Polycystic

Ovary
Syndrome
(PCOS)
Symptoms, Causes, and Treatment
Introduction

Polycystic ovary syndrome (PCOS) is a condition that affects a

woman’s hormone levels.

Women with PCOS produce higher-than-normal amounts of

male hormones. This hormone imbalance causes them to skip
menstrual periods and makes it harder for them to get
pregnant.

PCOS also causes hair growth on the face and body, and
baldness. And it can contribute to long-term health problems
like diabetes and heart disease.

Birth control pills and diabetes drugs can help fix the hormone
imbalance and improve symptoms.

Read on for a look at the causes of PCOS and its effects on a

woman’s body.

What is PCOS?

PCOS is a problem with hormones that affects women during

their childbearing years (ages 15 to 44). Between 2.2 and 26.7
percent of women in this age group have PCOS.
Many women have PCOS but don’t know it. In one study, up
to 70 percent of women with PCOS hadn’t been diagnosed.

PCOS affects a woman’s ovaries, the reproductive organs that

produce estrogen and progesterone — hormones that
regulate the menstrual cycle. The ovaries also produce a small
amount of male hormones called androgens.

The ovaries release eggs to be fertilized by a man’s sperm.

The release of an egg each month is called ovulation.

Follicle-stimulating hormone (FSH) and luteinizing hormone

(LH) control ovulation. FSH stimulates the ovary to produce a
follicle — a sac that contains an egg — and then LH triggers
the ovary to release a mature egg.

PCOS is a “syndrome,” or group of symptoms that affects the

ovaries and ovulation. Its three main features are:

 cysts in the ovaries

 high levels of male hormones
 irregular or skipped periods
In PCOS, many small, fluid-filled sacs grow inside the ovaries.
The word “polycystic” means “many cysts.”
These sacs are actually follicles, each one containing an
immature egg. The eggs never mature enough to trigger
ovulation.

The lack of ovulation alters levels of estrogen, progesterone,

FSH, and LH. Estrogen and progesterone levels are lower than
usual, while androgen levels are higher than usual.

Extra male hormones disrupt the menstrual cycle, so women

with PCOS get fewer periods than usual.

PCOS isn’t a new condition. Italian physician Antonio Vallisneri

first described its symptoms in 1721.

SUMMARY:Polycystic ovary syndrome (PCOS) affects up to

almost 27 percent of women during their childbearing years. It
involves cysts in the ovaries, high levels of male hormones,
and irregular periods.
What causes it?

Doctors don’t know exactly what causes PCOS. They believe

that high levels of male hormones prevent the ovaries from
producing hormones and making eggs normally.

Genes, insulin resistance, and inflammation have all been

linked to excess androgen production.
Genes

Studies show that PCOS runs in families.

It’s likely that many genes — not just one — contributes to

the condition.

Insulin resistance

Up to 70 percent of women with PCOS have insulin resistance,

meaning that their cells can’t use insulin properly.

Insulin is a hormone the pancreas produces to help the body

use sugar from foods for energy.

When cells can’t use insulin properly, the body’s demand for
insulin increases. The pancreas makes more insulin to
compensate. Extra insulin triggers the ovaries to produce
more male hormones.

Obesity is a major cause of insulin resistance. Both obesity

and insulin resistance can increase your risk for type 2
diabetes.

Inflammation

Women with PCOS often have increased levels of

inflammation in their body. Being overweight can also
contribute to inflammation. Studies have linked excess
inflammation to higher androgen levels.

SUMMARY:Doctors don’t know exactly what causes PCOS.

They believe it stems from factors such as genes, insulin
resistance, and higher levels of inflammation in the body.
6 common symptoms of PCOS

Some women start seeing symptoms around the time of their

first period. Others only discover they have PCOS after they’ve
gained a lot of weight or they’ve had trouble getting
pregnant.

