Polycystic Ovary Syndrome: What You Should Know

Polycystic Ovary Syndrome: What You Should Know


Polycystic ovary syndrome, also known as polycystic ovarian syndrome, is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries make the egg that is released each month as part of a healthy menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released during ovulation as it should be.

PCOS can cause missed or irregular menstrual periods. Irregular periods can lead to:

  • Infertility. In fact, PCOS is one of the most common causes of female infertility.
  • Development of cysts (small fluid-filled sacs) in the ovaries

Who gets PCOS?

Between 5 percent and 10 percent of women of childbearing age (between 15 and 44) have PCOS. Most often, women find out they have PCOS in their 20s and 30s, when they have problems getting pregnant and see their doctor. But PCOS can happen at any age after puberty.

Women of all races and ethnicities are at risk for PCOS, but your risk for PCOS may be higher if you are obese or if you have a mother, sister or aunt with PCOS.

What are the symptoms of PCOS?

Some of the symptoms of PCOS include:

  • Irregular menstrual cycle. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year).
    • Or, their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods.
    • Too much hair on the face, chin, or parts of the body where men usually have hair. This is called “hirsutism.” Hirsutism affects up to 70 percent of women with PCOS.
    • Acne on the face, chest and upper back
    • Thinning hair or hair loss on the scalp; male-pattern baldness
    • Weight gain or difficulty losing weight
    • Darkening of skin, particularly along neck creases, in the groin and underneath breasts
    • Skin tags, which are small excess flaps of skin in the armpits or neck area

    What causes PCOS?

    The exact cause of PCOS is not known. Most experts think that several factors, including genetics, play a role:

    • High levels of androgens. Androgens are sometimes called “male hormones,” although all women make small amounts of androgens. Androgens control the development of male traits, such as male-pattern baldness. Women with PCOS have more androgens than estrogens. Estrogens are also called “female hormones.” Higher than normal androgen levels in women can prevent the ovaries from releasing an egg during each menstrual cycle, and can cause extra hair growth and acne, two signs of PCOS.
    • High levels of insulin. Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body’s cells do not respond normally to insulin. As a result, your insulin blood levels become higher than normal. Many women with PCOS have insulin resistance, especially those who are overweight or obese, have unhealthy eating habits, do not get enough physical activity and have a family history of diabetes (usually type 2 diabetes). Over time, insulin resistance can lead to type 2 diabetes.

    Can I still get pregnant if I have PCOS?

    Yes. Having PCOS does not mean you can’t get pregnant. PCOS is one of the most common, but treatable, causes of infertility in women. In women with PCOS, the hormonal imbalance interferes with the growth and ovulation. If you don’t ovulate, you can’t get pregnant.

    Your doctor can talk with you about ways to help you ovulate and to raise your chance of getting pregnant.

    Does PCOS raise my risk for other health problems?

    Yes, studies have found links between PCOS and other health problems, including:

    • Diabetes. More than half of women with PCOS will have diabetes or prediabetes before the age of 40.
    • High blood pressure. Women with PCOS are at greater risk of having high blood pressure compared with women of the same age without PCOS. High blood pressure is a leading cause of heart disease and stroke.
    • Unhealthy cholesterol. Women with PCOS often have higher levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol. High cholesterol raises this risk of developing heart disease and stroke.
    • Sleep apnea. This is when momentary and repeated stops in breathing interrupt sleep. Many women with PCOS are overweight or obese, which can cause sleep apnea. Sleep apnea raises your risk for heart disease and diabetes.
    • Depression and anxiety.
    • Endometrial cancer. Problems with ovulation, obesity, insulin resistance and diabetes increase the risk of developing cancer of the lining of the uterus or womb.

    Will my PCOS symptoms go away at menopause?

    Yes and no. PCOS affects many systems in the body. Many women with PCOS find their menstrual cycles become more regular as they get closer to menopause. However, their PCOS hormonal imbalance does not change with age, so they may continue to have symptoms.

    Also, the risks of PCOS-related health problems, such as diabetes, stroke and heart attack, increase with age. These risks may be higher in women with PCOS than those without.

    How is PCOS diagnosed?

