Polycystic ovary syndrome (PCOS)

What is PCOS?

PCOS happens when the ovaries make more androgens than usual. Androgens are hormones often called male hormones, though everyone makes some. Higher androgen levels can keep the ovaries from releasing an egg each month, which leads to irregular or missed periods.

Despite the name, not everyone with PCOS has cysts. The small sacs seen on ultrasound are egg follicles that didn’t mature, not true cysts.

PCOS is one of the most common hormone conditions in women of reproductive age. It affects about 1 in 10. Over time, it can raise the chance of type 2 diabetes, high cholesterol, sleep apnea, depression, and anxiety. Rare periods can also let the lining of the uterus build up, which raises the risk of uterine cancer.

What are the symptoms?

Symptoms vary a lot from person to person. They can include:

• Irregular, infrequent, or missed periods
• Extra hair on the face, chest, or belly (hirsutism)
• Acne, often on the face, chest, or upper back
• Thinning hair on the scalp
• Dark, velvety patches of skin in body folds, such as the neck or underarms
• Trouble getting pregnant
• Weight changes

Some people have only one or two of these.

What causes PCOS, and who is at risk?

The exact cause isn’t known. Genes play a role, and PCOS often runs in families. Insulin resistance is also common in PCOS. When the body makes extra insulin to keep blood sugar steady, the ovaries can make more androgens.

PCOS happens in people of all body sizes. You’re more likely to have it if your mother or sister has PCOS or if you have insulin resistance or type 2 diabetes.

How is PCOS diagnosed?

No single test diagnoses PCOS. For adults, current international guidelines look for at least 2 of these 3 signs after other causes are ruled out:

• Irregular periods: cycles shorter than 21 days or longer than 35 days, or missed periods
• Signs of high androgens: extra hair growth, acne, or high androgen levels on a blood test
• Polycystic ovaries: many small follicles on a pelvic ultrasound, or a high AMH (anti-Mullerian hormone) level on a blood test

Your clinician will also check for other conditions that can look like PCOS, such as thyroid problems, high prolactin (a hormone from the pituitary gland), and pregnancy. Once you’re diagnosed, you may have an A1C test (your average blood sugar over about 3 months) or an oral glucose tolerance test, plus cholesterol and blood pressure checks.

How is PCOS treated?

There’s no single treatment for PCOS. Your plan depends on your symptoms and goals, and it can change over time.

• Regular periods and protecting the uterus: hormonal birth control or progestin medicine
• Extra hair and acne: hormonal birth control, anti-androgen medicines, hair removal methods, and skin care. Anti-androgen medicines can harm a developing baby, so they’re used with reliable birth control.
• Blood sugar and insulin resistance: everyday habits and, for some people, metformin
• Getting pregnant: medicines that help the ovaries release an egg. A fertility specialist (reproductive endocrinologist) may also be part of your care.
• Everyday habits: regular movement, eating patterns that work for you, good sleep, and support for mood. These help with PCOS at any body size.

Living with PCOS and when to get care

PCOS is a long-term condition, and symptoms often change with age and life stage. Regular checks of blood sugar, cholesterol, blood pressure, and mood help catch changes early. Check in with your clinician if:

• Your periods are very irregular or you haven’t had one in 3 months
• You’re trying to get pregnant, or planning to soon
• Hair growth, acne, or hair thinning is bothering you
• You have signs of high blood sugar, such as feeling very thirsty or peeing more often
• You snore loudly or feel very sleepy during the day
• You’re feeling down or anxious