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Polycystic ovary syndrome (PCOS)

Overview

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.

The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease

Symptoms

The most common PCOS symptoms are missed, irregular, infrequent, or prolonged periods. Excess androgens can cause hair loss, hair in places you don’t want it (like on your face), and acne. Other symptoms include:

  • Darkened skin or excess skin (skin tags) on the neck or in the armpits
  • Mood changes
  • Pelvic pain
  • Weight gain around your middle

Complications

If you have PCOS and your androgen levels are too high, you have higher odds for a number of complications. These can differ from woman to woman and include:

Trouble getting pregnant. Cysts in the ovaries can interfere with ovulation. That’s when one of your ovaries releases an egg each month. If a healthy egg isn’t available to be fertilized by a sperm, you can’t get pregnant. You may still be able to get pregnant if you have PCOS. But you might have to take medicine and work with a fertility specialist to make it happen.

Insulin issues and diabetes. Insulin resistance may cause your body to make too many androgens. If you have insulin resistance, the cells in your muscles, organs, and other tissues don’t absorb blood sugar very well. As a result, you can have too much sugar moving through your bloodstream. This is called diabetes, and it can cause problems with your cardiovascular and nervous systems.

Metabolic syndrome. This group of symptoms raises the risk of cardiovascular disease . The symptoms include high triglyceride and low HDL (“good”) cholesterol levels, high blood pressure, and high blood sugar levels.

Other common complications of PCOS include:

  • Depression
  • Anxiety
  • Bleeding from the uterus and higher risk of uterine cancer
  • Sleep problems
  • Inflammation of the liver

causes

The exact cause of PCOS is unknown. There is evidence that genetics play a role. Several other factors also play a role in causing PCOS:

Higher levels of male hormones called androgens: High androgen levels prevent the ovaries from releasing eggs (ovulation), which causes irregular menstrual cycles. Irregular ovulation can also cause small, fluid-filled sacs to develop in the ovaries. High androgen also causes acne and excess hair growth in women.

Insulin resistance: Increased insulin levels cause the ovaries to make and release male hormone (androgens). Increased male hormone, in turn, suppress ovulation and contribute to other symptoms of PCOS. Insulin controls the way your body processes glucose (sugar) and uses it for energy. Insulin resistance means your body doesn't process insulin correctly, leading to high glucose levels in your blood. Not all individuals with insulin resistance have an elevated glucose or diabetes, but insulin resistance can lead to diabetes. Being overweight or having obesity can also contribute to insulin resistance. An elevated insulin level, even if your blood glucose is normal, can indicate insulin resistance.

Low-grade inflammation: People with PCOS tend to have chronic low-grade inflammation. Your healthcare provider can perform blood tests that measure levels of C-reactive protein (CRP) and white blood cells, which can indicate the level of inflammation in your body.

Diagnose

Your health care provider will ask about your medical history and your symptoms. You will also have a physical exam. This will likely include a pelvic exam. This exam checks the health of your reproductive organs, both inside and outside your body.

Some of the symptoms of PCOS are like those caused by other health problems. Because of this, you may also have tests such as:

Ultrasound. This test uses sound waves and a computer to create images of blood vessels, tissues, and organs. This test is used to look at the size of the ovaries and see if they have cysts. The test can also look at the thickness of the lining of the uterus (endometrium).

Blood tests. These look for high levels of androgens and other hormones. Your health care provider may also check your blood glucose levels. And you may have your cholesterol and triglyceride levels checked

Treatment

PCOS treatment focuses on managing your individual concerns, such as infertility, hirsutism, acne or obesity. Specific treatment might involve lifestyle changes or medication.

Lifestyle changes

Your doctor may recommend weight loss through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight — for example, losing 5 percent of your body weight — might improve your condition. Losing weight may also increase the effectiveness of medications your doctor recommends for PCOS, and can help with infertility.

Medications

To regulate your menstrual cycle, your doctor might recommend:

Combination birth control pills. Pills that contain estrogen and progestin decrease androgen production and regulate estrogen. Regulating your hormones can lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Instead of pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin.

Progestin therapy. Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy doesn't improve androgen levels and won't prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.

To help you ovulate, your doctor might recommend:

Clomiphene. This oral anti-estrogen medication is taken during the first part of your menstrual cycle.

Letrozole (Femara). This breast cancer treatment can work to stimulate the ovaries.

Metformin. This oral medication for type 2 diabetes improves insulin resistance and lowers insulin levels. If you don't become pregnant using clomiphene, your doctor might recommend adding metformin. If you have prediabetes, metformin can also slow the progression to type 2 diabetes and help with weight loss.

Gonadotropins. These hormone medications are given by injection.

To reduce excessive hair growth, your doctor might recommend:

Birth control pills. These pills decrease androgen production that can cause excessive hair growth.

Spironolactone (Aldactone). This medication blocks the effects of androgen on the skin. Spironolactone can cause birth defects, so effective contraception is required while taking this medication. It isn't recommended if you're pregnant or planning to become pregnant.

Eflornithine (Vaniqa). This cream can slow facial hair growth in women.

Electrolysis. A tiny needle is inserted into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle. You might need multiple treatments.

Lifestyle and home remedies

To help decrease the effects of PCOS, try to:

Maintain a healthy weight. Weight loss can reduce insulin and androgen levels and may restore ovulation. Ask your doctor about a weight-control program, and meet regularly with a dietitian for help in reaching weight-loss goals.

Limit carbohydrates. Low-fat, high-carbohydrate diets might increase insulin levels. Ask your doctor about a low-carbohydrate diet if you have PCOS. Choose complex carbohydrates, which raise your blood sugar levels more slowly.

Be active. Exercise helps lower blood sugar levels. If you have PCOS, increasing your daily activity and participating in a regular exercise program may treat or even prevent insulin resistance and help you keep your weight under control and avoid developing diabetes.

Preparing for your appointment

You may be referred to a specialist in female reproductive medicine (gynecologist), a specialist in hormone disorders (endocrinologist) or an infertility specialist (reproductive endocrinologist).

  • Here's some information to help you get ready for your appointment.
  • What you can do
  • List symptoms you've been having, and for how long
  • List all medications, vitamins and supplements you take, including the doses
  • List key personal and medical information, including other conditions, recent life changes and stressors
  • Prepare questions to ask your doctor
  • Keep a record of your menstrual cycles

For PCOS, some basic questions to ask your doctor include:

  • What tests do you recommend?
  • How does PCOS affect my ability to become pregnant?
  • What medications do you recommend to help improve my symptoms or ability to conceive?
  • What lifestyle modifications do you recommend to help improve my symptoms or ability to conceive?
  • What are the long-term health implications of PCOS?
  • I have other medical conditions. How can I best manage them together?
  • During your appointment, don't hesitate to ask other questions as they occur to you.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • What are your signs and symptoms? How often do they occur?
  • How severe are your symptoms?
  • When did each symptom begin?
  • When was your last period?
  • Have you gained weight since you first started having periods? How much weight did you gain, and when did you gain it?
  • Does anything improve or worsen your symptoms?
  • Are you trying to become pregnant, or do you wish to become pregnant?
  • Has your mother or sister ever been diagnosed with PCOS?

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