Polycystic Ovary Syndrome (PCOS)

Overview

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders in people with ovaries during their reproductive years. It involves a combination of irregular or absent ovulation, higher-than-usual levels of male-type hormones (androgens), and often ovaries that contain many small fluid-filled follicles visible on ultrasound. Despite the name, these are not true cysts and do not need to be removed.

PCOS affects far more than the ovaries. It is closely linked to how the body handles insulin and is associated with weight gain, type 2 diabetes risk, and changes in mood and skin. The features vary widely from person to person, and PCOS can cause difficulty getting pregnant. While there is no cure, the condition can be effectively managed with lifestyle measures and medications tailored to a person's symptoms and goals.

Symptoms

Symptoms of PCOS often begin around puberty but can develop later. Common features include:

• Irregular, infrequent, or absent menstrual periods
• Difficulty getting pregnant due to irregular ovulation
• Excess hair growth on the face, chest, or back (hirsutism)
• Acne and oily skin
• Thinning hair or hair loss on the scalp
• Weight gain or difficulty losing weight
• Darkened patches of skin in body folds (acanthosis nigricans)
• Mood changes, including anxiety or low mood

Not everyone has all of these, and the severity ranges from mild to significant. Some people are diagnosed mainly because of irregular periods or trouble conceiving.

Causes

The exact cause of PCOS is not fully understood, but several interrelated factors are involved:

• Insulin resistance: Many people with PCOS have reduced sensitivity to insulin, leading to higher insulin levels that can increase androgen production.
• Excess androgens: Higher male-type hormone levels interfere with ovulation and cause acne and excess hair.
• Hormonal imbalance: Altered signaling between the brain and ovaries disrupts the normal menstrual cycle.
• Genetics: PCOS often runs in families.

These factors reinforce one another, which is why managing insulin resistance, often through weight and lifestyle changes, can improve many PCOS symptoms.

Risk Factors

Factors that increase the likelihood of PCOS or its complications include:

• A family history of PCOS or type 2 diabetes
• Overweight or obesity, which can worsen symptoms (though PCOS also occurs in people of normal weight)
• Insulin resistance
• A sedentary lifestyle

PCOS itself raises the risk of other conditions over time, including type 2 diabetes, high blood pressure, abnormal cholesterol, sleep apnea, endometrial (uterine lining) problems, and depression or anxiety. These risks make ongoing monitoring important.

Diagnosis

There is no single test for PCOS. Diagnosis is usually made when at least two of three features are present, after excluding other conditions:

• Irregular or absent ovulation (irregular periods)
• Signs or blood test evidence of excess androgens
• Polycystic-appearing ovaries on ultrasound

Evaluation typically includes a medical history, physical examination, blood tests to measure hormones and to rule out thyroid and other disorders, and sometimes a pelvic ultrasound. Tests for blood sugar and cholesterol are often done to assess metabolic health. Because other conditions can mimic PCOS, a careful assessment is important to confirm the diagnosis.

Treatment

Treatment is individualized and aims to relieve symptoms, restore regular cycles, and reduce long-term health risks. Options include:

• Lifestyle changes: A balanced diet, regular physical activity, and modest weight loss (when relevant) can improve insulin sensitivity, regulate cycles, and ease symptoms.
• Hormonal birth control: Combined pills or other hormonal methods to regularize periods, lower androgens, and improve acne and excess hair.
• Insulin-sensitizing medication: Metformin can help with insulin resistance and, in some people, with cycle regularity.
• Fertility treatment: Medications to stimulate ovulation, or other assisted methods, for those trying to conceive.
• Targeted therapies: Treatments for excess hair, acne, and hair loss.

Managing mental health and monitoring for diabetes, blood pressure, and cholesterol are also key parts of long-term care.

Prevention

PCOS cannot be prevented because it has a strong genetic and hormonal basis, but healthy habits can reduce its impact and lower the risk of complications:

• Maintaining a balanced diet and regular physical activity
• Aiming for and keeping a healthy weight
• Monitoring blood sugar, blood pressure, and cholesterol over time
• Not smoking and limiting alcohol
• Attending regular check-ups to manage symptoms and screen for related conditions

Early management of insulin resistance and metabolic health is especially helpful in limiting the long-term effects of PCOS.

When to See a Doctor

See a healthcare provider if you have irregular or missed periods, difficulty getting pregnant, excess hair growth, persistent acne, or unexplained weight gain. These can be signs of PCOS or another hormonal condition that benefits from evaluation and treatment.

Also seek care if you experience symptoms of related conditions, such as excessive thirst and urination (possible diabetes) or persistent low mood and anxiety. Early diagnosis allows you to manage symptoms, protect fertility if desired, and reduce the risk of long-term complications.

Related Topics

Frequently Asked Questions

References

1. Office on Women's Health, U.S. Department of Health and Human Services.
2. Mayo Clinic. Polycystic ovary syndrome (PCOS).
3. National Institute of Child Health and Human Development (NICHD).