The most common PCOS symptoms are:

 Irregular periods: A lack of ovulation prevents the

uterine lining from shedding every month. Some women
with PCOS get fewer than eight periods a year (10).
  Heavy bleeding: The uterine lining builds up for a longer
period of time, so the periods you do get can be heavier
than normal.
 Hair growth: More than 70 percent of women with this
condition grow hair on their face and body — including
on their back, belly, and chest (11). Excess hair growth is
called hirsutism.
 Acne: Male hormones can make the skin oilier than usual
and cause breakouts on areas like the face, chest, and
upper back.
 Weight gain: Up to 80 percent of women with PCOS are
overweight or obese (11).
 Male-pattern baldness: Hair on the scalp get thinner
and fall out.
 Darkening of the skin: Dark patches of skin can form in
body creases like those on the neck, in the groin, and
under the breasts.
 Headaches: Hormone changes can trigger headaches in
some women.
SUMMARY: PCOS can disrupt the menstrual cycle, leading to
fewer periods. Acne, hair growth, weight gain, and dark skin
patches are other symptoms of the condition.
How PCOS affects your body

Having higher-than-normal androgen levels can affect your

fertility and other aspects of your health.

Infertility

To get pregnant, you have to ovulate. Women who don’t

ovulate regularly don’t release as many eggs to be fertilized.
PCOS is one of the leading causes of infertility in women.

Metabolic syndrome

Up to 80 percent of women with PCOS are overweight or

obese. Both obesity and PCOS increase your risk for high
blood sugar, high blood pressure, low HDL (“good”)
cholesterol, and high LDL (“bad”) cholesterol.

Together, these factors are called metabolic syndrome, and

they increase the risk for heart disease, diabetes, and stroke.

Sleep apnea

This condition causes repeated pauses in breathing during the

night, which interrupt sleep.

Sleep apnea is more common in women who are overweight

— especially if they also have PCOS. The risk for sleep apnea
is 5 to 10 times higher in obese women with PCOS than in
those without PCOS.

Endometrial cancer

During ovulation, the uterine lining sheds. If you don’t ovulate

every month, the lining can build up.

A thickened uterine lining can increase your risk

for endometrial cancer.

Depression

Both hormonal changes and symptoms like unwanted hair

growth can negatively affect your emotions. Many with PCOS
end up experiencing depression and anxiety.
SUMMARY:Hormone imbalances can affect a woman’s health
in many ways. PCOS can increase the risk for infertility,
metabolic syndrome, sleep apnea, endometrial cancer, and
depression.
How PCOS is diagnosed

Doctors typically diagnose PCOS in women who have at least

two of these three symptoms:

 high androgen levels

 irregular menstrual cycles
 cysts in the ovaries
Your doctor should also ask whether you’ve had symptoms
like acne, face and body hair growth, and weight gain.
A pelvic exam can look for any problems with your ovaries or
other parts of your reproductive tract. During this test, your
doctor inserts gloved fingers into your vagina and checks for
any growths in your ovaries or uterus.

Blood tests check for higher-than-normal levels of male

hormones. You might also have blood tests to check
your cholesterol, insulin, and triglyceride levels to evaluate
your risk for related conditions like heart disease and diabetes.

An ultrasound uses sound waves to look for abnormal

follicles and other problems with your ovaries and uterus.

SUMMARY:Doctors diagnose PCOS if women have at least

two of three main symptoms — high androgen levels,
irregular periods, and cysts in the ovaries. A pelvic exam,
blood tests, and ultrasound can confirm the diagnosis.
Pregnancy and PCOS

PCOS interrupts the normal menstrual cycle and makes it

harder to get pregnant. Between 70 and 80 percent of women
with PCOS have fertility problems.

This condition can also increase the risk for pregnancy

complications.

Women with PCOS are twice as likely as women without the

condition to deliver their baby prematurely. They’re also at
greater risk for miscarriage, high blood pressure,
and gestational diabetes (19).

However, women with PCOS can get pregnant using fertility

treatments that improve ovulation. Losing weight and
lowering blood sugar levels can improve your odds of having
a healthy pregnancy.

SUMMARY:PCOS can make it harder to get pregnant, and it

can increase your risk for pregnancy complications and
miscarriage. Weight loss and other treatments can improve
your odds of having a healthy pregnancy.
Diet and lifestyle tips to treat PCOS

Treatment for PCOS usually starts with lifestyle changes like

weight loss, diet, and exercise.

