Polycystic Ovary Syndrome (PCOS)
A common hormonal disorder affecting periods, fertility, and metabolism
Quick Facts
- Type: Hormonal (endocrine) disorder
- Who it affects: Women of reproductive age
- Key features: Irregular periods, excess androgens, ovarian cysts
- Linked to: Insulin resistance, weight gain, infertility
Overview
Polycystic ovary syndrome (PCOS) is one of the most common hormone disorders in women of reproductive age. In PCOS the balance of reproductive hormones is disrupted, the ovaries often produce higher-than-normal amounts of androgens (male-type hormones), and ovulation may happen irregularly or not at all. Despite the name, not everyone with PCOS has visible cysts on the ovaries, and not everyone with ovarian cysts has PCOS.
PCOS is more than a reproductive condition. It is closely linked to how the body handles insulin and blood sugar, so it can affect weight, skin, hair, and long-term risk for conditions such as type 2 diabetes. With diagnosis and ongoing care, most people can manage symptoms effectively and protect their long-term health.
Symptoms
Symptoms vary widely from person to person and often begin around the time of the first period, though they can appear later. Common features include:
- Irregular, infrequent, or absent menstrual periods
- Difficulty getting pregnant due to irregular or absent ovulation
- Excess hair growth on the face, chest, or back (hirsutism)
- Acne or oily skin
- Thinning hair or hair loss on the scalp
- Weight gain or difficulty losing weight
- Darkened patches of skin, often on the neck or in skin folds
A diagnosis usually requires at least two of three features: irregular ovulation, signs of high androgens, and polycystic-appearing ovaries on ultrasound.
Causes
The exact cause of PCOS is not fully understood, but several factors interact:
- Insulin resistance: Many people with PCOS have cells that respond poorly to insulin, so the body makes more of it. High insulin can drive the ovaries to produce more androgens.
- Excess androgens: Higher levels of male-type hormones interfere with ovulation and cause acne and excess hair.
- Hormonal signaling: Changes in hormones released by the brain that control the ovaries can disrupt the normal menstrual cycle.
PCOS often runs in families, suggesting a genetic component, but lifestyle and weight can influence how strongly symptoms show up.
Risk Factors
- A family history of PCOS or type 2 diabetes
- Overweight or obesity, which can worsen insulin resistance
- Insulin resistance or prediabetes
- A sedentary lifestyle
PCOS can affect people of any body size, including those at a normal weight.
Diagnosis
There is no single test for PCOS. A doctor makes the diagnosis after ruling out other conditions and finding a combination of features:
- Medical history and exam: Reviewing menstrual patterns and checking for signs such as excess hair or acne.
- Blood tests: Measuring hormone levels, blood sugar, and cholesterol, and excluding thyroid and other hormone problems.
- Pelvic ultrasound: Looking at the ovaries and the lining of the uterus.
Treatment
Treatment is tailored to a person's symptoms and goals, such as managing periods, improving skin and hair, or supporting fertility.
- Lifestyle measures: Regular activity and a balanced diet can improve insulin sensitivity and ease symptoms; even modest weight loss can help when weight is a factor.
- Hormonal birth control: Combined pills can regulate periods, lower androgen-related symptoms, and protect the uterine lining.
- Insulin-sensitizing medicine: Metformin may be used to improve how the body handles blood sugar.
- Fertility treatment: Medicines that trigger ovulation can help those trying to conceive.
- Targeted symptom care: Treatments for acne, excess hair, or hair loss as needed.
Prevention and Long-Term Care
PCOS cannot be prevented, but its effects can be reduced and complications avoided:
- Stay physically active and aim for a balanced diet
- Maintain a weight that is healthy for you, as this can improve cycles and symptoms
- Have regular checks of blood sugar, blood pressure, and cholesterol
- Discuss period regularity, since long gaps between periods can affect the uterine lining over time
When to See a Doctor
See a doctor if you have irregular or missed periods, signs of excess androgens such as new excess hair or persistent acne, or trouble getting pregnant after trying for several months. Also seek care if you notice symptoms of high blood sugar, such as increased thirst and urination, or develop very heavy or prolonged menstrual bleeding.
Frequently Asked Questions
Can you get pregnant with PCOS?
Yes. Many people with PCOS conceive, though irregular ovulation can make it harder. Lifestyle changes, ovulation-inducing medicines, and other fertility treatments are often effective, so talk with a doctor if you are trying to conceive.
Does PCOS always cause cysts on the ovaries?
No. The name is misleading. Some people with PCOS do not have visible cysts, and the diagnosis is based on a combination of irregular ovulation, signs of high androgens, and ultrasound findings rather than cysts alone.
Is PCOS linked to diabetes?
PCOS is strongly associated with insulin resistance, which raises the risk of prediabetes and type 2 diabetes. Regular blood sugar checks and a healthy lifestyle help lower this risk.
Can losing weight cure PCOS?
Weight loss does not cure PCOS, but for people who are overweight, even a modest reduction can improve insulin sensitivity, make periods more regular, and ease symptoms. PCOS also occurs in people at a normal weight.
Will PCOS go away after menopause?
Some symptoms such as irregular periods naturally change after menopause, but the underlying metabolic effects of PCOS can persist. Long-term attention to blood sugar, blood pressure, and heart health remains important.
References
- Office on Women's Health, U.S. Department of Health and Human Services. Polycystic ovary syndrome.
- Mayo Clinic. Polycystic ovary syndrome (PCOS) — Symptoms and causes.
- National Institute of Child Health and Human Development (NICHD). Polycystic Ovary Syndrome.
- MedlinePlus, U.S. National Library of Medicine. Polycystic ovary syndrome.