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Polycystic Ovary Syndrome (PCOS)

What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a set of symptoms caused by a problem with a woman’s hormones. It affects the ovaries. These are the small organs that store a woman’s eggs. But it can also affect the rest of the body. PCOS is a very common condition in women of childbearing age. In some cases, it can lead to serious health issues if not treated.

Ovulation happens when a mature egg is released from an ovary. This happens so it can be fertilized by a male sperm. If the egg is not fertilized, it is sent out of the body during your period.

In some cases, a woman doesn’t make enough of the hormones needed to ovulate. When ovulation doesn’t happen, the ovaries can develop many small fluid-filled sacs (cysts). These cysts make hormones called androgens. Androgens are a type of hormone normally found in abundance in men, but women normally have them in smaller amounts. Women with PCOS often have high levels of androgens. This can cause more problems with a woman’s menstrual cycle. And it can cause many of the symptoms of PCOS.

Treatment for PCOS is often done with medicine. This can’t cure PCOS, but it helps reduce symptoms and prevent some health problems.

What causes PCOS?

Experts don't know the exact cause of PCOS. Many women with PCOS have insulin resistance. This means the body can't use insulin well. Insulin levels build up in the body and may cause higher androgen levels. Obesity can also increase insulin levels and make PCOS symptoms worse.

Who is at risk for PCOS?

You may be more likely to have PCOS if your mother or sister has it. You may also be more likely to have it if you have insulin resistance or are obese.

What are the symptoms of PCOS?

The symptoms of PCOS may include:

  • Missed periods, irregular periods, or very light periods

  • Ovaries that are large or have many cysts

  • Extra body hair, including the chest, stomach, and back (hirsutism)

  • Weight gain, especially around the belly

  • Acne or oily skin

  • Male-pattern baldness or thinning hair

  • Infertility 

  • Small pieces of extra skin on the neck or armpits (skin tags)

  • Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts

How is PCOS diagnosed?

Your healthcare provider will ask about your health history and your symptoms. You will also have a physical exam. This will likely include a pelvic exam. This exam checks the health of your reproductive organs, both inside and outside your body.

Some of the symptoms of PCOS are like those caused by other health problems. Because of this, you may also have tests, such as:

  • Ultrasound. This test uses sound waves and a computer to create images of blood vessels, tissues, and organs. This test is used to look at the size of the ovaries and see if they have cysts. The test can also look at the thickness of the lining of the uterus (endometrium).

  • Blood tests. These look for high levels of androgens and other hormones. Your healthcare provider may also check your blood glucose levels. And you may have your cholesterol and triglyceride levels checked.

How is PCOS treated?

Treatment for PCOS depends on a number of factors. These may include your age, how severe your symptoms are, and your overall health. The type of treatment may also depend on whether you want to become pregnant in the future.

If you do plan to become pregnant, your treatment may include:

  • A change in diet and activity. A healthy diet and more physical activity can help you lose weight and reduce your symptoms. They can also help your body use insulin more efficiently, lower blood glucose levels, and may help you ovulate.

  • Medicines to cause ovulation. Medicines can help the ovaries to release eggs normally. These medicines also have certain risks. They can increase the chance of a multiple birth (twins or more). And they can cause ovarian hyperstimulation. This is when the ovaries release too many hormones. It can cause symptoms, such as belly bloating and pelvic pain.

If you don't plan to become pregnant, your treatment may include:

  • Birth control pills. These help to control menstrual cycles, lower androgen levels, and reduce acne.

  • Diabetes medicine. This is often used to lower insulin resistance in PCOS. It may also help reduce androgen levels, slow hair growth, and help you ovulate more regularly.

  • A change in diet and activity. A healthy diet and more physical activity can help you lose weight and reduce your symptoms. They can also help your body use insulin more efficiently, lower blood glucose levels, and may help you ovulate.

  • Medicines to treat other symptoms. Some medicines can help reduce hair growth or acne.

What are possible complications of PCOS?

Women with PCOS are more likely to develop certain serious health problems. These include type 2 diabetes, high blood pressure, problems with the heart and blood vessels, and uterine cancer. Women with PCOS often have problems with their ability to get pregnant (fertility).

Living with PCOS

Some women struggle with the physical symptoms of PCOS, such as weight gain, hair growth, and acne. Cosmetic treatments, such as electrolysis and laser hair removal, may help you feel better about your appearance. Talk with your healthcare provider about the best ways to treat the symptoms that bother you.

When should I call my healthcare provider?

Call your healthcare provider if you have prolonged bleeding.

Key points about PCOS

  • PCOS is a very common hormone problem for women of childbearing age.

  • Women with PCOS may not ovulate, have high levels of androgens, and have many small cysts on the ovaries.

  • PCOS can cause missed or irregular menstrual periods, excess hair growth, acne, infertility, and weight gain. 

  • Women with PCOS may be at higher risk for type 2 diabetes, high blood pressure, heart problems, and endometrial cancer.

  • The types of treatment for PCOS may depend on whether or not a woman plans to become pregnant. Women who plan to become pregnant in the future may take different kinds of medicines.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your healthcare provider if you have questions.

Medical Reviewers:

  • Donna Freeborn PhD CNM FNP
  • Heather M Trevino BSN RNC
  • Irina Burd MD PhD
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