Polycystic Ovary Syndrome (PCOS)
What is polycystic ovarian syndrome?
Polycystic ovarian syndrome (PCOS) is a hormonal imbalance caused by the ovaries (the organ that produces and releases eggs) creating excess male hormones. If you have PCOS, your ovaries produce unusually high levels of hormones called androgens. This causes your reproductive hormones to become imbalanced. As a result, people with PCOS often have erratic menstrual cycles, missed periods and unpredictable ovulation. Small cysts may develop on your ovaries (fluid-filled sacs) due to lack of ovulation (anovulation). However, despite the name "polycystic," you do not need to have cysts on your ovaries to have PCOS.
PCOS is one of the most common causes of female infertility. It can also increase your risk for other health conditions. Your healthcare provider can treat PCOS based on your symptoms and if you have plans for having children.
Who can get PCOS?
A woman can get PCOS any time after puberty. Most people are diagnosed in their 20s or 30s when they are trying to get pregnant. You may have a higher chance of getting PCOS if you are overweight or have obesity, or if other people in your family have PCOS.
How common is PCOS?
PCOS is very common — up to 15% of women of reproductive age have it.
Symptoms and Causes
What is the main cause of polycystic ovarian syndrome?
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.
What are the symptoms of polycystic ovarian syndrome?
The most common symptoms of PCOS include:
- Irregular periods: Abnormal menstruation involves missing periods or not having a period at all. It may also involve heavy bleeding during periods.
- Abnormal hair growth: Excess facial hair and heavy hair growth on the arms, chest and abdomen (hirsutism). This affects up to 70% of women with PCOS.
- Acne: PCOS can cause acne, especially on the back, chest and face. This acne may continue past the teenage years and may be difficult to treat.
- Obesity: About 80% of women with PCOS are overweight or have obesity, and have trouble losing weight.
- Darkening of the skin: Patches of dark skin, especially in the folds of your neck, armpits, groin (between the legs) and under the breasts. This is known as acanthosis nigricans.
- Cysts: Many women with PCOS have small pockets of fluid in their ovaries.
- Skin tags: Skin tags are little flaps of extra skin. They're often found in the armpits or on the neck in women with PCOS.
- Thinning hair: People with PCOS may lose patches of hair on their heads or start to go bald.
- Infertility: PCOS is the most common cause of female infertility. Decreased frequency or lack of ovulation can result in not being able to conceive.
Can I have PCOS but not have any symptoms?
Yes, it’s possible to have PCOS and not have any symptoms. Many people don't even realize they have the condition until they have trouble getting pregnant or are gaining weight for unknown reasons. It’s also possible to have mild PCOS, where the symptoms are not severe enough for you to notice.
Diagnosis and Tests
How is polycystic ovarian syndrome diagnosed?
In most cases, your healthcare provider can diagnose PCOS after an examination. They may order blood tests or perform an ultrasound to help with the diagnosis.
Your healthcare provider will:
- Talk to you about your symptoms and medical history.
- Ask about your family’s medical history.
- Take your weight and blood pressure.
- Perform a physical exam, looking specifically for excess facial hair, hair loss, acne, discolored skin and skin tags.
- Perform a pelvic exam to look for swollen ovaries or other growths in your uterus.
- Order blood tests to check hormone levels and glucose levels.
- Perform a pelvic ultrasound to look for cysts in your ovaries and check the thickness of the lining of your uterus.
Typically, you are be diagnosed with PCOS if you have at least two of the following:
- Irregular or missed periods. Some people with PCOS have very heavy bleeding when they do have a period.
- Signs of excess androgen such as acne or excessive hair growth. Or, a blood test confirming excess androgen levels.
- Cysts on one or both ovaries. Many people don’t develop cysts.
Management and Treatment
How is polycystic ovarian syndrome treated?
Your healthcare provider will determine treatment based on your symptoms, medical history and other health conditions, and if you want to get pregnant. Treatments can include medications, lifestyle changes or a combination of both.
If you do not plan to become pregnant, treatments include:
- Hormonal birth control: Options include birth control pills, patches, shots, a vaginal ring or an intrauterine device (IUD). Hormonal birth control helps to regulate your menstrual cycle, improve acne and help with excess hair growth.
