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

Polycystic Ovary Syndrome (PCOS) is a hormonal condition affecting 1 in 10 women. It causes irregular periods, excess androgen levels, and often small cysts on the ovaries. While there's no cure, symptoms can be managed with medication and lifestyle changes. The most important step is to see a doctor if you notice irregular cycles, unwanted hair growth, or trouble conceiving.

In plain words

PCOS is a common hormonal problem that affects women during their childbearing years. It can cause irregular periods, unwanted hair growth, and problems getting pregnant. Small cysts may form on the ovaries. While there is no cure, treatments can help manage symptoms. These include medicines and lifestyle changes. See a doctor if you have irregular periods, trouble losing weight, or extra hair growth on your face or body.

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

Polycystic Ovary Syndrome (PCOS) is a hormonal condition affecting 1 in 10 women. It causes irregular periods, excess androgen levels, and often small cysts on the ovaries. While there's no cure, symptoms can be managed with medication and lifestyle changes. The most important step is to see a doctor if you notice irregular cycles, unwanted hair growth, or trouble conceiving.

Symptoms

Early symptoms

  • Irregular periods: Fewer than 9 periods per year or cycles longer than 35 days. Periods may be very light or unusually heavy. (3) (1)
  • Excess hair growth: Hirsutism - thick, dark hair growth on face, chest, back or buttocks (areas where men typically grow hair). (3)
  • Acne or oily skin: Persistent acne that continues past teenage years or severe acne that doesn't respond to usual treatments. (3)
  • Weight gain: Difficulty losing weight or unexplained weight gain, especially around the waist. (1) (3)
  • Thinning scalp hair: Hair loss or thinning that resembles male-pattern baldness. (3)

Serious or emergency symptoms

  • Infertility: Difficulty getting pregnant due to lack of ovulation. PCOS is one of the most common causes of female infertility. Discuss fertility options with a specialist if trying to conceive for over a year (or 6 months if over 35). (3) (1)
  • Darkened skin patches: Patches of thick, velvety, darkened skin in body creases (neck, groin, under breasts) - called acanthosis nigricans. Can indicate insulin resistance. See a doctor for diabetes screening if noticed. (3)

Causes

Primary causes

  • Insulin resistance: When cells don't respond normally to insulin, the body makes extra insulin. High insulin levels increase androgen production, which interferes with ovulation. (6) (7)
  • Hormone imbalance: Higher than normal levels of androgens (male hormones) prevent ovaries from releasing eggs regularly and cause PCOS symptoms. (6) (7)
  • Genetic factors: PCOS tends to run in families. Specific genes haven't been identified, but family history is a known risk factor. (6)

Risk factors

Family history

Having a mother or sister with PCOS increases your risk. Certain gene variations may play a role. (6)

Obesity

Excess weight worsens insulin resistance, which can increase PCOS symptoms. Notably, lean women can also develop PCOS. (1) (8)

Diagnosis

There's no single test for PCOS. Your doctor will ask about symptoms, menstrual patterns, and medical history. They'll check for physical signs like excess hair growth. Blood tests measure hormone levels (androgens, LH/FSH ratio). An ultrasound may show ovarian cysts, though you can have PCOS without cysts. Other conditions like thyroid problems must be ruled out first.

Physical exam

Check for signs of excess hair growth, acne, or skin discoloration. May measure BMI and blood pressure. (5)

Pelvic exam/ultrasound

Look for enlarged ovaries with small cysts (not essential for diagnosis but may support it). (5) (7)

Blood tests

Measure hormone levels (testosterone, LH, FSH), check for insulin resistance, and rule out thyroid issues. (5) (7)

Treatment

Medication options

Hormonal contraceptives

Regulate menstrual cycles, reduce androgen levels, and improve acne/hirsutism. Estrogen + progestin formulations are commonly used. (4) (2)

Anti-androgens

Block effects of male hormones to reduce excess hair growth and acne. Often combined with birth control pills. (4)

Metformin

Improves insulin sensitivity in PCOS patients with insulin resistance or prediabetes. May help regulate periods and aid weight loss. (4) (1)

Lifestyle and self-care

  • Healthy eating habits: Focus on whole foods, high-fiber carbs, lean proteins. Aim for low-glycemic index foods to help manage insulin levels. Even modest weight loss (5-10% of body weight) can improve symptoms. (4) (2)
  • Regular physical activity: At least 150 minutes per week of moderate activity (like brisk walking) to help lower insulin resistance. Strength training 2-3 times weekly helps maintain muscle mass. (4) (2)
  • Stress management: Chronic stress can worsen PCOS symptoms. Relaxation techniques like yoga or mindfulness may help regulate hormones. (4)

Always discuss dosing and treatment changes with your own prescriber.

Possible complications

  • Type 2 diabetes: Over half of women with PCOS develop diabetes or prediabetes before age 40 due to insulin resistance. Regular glucose monitoring is important. (1)
  • Infertility: Lack of ovulation makes conception difficult without medical help. Fertility treatments like clomiphene may be needed. (2)
  • Endometrial cancer risk: Infrequent periods can cause thickening of the uterine lining (endometrial hyperplasia), increasing cancer risk over time. (2)

When to see a doctor

Routine follow-up

  • If you have irregular periods, excess facial/body hair, acne that doesn't respond to treatment, or trouble getting pregnant after a year of trying. (5)

Seek emergency care

  • Severe pelvic pain could indicate ovarian torsion or ruptured cyst - seek immediate medical attention. (3)

Frequently asked questions

What is Polycystic Ovary Syndrome?

PCOS is a hormonal disorder where ovaries produce excess androgens (male hormones). It causes irregular periods, excess hair growth, and often small cysts on the ovaries. It affects 1 in 10 women and can impact fertility. (1) (2)

What are the first signs of Polycystic Ovary Syndrome?

Early signs include irregular/painful periods, trouble managing weight, acne that persists after teens, and unusual hair growth on face or body. Symptoms often start around puberty but may appear later. (3) (1)

What causes Polycystic Ovary Syndrome?

Exact cause is unknown but involves insulin resistance, hormone imbalances, and genetic factors. High insulin levels boost androgen production, which interrupts normal ovulation. (6) (7)

How is Polycystic Ovary Syndrome treated?

Treatment focuses on symptoms - birth control pills regulate periods, anti-androgens reduce excess hair, metformin improves insulin sensitivity. Lifestyle changes like diet/exercise are foundational. (4) (1)

Can Polycystic Ovary Syndrome be cured?

There's no cure yet, but symptoms can be effectively managed. Many women find periods become more regular with treatment. Maintaining a healthy weight helps control symptoms long-term. (4)

References

  1. CDC - PCOS and Diabetes source 1
  2. NHS - Polycystic ovary syndrome source 2
  3. NHS - PCOS Symptoms source 3
  4. NHS - PCOS Treatment source 4
  5. NHS - PCOS Diagnosis source 5
  6. NHS - PCOS Causes source 6
  7. MedlinePlus - PCOS source 7
  8. WHO - PCOS Fact Sheet source 8