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PCOS: Polycystic Ovary Syndrome In-Depth

A comprehensive guide to managing PCOS in Nigerian women

Polycystic ovary syndrome (PCOS) affects approximately 8-13% of reproductive-age Nigerian women and is the most common cause of irregular periods and female infertility. Despite being so prevalent, it remains widely misunderstood and undertreated. PCOS is a hormonal and metabolic disorder with diverse presentations — some women have mainly irregular periods and fertility problems; others have more troubling features of excess androgen (testosterone) such as facial hair and acne. Importantly, PCOS significantly increases risk of diabetes, heart disease, and endometrial cancer — making long-term management about much more than fertility.

Signs and Symptoms

✓ Irregular or absent periods (oligomenorrhoea/amenorrhoea): cycles longer than 35 days or fewer than 9 periods per year
✓ Signs of excess androgen: facial hair (hirsutism), acne on the face and back, scalp hair thinning (androgenic alopecia)
✓ Difficulty conceiving (anovulatory infertility)
✓ Weight gain, particularly around the abdomen
✓ Skin tags and darkening of skin folds (neck, armpits, groin) — acanthosis nigricans from insulin resistance
✓ Mood changes, anxiety, depression

Risk Factors

When to Seek Help

Gynaecologist/endocrinologistIrregular periods for more than 3 months not explained by pregnancy, weight loss, or extreme exercise; difficulty conceiving for more than 12 months; significant hirsutism or acne
Metabolic screeningAll PCOS patients should be screened for impaired glucose tolerance (oral glucose tolerance test) and lipid profile — independent of weight; repeat every 1-3 years
Mental healthDepression and anxiety are significantly more common in PCOS — screen and offer treatment; PCOS-specific counselling support is available in Nigeria through fertility clinics

Tests & Diagnosis

🧪 Pelvic ultrasound
Shows polycystic ovaries: 12+ follicles 2-9mm in size, or ovarian volume >10mL; the diagnostic criterion most used in Nigeria
🧪 LH, FSH, testosterone
Elevated LH:FSH ratio >2:1 and elevated total or free testosterone support PCOS diagnosis
🧪 TSH (thyroid function)
Hypothyroidism causes similar symptoms — must be excluded in all women with irregular periods
🧪 Prolactin
Elevated prolactin from pituitary adenoma also causes irregular periods — must be excluded
🧪 Oral glucose tolerance test (OGTT)
More sensitive than fasting glucose for detecting impaired glucose tolerance in PCOS; recommended for all PCOS patients
🧪 Lipid profile
Dyslipidaemia common in PCOS — raises cardiovascular risk

Treatment Options

1
Lifestyle modification — the cornerstone
Weight loss of even 5-10% of body weight in overweight women with PCOS restores ovulation in 55-80%; reduces testosterone, improves insulin resistance, and reduces long-term metabolic risk; structured exercise programme + calorie-controlled diet
2
Combined oral contraceptive pill (COCP)
Regulates periods, reduces androgen effects (acne, hirsutism), and prevents endometrial hyperplasia from prolonged anovulation; choose pills with less androgenic progestogens (desogestrel, drospirenone); not suitable for women trying to conceive
3
Metformin
Improves insulin sensitivity; reduces androgen levels; helps restore ovulation; reduces diabetes risk; 500mg twice or three times daily with food; available and affordable in Nigeria; safe for long-term use
4
Fertility treatment
Letrozole (first-line ovulation induction — superior to clomiphene in PCOS); clomiphene citrate; injectable gonadotrophins; IVF for cases not responding to oral agents
5
Hirsutism treatment
Spironolactone 50-150mg daily (anti-androgen — contraindicated in pregnancy); eflornithine cream for facial hair; laser hair removal; combined OCP; results take 3-6 months to become apparent

Frequently Asked Questions

Is PCOS curable?
PCOS is a lifelong condition that can be managed but not cured. Many symptoms improve with lifestyle changes, and fertility can often be achieved with treatment. The underlying hormonal and metabolic abnormalities require ongoing monitoring and management.
Can a woman with PCOS get pregnant?
Yes — most women with PCOS can conceive with appropriate treatment. Ovulation induction with letrozole is highly effective (cumulative pregnancy rate 50-70% over several cycles). IVF is reserved for cases where simpler treatments fail.
Does PCOS cause diabetes?
Not inevitably, but PCOS significantly increases the risk of type 2 diabetes — 50% of PCOS women develop type 2 diabetes by age 40. This risk is significantly reduced with lifestyle modification, maintaining healthy weight, and sometimes metformin. Regular glucose monitoring is essential.
Does the period always return after PCOS treatment?
With lifestyle modification and/or medications, most women with PCOS see improved menstrual regularity. Complete normalisation depends on the degree of underlying insulin resistance and androgen excess. The COCP provides reliable regular withdrawal bleeds but does not induce ovulation.
Are there PCOS specialists in Nigeria?
Reproductive endocrinology and fertility specialists at teaching hospital gynaecology departments manage PCOS. The Lagos University Teaching Hospital (LUTH) and University College Hospital Ibadan (UCH) have dedicated fertility clinics. Private fertility clinics in Lagos, Abuja, and other cities provide comprehensive PCOS care.

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