Polycystic ovary syndrome

Polycystic ovary syndrome, or PCOS, is a hormonal disorder that affects your ovaries, the small organs that contain your eggs. PCOS develops during your reproductive years, starting from when you get your first period to when you reach menopause. It is one of the leading causes of infertility, and it can lead to serious long-term health consequences.

A hormonal imbalance

Polycystic ovary syndrome (PCOS) happens when there is an imbalance in the chemicals in your brain and the hormones in your body. This imbalance changes your menstrual cycle and causes other symptoms, like body hair growth and weight gain.

Treatments for PCOS vary

Symptoms and causes of PCOS vary from person to person. So too does treatment.

There is no “silver bullet” cure for polycystic ovary syndrome, so partner with your doctor to find a treatment approach that works best for you.

What causes polycystic ovary syndrome?

Polycystic ovary syndrome, or PCOS, can occur from an imbalance in the chemicals in your brain and the hormones in your body. This imbalance changes your menstrual cycle. It can also cause other symptoms, like body hair growth and weight gain.

Hormones and the menstrual cycle

The menstrual cycle happens every month to prepare the body for a possible pregnancy.

First, your body prepares your uterus for pregnancy by thickening the uterine lining. Additionally, several eggs start maturing in sacs called follicles. Halfway through the cycle, a single, mature egg is released from its follicle into the fallopian tubes. This is referred to as ovulation. If the egg does not get fertilized, the cycle ends with the uterus shedding its lining, causing a period. All of these processes are controlled by your hormones.

If you have PCOS, then the eggs don’t mature properly, or your body does not produce enough of the right hormones to cause ovulation.

This means that the eggs never fully mature, and they stay inside their follicles. These follicles then become fluid-filled cysts.

Certain things can disrupt ovulation and your normal hormonal cycle, leading to the symptoms that characterize PCOS:

  • Excessive male hormones (androgens). Androgens are a group of hormones usually associated with the development of male traits. Women with PCOS may have higher-than-normal androgen levels, which prevent ovulation.
  • Insulin resistance. Insulin is the hormone responsible for regulating your blood sugar levels and helps you turn food into energy. Insulin resistance is a condition where your body does not respond to insulin like it normally does, which means your body needs to produce more insulin than normal. High insulin levels, in turn, can prevent ovulation and cause your ovaries to produce androgens.

PCOS risk factors

A risk factor is anything that increases your chance of developing a condition. Risk factors for PCOS include:

  • Being obese or overweight.
  • Having a family history of PCOS.
  • Having low-grade inflammation, as chronic inflammation may play a role in causing your ovaries to produce androgens.

Two women strolling outside

Symptoms of PCOS

Symptoms of polycystic ovary syndrome vary from person to person. The most common symptoms include:

  • Acne. Androgen hormones make your skin oilier. This can lead to more acne, especially cystic acne along the jaw, chin, and cheeks.
  • Excess hair growth (hirsutism). Androgens can cause more body hair growth. You may grow dark, coarse hair on your stomach, chest, back, or face.
  • Hair loss. You may experience thinning hair or male-pattern baldness. This is related to increased levels of androgen.
  • Heavy periods. When you do get a period, you may experience heavy bleeding, since your uterine lining has had a longer time to build up.
  • Infertility. Difficulty getting pregnant.

  • Irregular periods. When you don’t ovulate, you don’t menstruate (have a period). Your periods may be irregular and hard to predict.
  • Pelvic pain. Large ovarian cysts can sometimes cause pelvic pain.
  • Skin patches. Patches of dark, thickened skin on your neck, armpits, or under your breasts.
  • Skin tags. Small pieces of excess skin that are usually found near the armpits or neck.
  • Weight gain. PCOS commonly causes weight gain, especially around the belly. This is related to insulin resistance, and it can be very hard to lose the extra pounds.

How is PCOS diagnosed?

Woman checking in for clinic visit

If you have symptoms of PCOS, you should talk to your doctor right away. They will ask you about your medical and family history, lifestyle, and symptoms. They will likely do a physical exam as well.

While no single test can diagnose PCOS, your doctor may order the following tests:

  • Blood tests. Your doctor may analyze a sample of your blood for androgen levels. High androgen levels may indicate PCOS. Your doctor may also check your blood sugar level for signs of insulin resistance, and they may check your cholesterol levels.
  • Pelvic exam. A gynecologist manually feels areas of your pelvis for signs of abnormalities, cysts, scar tissue, or enlarged ovaries.
  • Ultrasound. This test uses sound waves and a computer to create images of your organs on a screen. Your doctor will press a wand against your belly or insert it into your vagina so that they can get a clear picture of your ovaries. They will check for cysts or other abnormalities.

Your doctor may also recommend you get tested for complications of PCOS, like sleep apnea and depression.

Unfortunately, polycystic ovary syndrome is often underdiagnosed by healthcare providers who are not familiar with the disease and don’t know what to look for. Consider getting a second opinion from an OB/GYN specialist if your symptoms do not respond to treatment or if you are unsatisfied with your care.

