What Is Polycystic Ovary Syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects people with ovaries. PCOS causes hormonal imbalance and metabolism problems; it may lead to infertility.

PCOS affects about 1 in 10 adults with ovaries. It is usually diagnosed in a person’s 20s or 30s but can occur at any age after puberty.1 There is no cure for PCOS, although it can be managed. PCOS often causes irregular periods, ovarian cysts, and infertility.

This article discusses the symptoms, causes, diagnosis, and treatment options for PCOS.

PCOS Symptoms

Symptoms of PCOS can vary, and most people with the disorder will not experience all of them. The most common symptom is irregular menstrual periods.1 People with PCOS may experience missed or frequent periods more often than every 21 days.

Additional symptoms of PCOS include:1

• Facial hair
• Acne
• Hair thinning
• Weight gain
• Skin darkening
• Skin tags

Exploring the Role of Ovarian Follicles in Reproductive Health

What Are the First Signs of PCOS?

The first sign of PCOS is usually irregular periods. You may notice missed periods. People with PCOS may also experience menstrual cycles that are longer or shorter than average.2

What Causes PCOS?

The exact cause of PCOS is unknown, but researchers have identified several risk factors. People with PCOS tend to have high levels of androgens, hormones usually associated with the male sex. Having a high level of androgens may prevent the ovaries from releasing an egg each month. High androgen levels may also lead to facial hair growth and acne.1

People with PCOS are also more likely to have insulin resistance when the body’s cells do not typically respond to insulin. This results in higher levels of insulin as the body tries to control the blood sugar level.

Excess weight, lack of physical activity, and a family history of diabetes are also PCOS risk factors.1

PCOS

Low Progesterone Effects: How to Raise Your Levels

Diagnosis: How to Test for PCOS

When you and a healthcare provider suspect you have PCOS, you will likely undergo several tests to rule out other syndromes and conditions. Tests used to diagnose PCOS include:1

• Physical exam: Checks vital signs, weight, body mass index (BMI), waist circumference, and symptoms of PCOS, including facial hair, acne on the chest or back, and skin discoloration
• Pelvic exam: Looks for signs of elevated androgens (such as facial or chest hair and enlarged ovaries)
• Pelvic ultrasound: Examines the ovaries for cysts and inspects the lining of the uterus
• Blood tests: Check androgen levels, hormone levels, and thyroid function

To diagnose PCOS, at least two of the following symptoms must be present:1

• Irregular periods
• Physical signs of elevated androgens (body or facial hair, chest or back acne, or hair thinning)
• High levels of androgens
• Polycystic appearance of ovaries seen on ultrasound

PCOS Treatment

There is no permanent cure for PCOS, but the symptoms can be well-managed. Your treatment plan will depend on your symptoms, how long they have lasted, how severe they are, and any other complications.

Weight Loss

Obesity or being overweight is a risk factor for PCOS. If you have this risk factor, losing weight could significantly improve your symptoms. Lifestyle changes that help with weight loss include healthy eating and regular physical activity.1

Weight loss has been linked to lower blood glucose and insulin levels and improved hormonal balance. A 10% reduction in body weight can lead to more regular menstrual periods and improved fertility.1

Hair Removal

Removing new facial or body hair through hair removal cream, laser hair removal, or electrolysis is possible. Be sure to use a gentle cream specifically made for facial hair.

You can also slow the growth of facial and body hair. Talk with a healthcare provider about a topical prescription cream like Vaniqua (eflornithine).3

Medications

Discuss medication options with a healthcare provider if lifestyle changes have not effectively managed your PCOS symptoms. The goal of medication therapy is usually to make the menstrual cycle more regular and improve the balance of hormones.

Medications used to treat PCOS may include:1

• Hormonal birth control: Oral pills, patch, intrauterine device (IUD), vaginal ring, injections
• Antiandrogenic medications: To control symptoms of androgens (hair loss, hair growth, acne)
• Metformin: A type 2 diabetes drug that may also lower blood sugar, insulin, and androgen levels.

