Understanding Polycystic Ovary Syndrome (PCOS): Foundations, Realities, Innovations

PCOS: A Hormonal Disorder with Systemic Consequences

Polycystic Ovary Syndrome (PCOS) is a multifactorial endocrine disorder that affects approximately 1 in 10 women worldwide, according to the WHO. Long perceived as merely a fertility issue, PCOS is now recognized as a chronic condition with metabolic, cardiovascular, psychological, and genetic dimensions. It represents a major public health concern that remains underestimated, particularly in Africa, where epidemiological data are limited but where the prevalence appears to be similar to global estimates (ranging from 5% to 20%, depending on the diagnostic criteria used).

Definition and Diagnostic Criteria: The Essentials to Know

PCOS is defined by the Rotterdam Criteria (2003). The diagnosis is made when at least two of the following three elements are present:

• Oligo-ovulation or anovulation: Irregular or absent menstrual periods.
• Hyperandrogenism (clinical or biochemical): Acne, hirsutism, androgenic alopecia, or elevated circulating androgens.
• Polycystic ovaries on ultrasound: Presence of more than 12 follicles or an ovarian volume >10 mL in at least one ovary.

It is important to note that the mere presence of cysts on ultrasound is not sufficient. Diagnosis also requires the exclusion of other causes of hyperandrogenism (such as congenital adrenal hyperplasia, ovarian tumors, etc.).

A Metabolic and Hormonal Disorder

PCOS is not limited to reproductive symptoms. It is often associated with insulin resistance, even in women of normal weight (referred to as “lean PCOS”). This resistance leads to hyperinsulinemia, which in turn stimulates the ovaries to produce more androgens, worsening symptoms. This hormonal vicious cycle explains the complexity of managing the condition.

Moreover, recent studies have identified specific microRNAs (miRNAs) in ovarian cells that could potentially serve as non-invasive biomarkers for diagnosis in the future.nostic précoce ou des cibles thérapeutiques futures.

Recent Discoveries Little Known to the Public

• PCOS and Epigenetics: Research shows that epigenetic modifications induced in utero may promote the development of PCOS in female offspring, even in the absence of classic genetic mutations.
• “Lean” PCOS: Around 30% of women with PCOS have a normal BMI, yet still exhibit the same hormonal and metabolic disturbances as those with overweight or obesity.
• Endocrine Disruptors: Prenatal exposure to substances such as bisphenol A (BPA) is suspected of disrupting ovarian development through epigenetic mechanisms.
• Cardiovascular Risk: A meta-analysis published in 2024 revealed a 64% increased risk of cardiovascular disease in postmenopausal women with PCOS, regardless of body weight.
• Emerging Treatments: New molecules such as GLP-1 receptor agonists (e.g., semaglutide) and artemisinin, an antimalarial agent, have shown promising results in regulating menstrual cycles and reducing androgen levels.

A Multidimensional Diagnostic Approach

For healthcare professionals, the diagnosis is based on an integrative approach.

• Medical history and clinical examination: Assessment of hirsutism (Ferriman-Gallwey score), BMI, acne, and hair loss.
• Hormonal workup: Total and free testosterone, LH/FSH, prolactin, TSH.
• Metabolic evaluation: Blood glucose, oral glucose tolerance test (OGTT), lipid profile.
• Transvaginal pelvic ultrasound: Visualization of follicles and ovarian volume.

PCOS in Africa: Local Challenges, Global Responses

Malgré une prévalence comparable au reste du monde, les patientes africaines font face à :

• Limited access to ultrasound and hormonal testing.
• Lack of awareness of PCOS among healthcare personnel.
• Stigmatization related to visible symptoms (such as hirsutism and infertility).
• Absence of standardized protocols in primary healthcare settings.

Local initiatives (e.g., the University Hospital Center of Yaoundé) are beginning to document cases and train practitioners for earlier diagnosis.

Technologies and Innovations: Toward Accessible Care

Technological advances offer concrete opportunities for low-resource settings:

• Portable ultrasounds adapted for rural areas.
• Low-cost rapid hormonal tests.
• Mobile apps for tracking menstrual cycles and symptoms.
• Artificial intelligence to analyze symptom patterns and guide diagnosis.

Recommendations for Integrated Care

• Train healthcare professionals in the multidisciplinary approach to PCOS.
• Integrate PCOS into national reproductive health policies.
• Fund local research on the African-specific aspects of the syndrome.
• Include systematic psychological support in care pathways.

Conclusion: A Global Vision for an Underrecognized Disorder

PCOS is a chronic, complex, and multifaceted disorder. Improving its management requires a holistic and coordinated approach , ranging from early diagnosis to therapeutic innovations, public awareness, and caregiver training. Faced with a global challenge with local repercussions, a collective commitment is needed to better understand, diagnose and treat PCOS, in all its dimensions, and for all women.

Main Sources:

• LiveScience (2025), VerywellHealth (2024), Journal of Clinical Endocrinology & Metabolism (2024)
• ESHRE, Endocrine Society, PCOS Awareness Association
• Revue scientifique Cells (MDPI, 2023)