In 1935, two Chicago doctors described seven women who shared a puzzling set of problems: periods that had stopped or turned irregular, extra body and facial hair, weight gain and trouble conceiving. Irving Stein and Michael Leventhal, colleagues at Michael Reese Hospital who had met there as interns in 1925, published their account in a leading obstetrics journal under the title “Amenorrhea Associated with Bilateral Polycystic Ovaries.” Nobody had grouped these symptoms into one condition before. The common view blamed inflammation.
Stein and Leventhal disagreed. They argued the cysts were a sign of a hormonal problem, with the pituitary gland a likely driver. Estrogen treatment, which they tried first on four of the women, gave only temporary and irregular relief. So they turned to surgery, removing between one-half and three-fourths of the cystic ovarian tissue in a procedure called a wedge resection. All seven women, they reported, did well afterward, and doctors used a technique called pneumoperitoneum to image the ovaries before operating.
A small clue that mattered
Under the microscope every tissue sample showed theca cells lining the cysts. These cells make androgens, the so-called male hormones. The pair said little about it. Later researchers took it up, and the idea that excess androgens sit at the heart of the condition grew from there. By 2026 the paper had drawn around 3,400 citations, and the condition was first known as Stein-Leventhal syndrome before the name PCOS took hold in the 1990s.
Wedge resection has since been dropped because it is invasive and its success is not guaranteed. Doctors now typically prescribe oral contraceptives, spironolactone or metformin, which helps with the insulin resistance that often goes along with PCOS.
Defining it is still hard
Agreeing on what counts as PCOS took decades more. The NIH published a definition in 1990. In 2003 the Rotterdam criteria widened it, creating two more phenotypes. One covers women who ovulate normally but have polycystic ovaries and extra androgens; the other covers women with irregular ovulation and polycystic ovaries but no androgen excess. The 2018 international guideline endorses Rotterdam for adults, so a diagnosis requires any two of three findings. These are androgen excess (seen in symptoms or blood tests), problems with ovulation, and a polycystic look on ultrasound.
Depending on how it is defined, between 5% and 15% of American women are thought to have the condition, and it carries higher risks of cardiometabolic problems, mood disorders and body image troubles. For women and their families, the lack of firm evidence has real consequences. Bulent Yildiz of Hacettepe University pointed out that the 2018 guideline holds 166 recommendations, yet only 31 are evidence-based. Another 59 came from clinical consensus and 76 are clinical practice points.
Andrea Dunaif of Mount Sinai, told Endocrine Today the field is the field “chronically underfunded.” Awareness remains low, the report adds, partly because the name misleads: a diagnosis can be made without polycystic ovaries.
Sources
- Amenorrhea Associated with Bilateral Polycystic Ovaries (1935) (Embryo Project Encyclopedia)
- Better evidence needed to define, treat PCOS (Healio)