Losing just 5 to 10 percent of your body weight can help

regulate your menstrual cycle and improve PCOS
symptoms. Weight loss can also improve cholesterol levels,
lower insulin, and reduce heart disease and diabetes risks.

Any diet that helps you lose weight can help your condition.
However, some diets may have advantages over others.
Studies comparing diets for PCOS have found that low-
carbohydrate diets are effective for both weight loss and
lowering insulin levels. A low glycemic index (low-GI) diet that
gets most carbohydrates from fruits, vegetables, and whole
grains helps regulate the menstrual cycle better than a regular
weight loss diet.

A few studies have found that 30 minutes of moderate-

intensity exercise at least three days a week can help women
with PCOS lose weight. Losing weight with exercise also
improves ovulation and insulin levels.

Exercise is even more beneficial when combined with a

healthy diet. Diet plus exercise helps you lose more weight
than either intervention alone, and it lowers your risks for
diabetes and heart disease.

SUMMARY:PCOS treatment starts with lifestyle changes like

diet and exercise. Losing just 5 to 10 percent of your body
weight if you’re overweight can help improve your symptoms.
Common medical treatments

Birth control pills and other medicines can help regulate the
menstrual cycle and treat PCOS symptoms like hair growth
and acne.

Birth control

Taking estrogen and progestin daily can restore a normal

hormone balance, regulate ovulation, relieve symptoms like
excess hair growth, and protect against endometrial cancer.
These hormones come in a pill, patch, or vaginal ring.
Metformin

Metformin (Glucophage, Fortamet) is a drug used to treat

type 2 diabetes. It also treats PCOS by improving insulin
levels.

One study found that taking metformin while making changes

to diet and exercise improves weight loss, lowers blood sugar,
and restores a normal menstrual cycle better than changes to
diet and exercise alone (24).

Clomiphene

Clomiphene (Clomid) is a fertility drug that can help women

with PCOS get pregnant. However, it increases the risk for
twins and other multiple births (25).

Hair removal medicines

A few treatments can help get rid of unwanted hair or stop it

from growing. Eflornithine (Vaniqa) cream is a prescription
drug that slows hair growth. Laser hair
removal and electrolysis can get rid of unwanted hair on your
face and body.

Surgery

Surgery can be an option to improve fertility if other

treatments don’t work. Ovarian drilling is a procedure that
makes tiny holes in the ovary with a laser or thin heated
needle to restore normal ovulation.

SUMMARY:Birth control pills and the diabetes drug

metformin can help bring back a normal menstrual cycle.
Clomiphene and surgery improve fertility in women with
PCOS. Hair removal medicines can rid women of unwanted
hair.
When to see a doctor

See a doctor if:

 You’ve missed periods and you’re not pregnant.

 You have symptoms of PCOS, such as hair growth on
your face and body.
 You’ve been trying to get pregnant for more than 12
months but haven’t been successful.
 You have symptoms of diabetes, such as excess thirst or
hunger, blurred vision, or unexplained weight loss.
If you have PCOS, plan regular visits with your primary care
doctor. You’ll need regular tests to check for diabetes, high
blood pressure, and other possible complications.

SUMMARY:See your doctor if you’ve skipped periods or you

have other PCOS symptoms like hair growth on your face or
body. Also see a doctor if you’ve been trying to get pregnant
for 12 months or more without success.
The bottom line

PCOS can disrupt a woman’s menstrual cycles and make it

harder to get pregnant. High levels of male hormones also
lead to unwanted symptoms like hair growth on the face and
body.

Lifestyle interventions are the first treatments doctors

recommend for PCOS, and they often work well. Weight loss
can treat PCOS symptoms and improve the odds of getting
pregnant. Diet and aerobic exercise are two effective ways to
lose weight.

Medicines are an option if lifestyle changes don’t work. Birth

control pills and metformin can both restore more normal
menstrual cycles and relieve PCOS symptoms.