Treatments for polycystic ovary syndrome

Because PCOS symptoms and causes can vary from person to person, treatments must be tailored to you. Among the different treatment approaches for PCOS:

Medication

Medication is often the first-line treatment for polycystic ovary syndrome. Among the more commonly prescribed medications:

  • Hormonal contraceptives (birth control pills). Hormonal birth control pills, patches, and rings that contain both estrogen and progestin can help regulate your menstrual cycle and reduce androgen production. This treatment relieves the symptoms of PCOS, although it does not cure the condition itself.
  • Metformin. This drug is commonly used to treat prediabetes and type 2 diabetes. It works by increasing your insulin sensitivity and reducing insulin levels in your blood. This can help restore a normal menstrual cycle. When combined with diet and exercise, it also helps you lose weight.
  • Clomiphene. If you are trying to start a family, your doctor may prescribe you clomiphene. This is a fertility drug that helps you ovulate. However, it can also increase your chance of having multiple births. Clomiphene also does not treat the underlying causes of PCOS or protect you from complications like heart disease and diabetes.
  • Spironolactone. This medication is normally prescribed to treat high blood pressure. However, it can also help with excessive hair growth, scalp hair loss, and acne. It works by blocking the effects of androgen. However, it can cause birth defects, so you will need to take an effective contraceptive along with it.
  • Eflornithine. This is a medicated facial cream that slows hair growth and can help you manage unwanted facial hair growth.

Other treatments

  • Electrolysis. This is a permanent hair removal treatment. A small needle is inserted into each follicle, and an electric current destroys the hair follicle to prevent further hair growth. Most people need more than one electrolysis treatment. Note that this treatment may not be covered by insurance.
  • In vitro fertilization (IVF). PCOS can impact your fertility and make it challenging to start a family. However, you may be a candidate for a fertility treatment like in vitro fertilization (IVF). IVF is a procedure in which an egg is removed from your body and fertilized externally, in a lab setting. The fertilized egg is then implanted in your uterus and allowed to grow. Compared to medication alone, IVF has a lower risk of multiple births. Not everyone is a good candidate for IVF, but if you are struggling to start a family, you should talk to a UCHealth specialist.
  • Mental health treatment. PCOS is linked to increased rates of depression, anxiety, and eating disorders. These are real medical problems that require treatment. If you think you may be suffering from mental illness, consider trying counseling, therapy or talking to your doctor about medications.

Surgery

Rarely, your doctor may recommend that you have surgery to help with polycystic ovary syndrome.

The most common surgical procedure is ovary drilling. In this procedure, your doctor uses a small needle to make holes in your ovaries. The outer layer (cortex) of the ovary is then destroyed with heat or electricity. This layer tends to be abnormally thick in people with PCOS, and it can get in the way of ovulation.

Ovarian drilling is usually not recommended, although it may be a solution for people who cannot ovulate despite weight loss and medications.

Lifestyle changes

One way you can take control of PCOS is by taking control of your lifestyle.

  • Lose weight. If you have PCOS, losing even a small amount of weight (5-10% of your body weight) can help you feel better. It can also help reduce your risk for diabetes and heart disease. Of course, losing weight is easier said than done when it comes to PCOS. You may want to consider consulting with a dietician to get personalized nutrition advice and create achievable weight loss goals. Also talk to your doctor about weight-loss programs. Try to avoid “yo-yo dieting” – falling in and out of diet programs. This can worsen blood sugar problems, reduce your metabolism, and exacerbate eating disorders.
  • Limit carbohydrates. Limiting your intake of refined carbohydrates (like sugars, sweets, and white bread) can help with your blood sugar levels. Consider choosing complex carbs, like those found in fruits and vegetables. Some people find that other diets, like the keto diet, help with their symptoms. Talk to your doctor before making this kind of change to your diet, as it can come with serious risks.
  • Exercise regularly. Being active helps moderate your blood sugar levels and can be an important part of weight management.

Of course, being proactive is always the best course of action. It is never too late to start leading a healthier life. Talk to your doctor about a diet and exercise plan that might be right for you.

Woman on rowing machine at gym

If PCOS is left untreated, it can lead to other health problems, including:

Gestational diabetes. If you do get pregnant and have polycystic ovary syndrome, you may be at risk for pregnancy complications like gestational diabetes. This is a type of diabetes that develops during pregnancy, and it can lead to complications like preterm delivery, high birth weight, and a greater risk for diabetes later in life.

Type 2 diabetes. Type 2 diabetes is a condition in which your body is unable to use insulin and your blood sugar becomes too high. Insulin resistance can eventually develop into type 2 diabetes, especially if it is not managed.

Infertility. Having an irregular menstrual cycle makes it much more challenging to get pregnant since your body does not ovulate regularly. This is why PCOS is one of the leading causes of infertility.

Mental health problems. You are much more likely to suffer from depression, anxiety, and eating disorders if you have PCOS.

Metabolic syndrome. Metabolic syndrome is a cluster of symptoms, including high blood pressure, high cholesterol, and high blood sugar. Together, these symptoms strongly increase your risk of developing cardiovascular disease.

Sleep apnea. Sleep apnea means you stop breathing multiple times while sleeping. This can lead to chronic fatigue, daytime sleepiness, and an increased risk for heart disease. Being overweight or obese is a leading cause of sleep apnea.

Uterine cancer. PCOS, high blood pressure, and high blood sugar all increase the likelihood of developing uterine cancer.