Surgery

Surgery may be used to improve fertility for those who are trying to become pregnant with PCOS. PCOS surgery is known as ovarian drilling. A surgeon makes small (laparoscopic) cuts in the abdomen and uses a needle with an electric current to make tiny holes in the ovary. This then leads to lower androgen levels and increases the odds of ovulation.4

Ovarian drilling aims to increase the chances of ovulation occurring each month. It is only used in people struggling with fertility and who have already tried lifestyle changes and medications.

Alternative PCOS Treatment

Complementary and alternative medicine (CAM) therapies can improve PCOS symptoms, especially for those who want to avoid taking hormonal birth control or other hormonal treatments. Alternative therapies that have been proven effective in the management of PCOS symptoms include:5

• Acupuncture: To reduce symptoms and induce ovulation and a more regular menstrual cycle
• Chinese herbal medicine: Certain herbs to help improve hormonal balance in people with PCOS (more research is needed)
• Supplements: Vitamins A, B, D, and E to regulate the menstrual cycle and improve fertility
• Tai chi: Physical activity and breath work proven to lower the risk of obesity and diabetes
• Yoga: Linked to improved PCOS symptoms and better hormonal balance
• Meditation for stress relief: To improve depression and anxiety symptoms
  

PCOS Complications

PCOS can lead to other health problems, and people with PCOS are at an increased risk of experiencing:21

• Diabetes: Over half of the people with PCOS develop diabetes or prediabetes before age 40.
• High blood pressure: PCOS raises blood pressure, which increases heart disease and stroke risk.
• High cholesterol: PCOS is associated with elevated low-density lipoprotein protein (LDL), known as the "bad cholesterol."
• Sleep problems: People with PCOS and obesity are at an increased risk of sleep apnea; this raises the risk of diabetes and heart disease.
• Mental health conditions: People with PCOS are at an increased risk of depression and anxiety.
• Endometrial cancer: The risk of endometrial cancer increases with obesity, insulin resistance, and any ovulation problems.

PCOS and Pregnancy

People with PCOS can become pregnant. However, it may affect the health of your pregnancy and baby, so it is critical to work closely with a healthcare provider before, during, and after pregnancy.

PCOS raises the risk of:1

• Miscarriage (pregnancy loss before 20 weeks)
• Gestational diabetes (diabetes that starts in pregnancy)
• Preeclampsia (high blood pressure that starts in pregnancy)
• Cesarean section (C-section) (surgical delivery of the baby)

It also affects the baby, raising the risk of macrosomia (large for gestational age) and needing care in the neonatal intensive care unit (NICU).1

To lower your risk of complications during pregnancy, it is best to start preparing before you become pregnant. Work with a healthcare provider to maintain a healthy weight and control blood sugar. It is also important to start taking a folic acid supplement as well.

Increasing Fertility Odds With PCOS

PCOSfertilization

To improve your fertility when you have PCOS, consider the following steps:1

• Weight loss: If your weight is classified as overweight or obese, weight loss can help to regulate your menstrual cycle and improve fertility.
• Medication: Certain medications, like Clomid (clomiphene) can help induce ovulation.
• Assisted reproductive technology: In vitro fertilization (IVF) may be recommended if lifestyle changes are unsuccessful. During IVF, the egg is fertilized outside the body and then placed in the uterus to implant.
• Ovarian drilling: Surgery may be recommended in severe cases of PCOS and infertility. Ovarian drilling may improve fertility by restoring ovulation.

PCOS Diet

Your diet can significantly impact PCOS symptoms and how you feel daily. Healthy dietary changes have been linked to weight loss and improved hormonal balance, insulin levels, and blood sugar. Both a Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet have been found to improve PCOS symptoms.6

Foods that are part of a healthy PCOS diet include:6

• Fruits that are low in glycemic index (the level at which blood sugar rises)
• Non-starchy vegetables
• Low-fat dairy
• Fish and lean proteins
• Healthy fats
• Nuts and legumes
• Whole grains

Foods to avoid with PCOS include:6

• Sweets
• Fried foods
• Saturated fats
• Processed foods
• Red meat
• Refined carbohydrates
• Alcohol

PCOS Outlook

There is no known cure for PCOS, but this syndrome can be well-managed. Lifestyle changes like a healthy diet and regular physical activity can improve PCOS symptoms.7 A healthcare provider can help you with the right medications or other treatments.