primary current concern is – whether it's controlling uncomfortable clinical symptoms, regulating cycles, or the desire to conceive.

• Lifestyle modification: Healthier food choices, mild carbohydrate reduction, exercise, and a potential loss of just 5% of body fat can significantly reduce symptoms and encourage spontaneous ovulation.
• Targeting insulin resistance: Most often, Metformin combined with appropriate Inositol supplements, according to current guidelines, improves metabolism, regulates the menstrual cycle, and reduces androgenic hormones.
• Combined contraception: Pills, rings, or specific low-dose gestagens are most commonly prescribed to protect reproductive organ health, regulate cycles, and drastically resolve acne and excess hair (if pregnancy is not planned).
• Fertility treatment (Ovulation stimulation): If conception is a priority, Letrozole (Femara) is preferred over Clomiphene under new protocols as the safest and highly effective first-line medication. Other solutions include follicle-stimulating hormone therapy, sometimes specific targeted surgery (Laparoscopic ovarian drilling - LOD) or IVF procedures.

When to Seek Professional Medical Help?

There is no need to endure symptoms or merely guess and research on forums. Contact us if you notice prolonged signs of cycle irregularity, persistent aesthetic issues that you suspect have a hormonal basis, or if you fail to achieve a desired pregnancy over several months of unprotected intercourse.