Irregular menstrual periods. Excess facial hair. Acne breakouts years after puberty. Difficulty getting pregnant. These are some of the common symptoms of polycystic ovary syndrome (PCOS), a condition caused by a hormone imbalance. Between 5 and 10 percent of women and people assigned female at birth have PCOS.  

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Women with PCOS have higher-than-normal levels of hormones called androgens. (Testosterone is one of the most common androgens.) The hormone imbalance causes a variety of symptoms, such as: 

  • Unpredictable menstrual cycles. 
  • Infrequent, unpredictable ovulation. 
  • A thickened uterine lining (endometrium), causing heavy menstrual flow. 
  • Infertility. 
  • Obesity. 
  • Insulin resistance. 
  • Excess body hair, especially on the face. 
  • Acne.

Because some of the key symptoms of PCOS affect menstrual cycles and fertility, the condition is usually diagnosed in people of childbearing age. Teenage girls sometimes learn that they have PCOS when providers investigate the cause of their erratic menstrual periods. Women in their 20s or 30s who are having trouble getting pregnant are often diagnosed with PCOS during infertility evaluations.  

It’s possible for women with PCOS to conceive, especially if they seek help at a fertility clinic. Women with PCOS who become pregnant are at greater risk of gestational diabetes and getting type 2 diabetes later in life. (More than half of women with PCOS have diabetes by the time they’re 40.)   

Between 40 and 85 percent of people with PCOS are overweight or obese, but some people with the condition have a healthy body weight. Women with weight in the normal range may not learn that they have PCOS until well after their teenage years because they exhibit fewer PCOS symptoms during adolescence.  

The effects of PCOS endure across the lifespan, even after menopause. Having PCOS increases a woman’s risk of: 

  • High cholesterol levels. 
  • Type 2 diabetes. 
  • Obesity. 
  • Sleep apnea. 
  • Endometrial cancer.

A variety of treatments are available to manage PCOS. Primary care providers, gynecologists and endocrinologists treat the condition.  

What causes PCOS?

Experts haven’t pinpointed exactly what causes PCOS, but they believe that genetic mutations that affect hormone levels, insulin levels and/or body weight are involved.  

When a woman has a regular menstrual cycle, her ovaries release an egg each month. (This is known as ovulation.) If the egg is fertilized by sperm, the woman becomes pregnant. If the egg isn’t fertilized, the woman will have a menstrual period, and the cycle repeats.  

When a woman has PCOS, an imbalance of estrogen, testosterone, pituitary hormones, and sometimes insulin resistance causes infrequent, unpredictable ovulation. It’s difficult for women with PCOS to become pregnant because there isn’t a way to reliably predict when they will ovulate or get their menstrual periods.  

Because the ovaries don’t regularly release eggs when someone has PCOS, the physical structure of the ovaries changes. The outsides of the ovaries become covered with tiny cysts that are actually fluid-filled sacs, each one containing an immature egg that wasn’t released. PCOS gets its name from the appearance of these cysts on the ovaries. Some patients believe that ovarian cysts are responsible for PCOS, but the cysts form on the ovaries as a result of the condition.  

How PCOS is diagnosed 

There’s no simple way to determine that someone has PCOS. Instead, providers make the diagnosis when a patient has at least two of these three criteria: 

  • A history of irregular menstrual periods. 
  • Evidence of high androgen/testosterone levels, such as excess facial hair or a blood test that confirms the hormone levels. 
  • An ultrasound that shows the patient’s ovaries have a polycystic appearance (covered with fluid-filled egg sacs).

Treatments for PCOS 

Providers consider a patient’s personal circumstances and goals (such as wanting to get pregnant) when deciding which PCOS treatment option is most appropriate:  

  • Everyone with PCOS can benefit from adopting a healthy diet, exercising regularly and losing weight when appropriate. A healthy lifestyle helps improve PCOS symptoms, and it may also decrease your risk of diabetes, high cholesterol and other complications.
  • If you have PCOS and you aren’t trying to get pregnant, providers typically prescribe a combined oral contraceptive, which contains the hormones estrogen and progesterone. The medication lowers testosterone levels, which helps regulate menstrual periods. It also decreases the incidence of acne and prevents the growth of unwanted hair in new places. Because the contraceptive causes menstrual periods every month, women shed their uterine lining before it becomes too thick. This decreases the risk of endometrial cancer.
  • If you have PCOS and you are trying to get pregnant, providers can prescribe medication to regulate ovulation. These medications are often quite effective, especially when combined with modest weight loss. Losing between 5 to 10 percent of your total body weight has been shown to help improve your body’s ability to ovulate. For patients who can’t conceive, even with the help of ovulation-regulating medication, in-vitro fertilization (IVF) is an option.
  • If you have PCOS and you’ve reached menopause, you won’t experience issues relating to menstrual cycles or ovulation anymore. However, you’re still at risk of diabetes, high cholesterol, sleep apnea and other complications that are associated with PCOS. It’s important to see a provider regularly to monitor your overall health and minimize your risk for these health conditions.

When to talk to your provider if you suspect PCOS 

Women and individuals assigned female at birth should talk to their primary care provider or gynecologist if they have irregular or infrequent menstrual periods, particularly if you:

  • Are obese. 
  • Have excess body hair, including facial hair. 
  • Have persistent acne beyond puberty. 
  • Are having difficulty getting pregnant. 
  • Have a mother or a sister who was diagnosed with PCOS.

Some women who have infrequent menstrual cycles consider themselves to be lucky because they only get menstrual periods three or four times a year. But ignoring the problem may have far-reaching impacts on their health.  

Instead of accepting your erratic menstrual periods as normal, ask your provider to determine the reason behind your abnormal cycles. If your provider diagnoses you with PCOS, there are a variety of management options that can be tailored to your unique circumstances. 

Looking for help?  

Our mission is to help you achieve the best results with the right care. We can help manage your symptoms and answer your questions about PCOS and gynecology. Learn more about PCOS or schedule an appointment. 

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