Polycystic Ovary Syndrome (PCOS): Symptoms, Causes and Treatment

Polycystic ovary syndrome (PCOS) is a set of symptoms linked to a hormone imbalance. It affects the ovaries and many other parts of the body. People with PCOS usually have at least two of these three problems:

• Not ovulating. Normally the ovaries release an egg each month. With PCOS, the egg may not develop properly or may not be released, so periods may be irregular or stop altogether.
• High androgen levels. Androgens are hormones important for male sexual development; women normally make smaller amounts. Higher levels can cause extra facial or body hair, called hirsutism.
• Cysts — small, fluid-filled sacs — in one or both ovaries.

Causes

The exact cause is unknown. Factors that may play a role include:

• genetics — PCOS tends to run in families;
• imbalances in androgen levels;
• insulin resistance, in which the body can't use insulin properly. Insulin helps move blood sugar (glucose) into cells for energy, so resistance can lead to high blood sugar.

Symptoms

PCOS often begins around age 11 or 12, near the time of the first period, but can develop later. Symptoms vary: some people have few or none and only learn they have PCOS when they have trouble getting pregnant. Symptoms may include:

• irregular or missed periods;
• too much hair on the face, chest, stomach or thighs;
• obesity, weight gain or difficulty losing weight;
• severe acne that may be hard to treat, and oily skin;
• patches of thick, dark skin (acanthosis nigricans);
• infertility — PCOS is one of the most common causes, though many women with PCOS can still get pregnant.

Linked health problems

PCOS is associated with:

• insulin resistance, which can lead to prediabetes and type 2 diabetes;
• heart disease, a risk that rises with age;
• high blood pressure;
• high LDL ("bad") and low HDL ("good") cholesterol;
• sleep apnea, in which breathing repeatedly stops during sleep;
• depression and anxiety.

Researchers don't know whether PCOS causes these problems, the problems cause PCOS, or other conditions cause both. Not everyone with PCOS will have them, but you and your provider may want to watch for them so they can be treated early.

Diagnosis

There's no single test. Your provider will examine you for physical signs, ask about your medical and family history, and may do a pelvic exam, a pelvic ultrasound to look for ovarian cysts and check the thickness of the uterine lining, and blood tests, including hormone levels.

Treatment

There's no cure, but treatment can manage symptoms.

• Lifestyle changes — keeping a healthy weight, being physically active and eating healthy foods — can ease many symptoms and lower the risk of related problems.
• Hormonal birth control — pills, shots or IUDs — can make periods more regular and help with acne and extra hair, for people who don't want to get pregnant.
• Anti-androgen medicines block androgens and can help with hair loss on the head, extra facial and body hair, and acne. They aren't FDA-approved for PCOS and can cause problems in pregnancy, so they may be taken with birth control.
• Insulin-sensitizing medicines, used for type 2 diabetes, improve insulin resistance, steady blood sugar and may lower androgen levels. They aren't FDA-approved for PCOS but may help symptoms.
• Acne treatments in pills, creams or gels.
• Hair removal — creams, laser hair removal or electrolysis.
• Fertility treatments, including medicines and procedures such as in vitro fertilization (IVF).

Sources

Based on "Polycystic Ovary Syndrome," MedlinePlus, U.S. National Library of Medicine; a work of the United States government in the public domain.