Polycystic ovary syndrome (PCOS) is a common hormonal condition that affects how the ovaries work. It is characterised by irregular ovulation, changes in hormone levels and, in many women, multiple small follicles visible on ultrasound.
PCOS can cause irregular periods, difficulty getting pregnant, acne, increased hair growth on the face and body and a tendency to gain weight. It is a chronic condition, but there are many ways to reduce symptoms and protect long term health.
In Lisbon, Dra. Joana Faria follows women with PCOS in Portuguese, English, French, and Spanish. The aim is to understand your priorities, confirm the diagnosis and build a plan that fits your life instead of forcing you into a one size fits all protocol.
This page focuses on PCOS. For related topics you can also read the pages on menstrual cycle alteration, contraception and endometriosis.
What it is
In a normal cycle, one follicle in the ovary grows, releases an egg (ovulation) and then the lining of the uterus is shed as a period. In PCOS, ovulation is infrequent or absent in many cycles. Several follicles may start to grow but none reaches full maturity.
This pattern is linked to higher levels of certain hormones, especially androgens, and to a degree of insulin resistance in many women. The exact cause is not fully understood, but genetic and environmental factors both play a role.
PCOS is not the same in every woman. Some women mainly have irregular periods, others have more acne or hair growth and others have metabolic changes such as increased blood sugar or cholesterol. Recognising this diversity is important when choosing the best treatment.
Main symptoms and when to worry
PCOS can present in many ways. The most frequent symptoms are:
- Irregular periods, cycles longer than 35 days or fewer than eight periods per year.
- Periods that stop for several months without pregnancy.
- Very heavy bleeding after long intervals without a period.
- Acne that persists beyond adolescence or is difficult to control.
- Increased hair growth on the face, chest, abdomen or thighs (hirsutism).
- Thinning hair on the scalp in some women.
- Weight gain or difficulty losing weight, particularly around the abdomen.
- Difficulty getting pregnant or needing a long time to conceive.
You should consider booking a consultation if your periods are very irregular, if you have gone more than three months without bleeding and you are not pregnant, if you feel bothered by acne or hair growth or if you have been trying to conceive for a year without success (six months if you are older than 35).
You should seek urgent care if you have very heavy bleeding with clots and dizziness or fainting, or if you have sudden severe abdominal pain that does not improve with usual painkillers. These situations are not specific to PCOS but need rapid evaluation.
Diagnosis: exams and what to expect
There is no single test that diagnoses PCOS. The diagnosis is based on a combination of symptoms, physical signs, blood tests and pelvic ultrasound, after excluding other possible causes.
During the evaluation, you can expect:
- Clinical history
Conversation about your menstrual cycle, pregnancies, family history of diabetes or PCOS, weight changes, physical activity and concerns about appearance or fertility. - Physical examination
Measurement of weight, height and blood pressure and observation of the skin, hair and distribution of body fat. The aim is not to judge, but to document objective information that will guide treatment. - Pelvic examination
When appropriate, evaluation of the pelvis to exclude other causes of pain or bleeding. - Transvaginal pelvic ultrasound
Ultrasound allows the doctor to count and measure follicles in the ovaries and to assess the thickness of the endometrium. The presence of many small follicles with a specific distribution can support the diagnosis of PCOS, especially in adults. - Blood tests
Hormone tests may include androgens, gonadotropins and other hormones that can mimic PCOS. Metabolic tests can include blood sugar, insulin, cholesterol and triglycerides to assess cardiovascular risk.
PCOS is a diagnosis made in context. Dra. Joana Faria will explain which criteria you meet, what this means for your future health and which aspects deserve closer follow up.
Treatment options and realistic expectations
PCOS is a chronic condition that can be managed very effectively. The best treatment depends on your age, symptoms, weight, metabolic profile and, above all, on whether or not you want to become pregnant soon.
Main pillars of treatment include:
- Lifestyle measures
Balanced nutrition, regular physical activity and good sleep can improve insulin resistance and hormone balance. Even modest weight loss in women with excess weight can lead to more regular cycles and easier ovulation. The goal is realistic, sustainable changes, not restrictive or extreme diets. - Cycle regulation
Hormonal treatments can regulate bleeding, protect the endometrium and reduce pain. They may be given as combined methods, progestin only methods or ciclos of progesterone, depending on your situation and preferences. - Treatment of acne and hair growth
Dermatologic care, specific medicines and local treatments (such as laser hair removal or other methods) can help improve skin and hair symptoms. This aspect is important because it directly affects self esteem. - Fertility oriented treatment
If you wish to become pregnant, options may include monitoring of natural cycles, medicines that stimulate ovulation and, in some cases, assisted reproductive techniques. The choice depends on your ovarian reserve, age, partner’s situation and other factors. - Metabolic risk reduction
Regular follow up of blood pressure, blood sugar and cholesterol helps to prevent long term complications such as diabetes and cardiovascular disease.
Realistic expectations are essential. PCOS does not have a quick cure, but many women achieve regular cycles, improved skin and hair and healthy pregnancies with the right support. Treatment plans can be adapted over time as your priorities change.
How Dra. Joana Faria approaches PCOS in practice
Dra. Joana Faria knows that PCOS is often reduced to a label given in a short consultation, sometimes with little explanation and a single prescription. Her approach is different and centred on the whole person, not only on the ovaries.
In daily practice she:
- Listens carefully to how irregular cycles, acne, hair growth or weight changes affect your daily life, relationships and self image.
- Explains clearly the mechanisms behind PCOS using simple language and images when helpful.
- Discusses in detail the pros and cons of each treatment, including how they may influence future fertility.
- Coordinates care with nutrition, dermatology, endocrinology and fertility teams whenever this can add value.
- Helps you set realistic goals and reviews them regularly, adjusting the plan when your situation or your plans change.
The aim is that you feel informed and supported, with concrete tools to manage PCOS instead of feeling guilty or responsible for a condition you did not choose.
