Polycystic ovary syndrome (PCOS) is a hormonal imbalance that occurs when the ovaries, which are responsible for producing and releasing eggs, create excess hormones. In women with PCOS, the ovaries produce unusually high levels of hormones known as androgens. This imbalance can lead to irregular menstrual cycles, missed periods, and unpredictable ovulation.
On an ultrasound, small follicle cysts -fluid-filled sacs containing immature eggs- may be seen on the ovaries due to a lack of ovulation (anovulation). However, it’s important to note that having cysts is not a requirement for a PCOS diagnosis; the term “polycystic” does not mean that cysts must be present. Additionally, these ovarian cysts are not dangerous or painful.
PCOS is one of the leading causes of infertility in women. The exact cause of PCOS remains unclear. However, early diagnosis and treatment, along with weight management, can reduce the risk of long-term health issues such as type 2 diabetes and heart disease.
Symptoms
The symptoms of polycystic ovary syndrome (PCOS) often begin around the time of the first menstrual period but can also develop later after menstruation has started.
A diagnosis of PCOS is typically made when at least two of the following symptoms are present:
- Irregular Periods: Many individuals with PCOS experience infrequent or irregular menstrual cycles. This can manifest as having fewer than nine periods a year or periods that occur more than 35 days apart. Additionally, some may have prolonged periods that last longer than usual, which can lead to difficulties in conceiving.
- Excess Androgen: Elevated levels of the hormone androgen can lead to symptoms such as increased facial and body hair, known as hirsutism. Other signs may include severe acne and male-pattern baldness.
- Polycystic Ovaries: The ovaries may be enlarged and contain multiple follicles with immature eggs. This can affect their normal functioning.
Symptoms of PCOS tend to be more pronounced in individuals with obesity.
When to See a Doctor
Consult your doctor if you have concerns about your menstrual cycles, are experiencing difficulty getting pregnant, or notice signs of excess androgen, such as new facial and body hair growth, acne, or male-pattern baldness.
Causes
The precise origin of polycystic ovary syndrome (PCOS) is not entirely understood. However, various factors are believed to contribute to its development, such as:
Insulin Resistance: Insulin is a hormone produced by the pancreas that helps cells absorb glucose, the body’s primary energy source. When cells become resistant to insulin, blood sugar levels can rise, causing the pancreas to produce more insulin in an attempt to regulate glucose. Excessive insulin production can lead to increased production of androgens, male hormones, which can disrupt ovulation and prevent eggs from being released properly.
A common sign of insulin resistance is the presence of dark, velvety patches of skin, often appearing on the neck, armpits, groin, or beneath the breasts. An increase in appetite and weight gain may also indicate insulin resistance.
Low-Grade Inflammation: Chronic low-grade inflammation occurs as the body’s immune response to infections or injuries. In PCOS, this prolonged inflammation may result in the ovaries producing higher levels of androgens, contributing to potential cardiovascular problems.
Genetic Factors: Some research suggests that certain genes could be associated with PCOS. A family history of the condition may increase the likelihood of developing PCOS.
Excessive Androgen Production: Women with PCOS often have higher levels of androgens, which can interfere with the normal ovulation process. This can prevent eggs from developing and being released. Excess androgen can also result in symptoms such as excessive hair growth (hirsutism) and acne.
Complications
PCOS can lead to a range of complications, including:
- Infertility
- Gestational diabetes or pregnancy-induced hypertension
- Miscarriage or preterm delivery
- Nonalcoholic steatohepatitis (a severe form of liver inflammation)
- Metabolic syndrome (a collection of risk factors like high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels)
- Type 2 diabetes or prediabetes
- Sleep apnea
- Mental health disorders (such as depression, anxiety, and eating disorders)
- Endometrial cancer (cancer of the uterine lining)
Obesity is common among individuals with PCOS and can exacerbate complications associated with the condition.
Diagnosis
There is no single test that definitively diagnoses PCOS. The diagnostic process typically begins with a detailed discussion of symptoms, medical history, medications, and menstrual patterns. A physical examination may be conducted to check for signs of excessive hair growth, acne, or insulin resistance.
Tests to confirm PCOS may include:
- Pelvic exam to check for any irregularities in the reproductive organs.
- Blood tests to measure hormone levels, excluding other potential causes of menstrual irregularities or androgen excess. Additional blood tests may include cholesterol and glucose levels.
- Ultrasound to examine the appearance of the ovaries and the thickness of the uterine lining, with a transducer inserted into the vagina to produce images on a computer screen.
If diagnosed with PCOS, further tests may be recommended to monitor for complications, such as blood pressure checks, glucose tolerance, cholesterol levels, and screenings for conditions like depression, anxiety, or obstructive sleep apnea.
Treatment
Managing PCOS typically involves addressing the symptoms that cause the most concern, such as infertility, excessive hair growth, acne, or obesity. Treatment may include lifestyle changes or medications.
Lifestyle Modifications
Weight loss, achieved through a balanced diet and moderate exercise, is often recommended. Even a modest weight reduction of about 5% of body weight can significantly improve symptoms. This can also enhance the effectiveness of medications prescribed for PCOS and improve fertility.
Medications
To regulate menstrual cycles, a gynecologist may prescribe:
- Combination birth control pills containing both estrogen and progestin to reduce androgen production and regulate estrogen levels. This helps control irregular periods, excess hair growth, and acne. It may also lower the risk of endometrial cancer.
- Progestin therapy for 10 to 14 days every 1 to 2 months to regulate periods and protect against endometrial cancer, although it does not address androgen levels or prevent pregnancy.
For fertility, a gynecologist may recommend:
- Clomiphene (an anti-estrogen medication) taken during the first part of the menstrual cycle to stimulate ovulation.
- Letrozole (Femara), a medication typically used for breast cancer, which can stimulate ovarian function.
- Metformin (a drug used to treat type 2 diabetes) can improve insulin sensitivity, regulate insulin levels, and support ovulation. It can also help with weight loss and prevent the progression of prediabetes to type 2 diabetes.
- Gonadotropins, which are hormone injections to promote ovulation.
If these medications are ineffective, assisted reproductive treatments, such as in vitro fertilization (IVF), may be considered.
To address excessive hair growth and acne, a gynecologist may suggest:
- Birth control pills to reduce androgen production.
- Spironolactone (Aldactone), which blocks the effects of androgens on the skin, including preventing excessive hair growth and acne. Effective contraception is required when using this medication.
- Eflornithine (Vaniqa), a cream that slows facial hair growth.
For hair removal, options such as electrolysis or laser hair removal may be considered. Both treatments require multiple sessions for effectiveness. Temporary methods, such as shaving or using depilatory creams, are also available but may result in thicker hair regrowth.
Acne treatments, including oral medications and topical creams or gels, can also improve skin condition.