- Insulin-sensitizing medicine: Metformin is a drug used to treat diabetes. It works by helping your body process insulin. Once insulin is controlled, some people with PCOS see improvements in their menstrual cycles.
- Medications to block androgens: Some drugs can block the effect of androgens. This helps control acne or hair growth caused by PCOS. Talk to your healthcare provider about whether they're right for you.
- Lifestyle changes: Losing weight and eating a healthy diet can have a positive effect on insulin levels.
If you want to become pregnant now or in the future, treatment for PCOS includes:
- Drugs to induce ovulation (releasing an egg): A successful pregnancy begins with ovulation. Certain drugs have been proven to induce ovulation in women with PCOS. The medications clomiphene and letrozole are taken orally, while gonadotropins are given by injection.
- Surgery: A surgical procedure called ovarian drilling can trigger ovulation by removing tissues in the ovaries that are producing androgen hormones. With newer medications available, surgeons now rarely perform this procedure.
- In vitro fertilization (IVF): Your egg is fertilized with your partner's sperm in a lab and then transferred to your uterus. This is an option for women with PCOS when medication doesn't help with ovulation.
Can I prevent PCOS or its effects?
There is no proven way to prevent PCOS, but you can take small steps to reduce your symptoms. For example, eating nutritious foods, exercising regularly and managing your weight can help you avoid the effects of PCOS.
Outlook / Prognosis
Does polycystic ovarian syndrome ever go away?
The hormone changes caused by menopause may make your PCOS go away, but not always. Sometimes the imbalance of hormones continues into menopause, meaning your imbalance does not change as you age. If your symptoms bother you or affect your quality of life, talk to your healthcare provider so they can recommend treating your symptoms.
Does PCOS put me at risk for other health conditions?
PCOS has been shown to put you at a higher risk for several health conditions, including:
- High blood pressure.
- Cardiovascular disease.
- Endometrial hyperplasia.
- Endometrial cancer.
- Sleep disorders such as sleep apnea.
- Depression and anxiety.
Talk to your healthcare provider to make sure you understand the risks of developing these conditions.
How do I cope with symptoms of PCOS?
One of the best ways to cope with PCOS is to lose weight with healthy eating and regular exercise. Even a small amount of weight loss can affect hormone levels and help to regulate your menstrual cycle and ease your symptoms.
If excess hair growth or acne is hurting your confidence, cosmetic treatments or working with a dermatologist might be helpful.
Finally, if you are trying to conceive and have been diagnosed with PCOS, know that you are not alone. Your healthcare provider will work with you to help you get pregnant. Eating healthy and lowering your stress levels can go a long way in helping you manage PCOS.
Frequently Asked Questions
Is polycystic ovarian syndrome genetic?
There is still a lot of research being done to understand the causes of PCOS. However, there is evidence that shows PCOS has a genetic or hereditary component.
Can I get pregnant if I have PCOS?
Yes, you can get pregnant if you have PCOS. PCOS can make it hard to conceive while also increasing your risk for certain pregnancy complications. Your healthcare provider will work with you to develop a treatment plan to help you ovulate. Your treatment plan could include medication or assisted reproductive technologies like IVF (In Vitro Fertilization).
Talk to your healthcare provider to make sure you understand your treatment plan and how you can increase your chances for a healthy and successful pregnancy.
What hormones affect PCOS?
Women with PCOS have a hormonal imbalance that disrupts the menstrual cycle, ovulation, and possibly, conception. These hormones are like an intricate web and the function of the female reproductive system relies heavily on its balance. The hormones that play a role in PCOS are:
- Androgens (like testosterone and androstenedione).
- Luteinizing hormone (LH).
- Follicle-stimulating hormone (FSH).
What's the difference between PCOS and endometriosis?
PCOS and endometriosis are different conditions, but both are linked to ovarian cysts and infertility. Endometriosis is a condition where the lining of your uterus (endometrium) grows in other places like your ovaries, vagina or fallopian tubes. It typically causes pelvic pain or severe menstrual cramps. Women with PCOS have irregular periods, unpredictable ovulation and other physical side effects due to excess male hormones.
A note from Cleveland Clinic
PCOS is a common cause of infertility and can be linked to other diseases. Talk to your healthcare provider about your symptoms if you suspect you have PCOS. Lifestyle changes and medical treatments can help you manage the symptoms, lower your risk of other health conditions and get pregnant.
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