Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among young females with millions of women living with this condition worldwide. Polycystic ovary syndrome (PCOS) is a disease in which many cysts form in the ovaries, which are a part of the female reproductive organ that produces and releases eggs. However, it is not necessary to have cysts to be diagnosed with PCOS.

Hormones are involved in various important functions of the body. PCOS is a syndrome as there is an imbalance of various hormone levels in the body that causes a range of symptoms. The hormones involved are androgens such as testosterone, luteinizing hormone, follicle-stimulating hormone, estrogen, progesterone and insulin. 
In particular, ovaries produce high levels of the hormone androgens, which is a ‘male’ hormone. This may lead to the ovaries being unable to ovulate or release an egg creating problems with fertility.
The exact cause of PCOS is still under investigation. However, factors related to genetics, diet, lifestyle choices, environmental pollutants, insulin resistance, obesity and hormone imbalance seem to contribute to PCOS. 
Tell-tale Signs of PCOS
PCOS affects every teenager or woman differently. However, there are signs and symptoms that can help identify people with this condition. Some people might have one sign or symptom while another person may have all signs or symptoms. 
Signs and symptoms include:
•    Irregular, missed or absent periods 
•    Excessive facial or body hair (hirsutism)
•    Weight gain
•    Acne or oily skin
•    Hair thinning or hair loss from head
•    Infertility   
•    Skin Darkening around the neck, breasts or 
    armpit
•    Anxiety and depression
•    Sleep issues
•    Fatigue
It is not necessary to have all 3 criteria present. PCOS can be diagnosed if at least 2 of the following criteria are met:
•    Irregular or missed periods
•    Signs of high levels of testosterone such as unwanted facial hair, acne or baldness. Alternatively, a blood test might be done to find elevated levels of testosterone
•    Polycystic ovaries on abdominal ultrasound.
•    Women with PCOS are also at a higher risk of developing diseases such as diabetes or pre-diabetes, high blood pressure, heart disease, stroke, sleep apnea and uterine cancer.

When Does PCOS Begin?
Although PCOS can begin at any age, the signs and symptoms usually start around puberty when a girl gets her first period. An absent or irregular, heavy period may be one of the first signs of PCOS.
However, most women are diagnosed with this lifelong condition between 20 to 30 years of age. 
Signs of Puberty vs. PCOS
Since puberty and PCOS begin around the same time usually, it is important to differentiate between them. PCOS needs medical attention whereas puberty is a normal process which every healthy girl goes through. Some signs of puberty include growing breasts, body hair, discharge, periods, mood changes and sudden increase in height. Here are a few ways you can differentiate:
•    Hair Distribution. During puberty, hair grows in the underarm and pubic areas. On the contrary, excessive hair growth due to PCOS occurs in the face, back, chest or back
•    Periods.  Irregular periods after the first period are normal for 2 to 3 years. However, it might indicate another medical condition like PCOS if the problem persists longer and other symptoms exist. 
•    Acne.  Acne is normal in teenage girls. However, if topical therapies are not helping in resolving acne, it may point to PCOS.
The Mental Repercussions of PCOS
PCOS patients are more likely to have mental health problems like anxiety and depression. Adolescent girls with PCOS are concerned with their self-image as they have to deal with issues such as obesity, acne and excessive, unwanted hair. Living with PCOS leads to a negative perception and dissatisfaction with their bodies. This may contribute to eating disorders along with low self-esteem and quality of life. PCOS is a leading cause of infertility. This also causes a lot of stress in females as they face a lot of societal pressure.  
PCOS-related Weight Gain and Obesity and How to Cater to it?
Weight gain or obesity is common in PCOS patients with around half of women experiencing weight gain. Moreover, having PCOS makes it much harder to lose weight. A person can determine if they are overweight or obese by calculating their BMI. Body Mass Index (BMI) is a ratio derived from a person’s weight and height. According to WHO, healthy weight is a BMI of 18.5 to 24.9, overweight is a BMI of 25 to 29.9 and obesity is a BMI equal to or greater than 30. It is important to manage obesity as it is associated with diseases such as heart attack, stroke and diabetes. 
The first line of management for obesity is lifestyle changes such as improving diet and exercising. Consulting a dietician to help with meal planning is recommended. Even a weight loss of just 5% can improve PCOS. As for exercising, a minimum of 150 minutes of moderate exercise per week is recommended.
On top of lifestyle management, medicines such as metformin which reduces insulin resistance are also prescribed to deal with obesity. Other medications that are prescribed work by acting as appetite suppressants, preventing fat absorption or slowing gastric emptying. If a patient is very obese with a BMI of 35 or more, surgery may be considered as a treatment option after careful consideration.
Treatments
PCOS is a condition that has no cure but can be managed. Treatment depends on the specific signs and symptoms that a woman might be experiencing. For obesity, lifestyle modifications are advised as first-line management.
Irregular, missed or absent periods are managed with medications. The most commonly prescribed medications are known as birth control pills or oral contraceptive pills (OCPs). 
Young females and women dealing with excessive body hair growth, hair loss and acne can consult with a dermatologist to find the best treatment options available. Medications that suppress androgen hormones, oral contraceptive pills and cosmetic procedures are some options available to treat hirsutism and acne.
Adolescents struggling with mental health issues should talk with a licensed mental health professional who can guide them. 
Although having PCOS does not mean a person can never have a baby, it can make it more difficult to get pregnant. When dealing with infertility, clomifene is usually given first to help the ovaries release an egg during ovulation. Different medications or In vitro fertilisation (IVF) may be tried if the patient is not responding to treatment. 
Diets
A balanced and healthy diet is important for managing PCOS as it nourishes the body and helps maintain normal weight, especially in growing teenage girls. People with PCOS may have insulin resistance. Insulin is a hormone that helps lower blood sugar levels. Insulin resistance means that sugar is not responding to insulin resulting in high sugar levels in the blood. Hence, a refined carbohydrate diet is not recommended, and it also makes it harder to lose weight.
People with PCOS are in a state of inflammation so food that promotes inflammation should be avoided or at least limited. Examples include:
•    White bread
•     Bakery products such as cakes, cookies, muffins
•     Sugary drinks such as sodas
•    Refined white flour
•    Pizza
•    Pasta
•    Red meat
•    Saturated fats such as butter
Foods that should be added to the diet are high-fibre food, whole grain, non-starchy vegetables and fruits. These foods will help sensitise the body to insulin, maintain a steady level of sugar in the blood and provide nutrition. Examples include:
•    Brown rice
•    Barley
•    Olive oil
•     Almonds and nuts
•     Leafy greens such as spinach and lettuce
•    Tomatoes
•    Fruits
•    Salmon
•    Tofu
•    Chicken
•    Beans and legumes
In addition to eating healthy food, it is also essential to drink plenty of water to stay hydrated. 
PCOS is a disease that many females suffer from. It may take some time to get diagnosed by a gynaecologist or endocrinologist but PCOS is not a hopeless condition. Lifestyle changes such as diet, exercise, managing stress and getting good quality sleep can help reduce symptoms and risk of developing diseases in the future. A multi-disciplinary approach is needed to treat PCOS which can provide individualised care for the patient.

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