Polycystic ovary syndrome (PCOS) is a complex condition that has different symptoms from one person to another. As many as one in 10 people with ovaries of childbearing age in the United States have PCOS, which is also the leading cause of infertility, according to the Office of Women's Health (OWH).
People with PCOS experience a hormonal imbalance which includes higher-than-normal levels of androgens (often referred to as "male" hormones), per the National Institute of Child Health and Human Development (NICHD). This can interfere with regular ovulation and result in symptoms such as extra facial hair.
Another hormonal imbalance found in people with PCOS is insulin resistance, says Mitchell Kramer, MD, chairman of obstetrics and gynecology at Northwell Health's Huntington Hospital in Huntington, New York. That means the cells don't respond as well as they should to insulin, the hormone that normally moves sugar out of the bloodstream and into cells. This can cause blood sugar levels to rise.
PCOS Causes and Risk Factors
No one knows exactly what causes the hormonal imbalance behind PCOS, although it seems to be a mix of genetics and lifestyle factors, according to the OWH. The condition can develop as young as 11 or 12, when children have their first period, or when people are in their 20s or 30s, per the Centers for Disease Control and Prevention (CDC).
Here are some of the factors that seem to contribute to PCOS:
- Genetics and family history. If you have a sibling or parent with PCOS, you are more likely to develop PCOS as well, per Johns Hopkins University. This suggests that certain gene mutations contribute to developing the condition.
- Obesity. People with obesity, or those who are overweight, are more likely to have PCOS, according to the CDC, although it's possible that PCOS contributes to obesity rather than the other way around.
- Insulin resistance. Many people with PCOS have insulin resistance. Insulin resistance can lead to weight gain and is also linked with rising levels of androgens, according to the NICHD.
- High levels of androgens. Everyone has androgens circulating in their bodies, but people with PCOS have elevated levels compared to people with ovaries who don't have the condition, per the OWH. This can not only interfere with ovulation but also contribute to characteristics such as facial hair.
There are many different symptoms of PCOS, but in order to be diagnosed with the condition, you need to have at least two of the following three, according to the Mayo Clinic:
- Irregular periods. Your doctor will look for evidence that you're not ovulating very often, usually for at least six months, says Amber Naresh, MD, assistant professor of obstetrics and gynecology at Tulane University School of Medicine in New Orleans. Irregular periods are one of the main symptoms of PCOS.
- Elevated hormones. Abnormally high levels of androgens are measured by a laboratory test or by outward signs, such as extra hair on your face, chest, stomach, back or other parts of the body (called hirsutism), per the OWH. Seventy percent of people with PCOS show this symptom, according to the OWH. Male-pattern baldness is another symptom, as is acne.
- Cysts. These little fluid-filled sacs on one or both ovaries can be picked up on an ultrasound.
Other symptoms of PCOS can include:
- Gaining weight or trouble losing weight, especially around your waist.
- Skin tags, typically in your armpits, on your neck or under your breasts.
- Patches of dark skin (called acanthosis nigricans) usually in the creases of your neck, groin and under your breasts.
- Infertility, which is often the symptom that brings people with PCOS to the doctor.
It's important to see a doctor, particularly an obstetrician-gynecologist, to get diagnosed for PCOS, Dr. Kramer says.
While there's no one test to diagnose the condition, your doctor will do a general physical exam, ask questions about your family history, learn about your symptoms and do lab and imaging tests. Part of diagnosing PCOS is ruling out other possible causes for the symptoms. Some things your doctor might do include:
- Check your levels of androgens, progesterone and estrogen, blood glucose and cholesterol, using hormonal blood tests, Dr. Kramer says.
- Perform a pelvic sonogram to look for signs of cystic ovaries.
- Give you a physical exam that includes checking your blood pressure, body mass index (BMI) and weight. Your doctor will also look for any signs of elevated androgen levels, such as extra facial hair.
There's no cure for PCOS and no one treatment for the condition. Instead, doctors recommend medications and lifestyle measures to manage individual symptoms.
"Treatment is tricky. It isn't one medicine or anything like that to reverse the condition or to restore the hormonal balance," Dr. Naresh says. "It depends on what aspect of the condition you're treating. We don't have a one-shot medicine that can treat all of the aspects."
Treatment tactics for PCOS include:
- Losing weight. "Sometimes losing weight can reverse the condition," Dr. Naresh says, if you're living with obesity or overweight. Diet and exercise are usually the first line of therapy to lose weight.
- Hormonal birth control. Birth control methods containing estrogen and progesterone can help regulate periods in those who don't want to get pregnant, Dr. Kramer says. They can also lower your risk of endometrial cancer (which is higher in people with PCOS), clear up acne and cut down on unwanted hair.
- Medications can zero in on specific symptoms. For example, spironolactone (Aldactone) is a blood pressure medication that helps with hair growth and acne by lowering androgen levels. Diabetes medications like Metformin can lower blood sugar and androgen levels and may help you lose weight, but won't usually help with acne or hirsutism. Creams, laser and electrolysis treatments can also help with acne, according to UCLA Health. And drugs to promote ovulation such as clomiphene (Clomid) can help you get pregnant, as can losing weight, in vitro fertilization and even surgery on your ovaries.
Health Risks of PCOS
It's important to get diagnosed and treated if you think you have PCOS. Infrequent periods can raise your risk for endometrial cancer. “That’s definitely a major complication,” Dr. Naresh says. “It’s one of the main reasons to treat it.”
Other potential complications as a result of PCOS include:
- Type 2 diabetes and gestational diabetes. More than half of people with PCOS end up with diabetes before they turn 40, per the CDC.
- Heart disease
- Obstructive sleep apnea
- Mood disorders
- Miscarriage and preeclampsia (high blood pressure) during pregnancy
- Severe anemia due to irregular periods
These risks can continue even after menopause.