Let’s Talk About PCOS: Sparking Awareness and Support

For our monthly Wellness Webinar, we got a deeper understanding of PCOS and how we can lend support to our diagnosed loved ones.

In honor of PCOS Awareness Month, we hosted our quarterly Hive Health Wellness Webinar last September 2023 that delved into all things PCOS or Polycystic Ovaries Syndrome.

1 in 10 women have this major health condition, but because of how little is known about the syndrome, we would have no idea how to support any of our loved ones who are diagnosed with it.

With our guest speaker, Jaycy Violago-Olivarez, MD, MBA, DPOGS, we invited all the Hive members, their family, and friends to join in. Read on to see a roundup of what you need to know about PCOS.

PCOS is one of the most common endocrinologic and metabolic disorders in women. One in 10 woman is affected with this condition.

According to WHO, Polycystic ovary syndrome (PCOS) affects an estimated 8–13% of reproductive-aged women. Up to 70% of affected women remain undiagnosed worldwide.

What is PCOS?

“Originally described as a syndrome consisting of: amenorrhea, hirsutism, and obesity in association with enlarged polycystic ovaries.” (Stein and Leventhal, 1935)

It is described as a syndrome because it is characterized by 3 symptoms which consistently occur together. These symptoms particularly are:

  1. No menses or irregular menses
  2. Hyperandrogenism such as presenting with acne, hirsutism or excess hair growth
  3. Ultrasound findings of polycystic ovaries

Common Signs and Symptoms

PCOS is underdiagnosed because it can manifest through different symptoms. The most common complaints of patients that lead to the diagnosis of PCOS are irregular periods, weight gain, infertility and severe acne.

There hasn’t been any study about the effectiveness of screening for PCOS, and that is why PCOS awareness is important for women to develop a better understanding of their health, and subsequently help improve their health seeking behaviors.

It’s important to note that PCOS isn’t screened by physicians, so women need to be aware of these symptoms.

Below are the common signs and symptoms women with PCOS have:

  • Irregular periods
  • Severe acne
  • Anxiety and depression
  • Weight gain
  • Polycystic ovaries
  • Insulin resistance
  • Hirsutism
  • Infertility
  • Male pattern alopecia

What’s difficult about this syndrome is that some, if not most, of its symptoms are common enough to happen to us on a regular basis caused by other reasons.

How PCOS is Diagnosed

To diagnose PCOS, there are 3 parameters that compose the criteria, these would be:

  1. Irregular menses
  2. Hyperandrogenism
  3. Polycystic ovaries

Here in the Philippines, we use the Rotterdam criteria which means we would need to fulfill at least 2 out of the 3 parameters to be diagnosed with PCOS.

The Menstruation Cycle

To start with the first of three parameters, let’s first revisit the menstrual cycle. For men, this would also shed light on what happens every month to the women in their lives. There are four different phases that are generally regulated by two major hormones, estrogen and progesterone.

Menstrual Cycle Length: Approximately 28 days


  • Menstruation (Days 1-5): Shedding of the uterine lining.
  • Follicular (Days 6-14): Egg matures in the ovaries.
  • Ovulation (Day 14): Release of the egg.
  • Luteal (Days 15-28): Preparing for pregnancy or cycle ends.

Menstrual Irregularity

Going back to the parameters that fulfill the criteria to diagnose PCOS, menstrual irregularity is one of the parameters or symptoms that can manifest in patients with PCOS. Irregularity of menses is based on frequency, duration, regularity, and volume. For PCOS patients, they often present with infrequency of menses.

This is our standard basis for regularity of menses, but women are still advised to consult with their OBGYNs if they are not certain. Also note that irregular menstruation can be caused by stress, change of diet, certain medications, and hormonal imbalances.


Hyperandrogenism is a cardinal feature of PCOS, patients can present with clinical or biochemical manifestation of this.

Example of symptoms of hyperandrogenism would include hirsutism or excess hair growth in certain parts of the body, acne, or hair thinning or balding in women. For patients who do not present with physical findings of hyperandrogenism but with a high risk of having PCOS, we ask for free testosterone levels to determine if the patient has biochemical hyperandrogenism.

