Polycystic Ovary Syndrome (PCOS)

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What is Polycystic Ovary Syndrome (PCOS)?

Polycystic Ovary Syndrome (PCOS), sometimes called Polycystic Ovarian Disease, is a hormonal disorder that affects between 6 to 10% of women. Symptoms often start once the menstrual cycle begins but may not appear until well into a woman’s 20s or 30s.

PCOS causes the ovaries to produce higher than normal amounts of androgens (male hormones). This interferes with egg production. The eggs that the ovaries normally produce develop into cysts, little sacs filled with liquid. Instead of being released during ovulation, as an egg would be released, the cysts build up in the ovaries and can become enlarged.

PCOS is also linked to insulin resistance (like diabetes) and can affect many systems in the body and have long-term health consequences.

What are the symptoms of PCOS?

PCOS is a diagnosis given to a cluster or group of symptoms. Different women with PCOS will experience different symptoms with different intensity. The most common symptoms of PCOS are:

• infrequent or irregular periods (oligomenorrhea);
• no periods at all (amenorrhea);
• excessive bleeding during your period (polymenorrhea);
• enlarged ovaries with multiple small painless cysts or follicles that form in the ovary;
• skin tags, teardrop-sized pieces of skin that can be as large as raisins and are typically found in the armpits or neck area (acrochordons);
• a disorder that causes darkening and thickening of the skin on the neck, groin, underarms or skin folds (acanthosis nigricans);
• thinning hair;
• excess hair all over the body, including the face (hirsutism);
• acne;
• weight gain and obesity;
• anxiety or depression;
• increased blood sugar; and
• infertility (note that not all women diagnosed with PCOS will experience infertility and that appropriate measures should still be taken to avoid getting pregnant if you do not wish to).

What causes PCOS?

No one knows what causes PCOS. Some researchers think that it may be caused by high insulin production. Insulin is a hormone that controls blood sugar levels. When too much insulin is produced the body releases extra male hormones.

While the exact genes have not been identified, PCOS seems to run in families.

How is PCOS diagnosed? 

A health care provider will perform a physical examination and ask about your medical history. They will ask questions about your family history as well as your period and its regularity. They will check your weight and look for physical symptoms, like acne, hair growth and darkened skin.  They may do a pelvic exam or a vaginal ultrasound to search for ovarian cysts. A vaginal ultrasound for PCOS is very much like an ultrasound for pregnancy. This allows your health care provider to see if there are any cysts or follicles in your ovaries, as well as thickening of the endometrium or wall of the uterus (of which a thin layer is normally shed with each menstrual period but can build up when there are fewer periods). They might also ask for blood tests to measure insulin, glucose (sugar) and other hormone levels. These tests may be used to diagnose PCOS or to rule out other conditions like thyroid or other ovarian problems. While you may have some of the symptoms listed above, other conditions do have overlapping symptoms with PCOS and should be ruled out.

Is there a cure for PCOS?

There is no cure for PCOS, but there are treatments available. These treatments can help balance the hormones in your body, or relieve some of the symptoms, such as acne and weight gain. Some of these treatments you can do yourself. For others, you need to see a health care provider.

What can I do to help myself?

Lifestyle changes may help improve your quality of life and prevent health problems in the long run. For example, you may consider limiting your intake of processed foods or foods with high sugar content. A balanced diet and exercise will help your body regulate your hormone cycles and may delay or even prevent some of the health problems associated with PCOS.

Some women try to avoid exposure to environmental pollution and processed food because these may contain endocrine disrupting chemicals. These chemicals can disrupt normal hormone levels, including those already affected by PCOS. 

Some products may help you fight hair loss and facial hair.

• Hair loss: Some women use a thickening shampoo and conditioner, or talk to their health care providers about safe hair regrowth treatments.
• Facial hair: Waxing, tweezing, bleaching, shaving, and depilatory creams are effective for hair removal. Electrolysis and laser treatments are other effective methods, but are expensive. Sometimes health care plans will cover these procedures.

What can a health care provider help me with?

PCOS is best treated by an endocrinologist, a doctor who specializes in hormone disorders.

A health care provider may help with PCOS symptoms such as acne and weight loss:

• Sometimes acne gets better when you are taking birth control pills or antiandrogens (drugs that lower the amount of male hormones in the body). Antiandrogens can usually be taken along with birth control pills. You can also see a dermatologist (a doctor who specializes in skin problems) for acne treatment, as well as medication to reduce discoloration on the neck, armpits and breasts. Note that while birth control pills will regulate your menstrual cycle, they will not change the underlying PCOS that will resurface once the pill is stopped.

• Weight loss can help deal with many of the symptoms, but it can be difficult for girls and women with PCOS to lose weight. A health care provider or a registered dietician can help. They can look at your medications, food intake, and exercise program and come up with a weight-management program. 

Insulin-sensitizing medications are also useful for many women with PCOS. 

For women who experience infertility, some fertility drugs or, more invasive, surgical techniques may help to restore ovulation.

What are the possible health problems associated with PCOS?

PCOS might be a problem of the ovaries, but it changes the body's hormone levels and can affect the whole body. Untreated PCOS can lead to: 

• Infertility and miscarriage;
• excessive hair growth;
• diabetes or pre-diabetes (impaired glucose tolerance) which tends to start at an earlier age;
• heart disease (such as heart attack and high blood pressure) and higher levels of bad cholesterol;
• bleeding in the uterus;
• increased risk of gestational diabetes (diabetes during pregnancy), pregnancy-induced high blood pressure, and premature delivery;
• sleep apnea (brief periods when you stop breathing during sleep); and
• slightly increased risk of breast cancer, and
• increased risk of uterine cancer.

Not all women with PCOS will develop all of these conditions, but having PCOS increases the risks. 

While there are options for treatment of  some of the symptoms of PCOS, future research on better understanding the causes may offer the most hope.

Where can I find more information?

• PCOS: A Woman’s Guide to Dealing with Polycystic Ovary Syndrome by Colette Harris with Dr. Adam Carey; Thorsons, London; 2000.
• Polycystic Ovary Syndrome
• Polycystic Ovary Syndrome: A Guide for Teens
• Polycystic ovary syndrome and women with diabetes

Revised March 2013.