    There is no single test to diagnose PCOS. To help diagnose PCOS and rule out other causes of your symptoms, your doctor may talk to you about your medical history and do a physical exam and different tests:

    • Physical exam. Your doctor will measure your blood pressure, body mass index and waist size. He or she will also look at your skin for extra hair on your face, chest or back; acne; or skin discoloration. Your doctor may look for any hair loss or signs of other health conditions (such as an enlarged thyroid gland).
    • Pelvic exam. Your doctor may do a pelvic exam for signs of extra male hormones (for example, an enlarged clitoris) and check to see if your ovaries are enlarged or swollen.
    • Pelvic ultrasound. This test uses soundwaves to examine your ovaries for cysts and check the endometrium.
    • Blood tests. Blood tests check your androgen hormone levels, sometimes called “male hormones.” Your doctor will also check for other hormones related to other common health problems that can be mistaken for PCOS, such as thyroid disease. Your doctor may also test your cholesterol levels and test you for diabetes.

    Once other conditions are ruled out, you may be diagnosed with PCOS if you have at least two of the following symptoms:

    • Irregular periods, including periods that come too often, not often enough, or not at all
    • Signs that you have high levels of androgens

    How is PCOS treated?

    There is no cure for the disorder, but you can manage the symptoms. You and your doctor will work on a treatment plan based on your symptoms, your plans for children and your risk for long-term health problems, such as diabetes and heart disease. Many women will need a combination of treatments.

    What steps can I take at home to improve my PCOS symptoms?

    You can take steps at home to help your PCOS symptoms, including:

    • Losing weight. Healthy eating habits and regular physical activity can help relieve PCOS-related symptoms. Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, and help your hormones reach normal levels. Even a 10 percent loss in body weight can help make your menstrual cycle more regular and improve your chances of getting pregnant.
    • Removing hair. You can try facial hair removal creams, laser hair removal or electrolysis to remove excess hair. You can find hair removal creams and products at drugstores. Procedures like laser hair removal or electrolysis must be done by a doctor and may not be covered by health insurance.
    • Slowing hair growth. A prescription skin treatment can help slow the growth rate of new hair in unwanted places.

    What types of medicines treat PCOS?

    The types of medicines that treat PCOS and its symptoms include:

    • Hormonal birth control, including the pill, patch, shot, vaginal ring and IUD.
    • Anti-androgen medicines. These medicines block the effect of androgens and can help reduce scalp hair loss, facial and body hair growth and acne. They are not approved by the FDA to treat PCOS symptoms. These medicines can also cause problems during pregnancy.
    • Metformin is often used to treat type 2 diabetes and may help some women with PCOS symptoms, though it has not been approved for that reason. Metformin improves insulin’s ability to lower your blood sugar and can lower both insulin and androgen levels. After a few months of use, metformin may help restart ovulation, but it usually has little effect on acne and extra hair on the face or body. Recent research shows that metformin may have other positive effects, including lowering body mass and improving cholesterol levels.

    What are my treatment options for PCOS if I want to get pregnant?

    You have several options to help your chances of getting pregnant if you have PCOS:

    • Losing weight. If you are overweight or obese, losing weight through healthy eating, including eating the right amount of calories for you, and regular physical activity can help make your menstrual cycle more regular and improve your fertility.
    • Medicine. After ruling out other causes of infertility in you and your partner, your doctor might prescribe medicine to help you ovulate.
    • In vitro fertilization may be an option if medicine does not work. Compared to medicine alone, IVF has higher pregnancy rates and better control over your risk for twins and triplets.
    • Surgery is also an option, usually only if the other options do not work. The outer shell of ovaries is thickened in women with PCOS and thought to play a role in preventing spontaneous ovulation. Ovarian drilling is a surgery in which the doctor makes a few holes in the surface of your ovary using lasers or a fine needle heated with electricity. Surgery usually restores ovulation, but only for six to eight months.

    How does PCOS affect pregnancy?

    PCOS can cause problems during pregnancy for you and for your baby. Women with PCOS have higher rates of:

    Your baby also has a higher risk of being heavy and of spending more time in a neonatal intensive care unit.

    Researchers continue to search for new ways to treat PCOS. To learn more about current PCOS treatment studies, visit ClinicalTrials.gov.