  • Often considered central or cardinal feature
  • May be clinical or biochemical
  • Majority have ovarian source of hyperandrogenism

Testosterone: 0.7-1.2 ng/mL

Androstenedione levels: 3-5 ng/mL

Polycystic Ovaries

Last but not the least, the third parameter to discuss is polycystic ovaries on ultrasounds.

So here we have a photo of a normal ovary with a few follicles and a dominant follicle. Over to the left, you will see a polycystic ovary presenting the classic string of pearls or pearl necklace pattern.

10-25% of women may have no symptoms but may present with this ultrasound finding.

On the otherhand, ultrasound is the gold-standard to detect PCOS but PCOS may exist even without this ultrasound finding.

This may be a little bit confusing, but to simplify it, you must be aware of the 3 parameters and that you just need ⅔ to be diagnosed with PCOS. With that said, there are 4 phenotypes of PCOS.

The 4 Phenotypes of PCOS

The different phenotypes of PCOS are as follows:

  1. Classic
  2. Essential NIH Criteria
  3. Ovulatory
  4. Non-hyperandrogenic

As mentioned above, at least 2 out of 3 of the parameters or symptoms need to show before being diagnosed with PCS. These symptoms reflect which phenotype the patient might have.


The pathophysiology behind the disease remains controversial. The theory of nature vs nurture applies. We do not know that there is a likely genetic predisposition of the disease but definitely, environmental and external factors may also contribute to the development of PCOS.


PCOS is a condition that evolves as a woman evolves as well. It is a lifelong condition that should be taken seriously, not because it is deadly or severely detrimental to your health, but because it is something that can affect the reproductive and metabolic wellness of a woman throughout her different stages in life.

Below are the common complications of PCOS and what ages they may affect.

  • Infertility
  • Endometrial hyperplasia and cancer
  • Ovarian cancer
  • Type 2 Diabetes
  • Cardiovascular disease
  • Sleep Obstructive Apnea
  • Psychosocial issues

It’s very important that she is guided by the right experts as she experiences these changes. If PCOS and its metabolic effects are not addressed early on, complications and subsequent conditions can arise in the future.

Management of PCOS

When it comes to managing PCOS, because it is a syndrome, there are general points to consider that would apply based on presenting symptoms and conditions that a patient may present with.

Unfortunately, there is currently no cure for PCOS. So lifestyle modification is essential in managing the symptoms of PCOS.

  • Healthy lifestyle behaviors should be recommended in all women with PCOS.
  • Weight reduction
    • Even a small reduction in weight 2-5% can result in significant improvements in metabolic and reproductive functions
    • Achievable goals such as 5% to 10% weight loss yielded significant clinical improvement
    • An energy deficit of 30% or 500-750 kcal/day could be prescribed
    • As for dieting, Keto is a specific diet that has been scientifically proven to effectively help with glucose control
    • The most important thing for weight reduction and management is about finding what’s sustainable for each individual
  • Medications - to treat individual symptoms, but not PCOS
    • Combined oral contraception
    • Metformin
    • Clomiphine, Letrozole

Because PCOS is a condition that evolves throughout the life stages of a woman, it’s inherently important that awareness of this misunderstood syndrome, and that not just women but everyone know the basics of PCOS management. Family and friends who support both physically, mentally, and emotionally are significant in the holistic management of the condition! Here’s how you can support a loved one diagnosed with PCOS:

  • Make lifestyle changes easier by encouraging them
  • Try eating healthy with them
  • Try new activities together; aside from working out or going to the gym, focus on sustainable exercises like walking, new sports or hobbies, and the like
  • In your own way, keep spreading awareness so that more people are familiar with the condition and how to manage it

Remember: Being proactive first in acknowledging potential symptoms and getting diagnosed is important. And getting diagnosed is not a death sentence! The management of PCOS is tailored to the complications experienced by the patient, meaning different experts can help find the best way to manage PCOS.