Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a hormonal-metabolic disorder characterized by androgen excess, disrupted ovulation, and frequently insulin resistance. The “polycystic” ovaries are not usually ovaries filled with pathologic cysts. They contain many small follicles that began developing but did not mature and ovulate. Insulin resistance often intensifies the disorder. Higher circulating insulin stimulates ovarian androgen production and reduces sex hormone-binding globulin, leaving more biologically active androgen available. Androgen excess disrupts follicle maturation, so ovulation becomes infrequent or absent. Without regular ovulation, progesterone exposure is reduced and the endometrium may be exposed to prolonged, unopposed estrogen stimulation. That mechanism explains the familiar pattern: - Infrequent, absent, or unpredictable menstrual bleeding reflects oligo- or anovulation. - Hirsutism, acne, and androgenic scalp hair thinning reflect androgen excess. - Difficulty conceiving reflects irregular or absent ovulation. - Acanthosis nigricans, central adiposity, dyslipidemia, hypertension, and elevated glucose suggest insulin resistance and cardiometabolic risk. PCOS can occur across body sizes. Avoid treating body weight as the diagnosis or as a prerequisite for care. The nurse should recognize metabolic risk while providing non-stigmatizing, goal-directed care.