Symptoms
Common signs and symptoms of polycystic ovarian syndrome include:
Abnormal hair growth, also known as hirsutism, found on the upper lip, chin, around the nipples, or on the abdomen Acne Amenorrhea (absence of monthly menstrual cycles) or oligomenorrhea (irregular monthly menstrual cycles) Elevated levels of the hormone LH (making at-home ovulation tests difficult to use) High levels of androgens, also known as hyperandrogenism Infertility Insulin resistance Irregular or absent ovulation (anovulation) Male pattern balding Oily skin and hair Obesity (though women with PCOS can be underweight or at a normal weight) Presence of polycystic ovaries during ultrasound examination Recurrent miscarriage
Less common signs and symptoms of PCOS include:
Dry skinEating disordersFatigueFatty liverHeadachesHidradenitis suppurativa (painful lumps under the skin)High blood pressureHyperkeratosis (thickened skin)Insomnia or poor sleepMood changesPelvic painRuptured cystSleep apnea
You do not need to have every symptom to be diagnosed. PCOS can present in different ways. For example, many people with PCOS do not have abnormal hair growth and are at a healthy weight. Some people with PCOS may not have a menstrual cycle for months at a time, while others with PCOS may only have slightly irregular cycles. You can also have PCOS-like ovaries without having a full PCOS. This condition usually presents with the internal findings on your ovaries without any of the outward, classic symptoms such as obesity, facial hair, and acne and can be pretty common.
Diagnosis
Not everyone agrees on the criteria for diagnosing PCOS, and its definition has been changed over the years. That said, the most commonly used diagnostic criteria require two out of three of the following:
Irregular or absent menstrual cycles, caused by chronic anovulationBlood test confirmation or outward signs of high levels of androgens (abnormal hair growth, acne)Presence of polycystic ovaries, as seen by ultrasound examination
In addition, other potential causes of anovulation or high androgen levels must be ruled out. This usually includes testing for congenital adrenal hyperplasia, androgen-secreting tumors, and hyperprolactinemia. Blood work will be ordered to check levels of hormones, blood sugar (for insulin resistance), and lipids. Transvaginal ultrasound may be ordered to see if the ovaries appear polycystic. Taking a detailed history is also an important part of PCOS diagnosis. Your doctor will want to know about how regular your menstrual cycles are, and ask about unwanted hair growth. Because PCOS is diagnosed by looking at the greater picture, and by excluding other potential diseases that can cause similar symptoms, it’s important to see your doctor for an accurate diagnosis.
Causes
The exact cause of PCOS is not known, however, most experts think that several factors,including genetics, play a role:
Family history: If your mother or sister has PCOS, you are more likely to develop the condition.High levels of androgens: A common finding with PCOS is abnormally high levels of androgen hormones. While androgens are found in both men and women, they are considered to be primarily male hormones. High androgen levels are associated with some of the more visibly distressing symptoms of PCOS, including acne and abnormal hair growth.Insulin resistance: Women with PCOS frequently have insulin resistance, meaning their bodies do not respond appropriately to insulin. The risk of insulin resistance runs higher if you are over 40, overweight, have high blood pressure, live a sedentary lifestyle, and have high cholesterol.Polycystic ovaries: People with PCOS often have polycystic ovaries, or ovaries that have many tiny, benign, and painless cysts. However, polycystic ovaries do not always point to PCOS. Studies have found that some people have polycystic ovaries, normal ovulation, and no other signs of an endocrine disorder like PCOS.
Treatment
There is no cure for PCOS, but treatments can address its symptoms and complications. For example, medications can be used to help regulate menstruation, while lifestyle remedies (like weight loss or exercise) can help reduce related risks like metabolic syndrome. Treatment for PCOS will also depend on whether or not you’re trying to get pregnant.
Menstrual Dysfunction
If pregnancy is not a priority, birth control pills may be used to help regulate your menstrual cycles. Some people are afraid to go on birth control pills because they think it will further harm their fertility. The research on birth control hasn’t found this to be true. Birth control shouldn’t harm your long-term fertility. However, it is also important to know that the pill doesn’t “cure” your PCOS. You may start getting regular cycles while on the pill. These are artificially created. Once you stop taking the pill, if your cycles were irregular before, they will likely be irregular again. In addition to birth control pills, vaginal contraceptive rings and intrauterine devices (IUDs) containing progesterone can also help treat menstrual dysfunction.
Infertility
The abnormal hormone levels associated with PCOS lead to problems with ovulation. These irregularities in ovulation are the main cause of infertility. PCOS is also associated with a higher risk of early miscarriage. Research on PCOS has shown that the miscarriage rate may be as high as 30% to 50%, which is twice as high as in the general population. It’s not exactly clear why miscarriage is more common in people with PCOS, but some theories include the following:
Insulin resistanceLess-than-favorable environment for an embryo to implant in the uterine lining (due to abnormal hormone levels associated with PCOS)Poor egg quality, related to premature or late ovulation
For those trying to get pregnant, the treatment for PCOS is similar to the treatments used for treating anovulation, including:
Clomid (clomiphene citrate): The first line of treatment for people with PCOS, Clomid can help stimulate ovulation. Femara (letrozole): This cancer medication is sometimes used off-label to stimulate ovulation in people with PCOS. Some research, however, suggests that Femara may offer significantly higher rates of pregnancy within this population than Clomid. Glucophage (metformin): A commonly prescribed diabetes drug, metformin is used to treat insulin resistance and is also used on people who are Clomid-resistant (which means the drug does not work for them), with or without insulin resistance. Gonadotropins: Injectable hormones comprised of follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH), gonadotropins are commonly used when Clomid or Femara fail to induce ovulation.
Acne and Abnormal Hair Growth
People with PCOS frequently have to deal with cosmetic issues like acne or unwanted hair, especially on the face. Thankfully, there are a number of medications and possible interventions today that can help you deal with this. Drugs and topical preparations used to treat PCOS-induced acne include:
Benzoyl peroxide, works by introducing oxygen into the pores, which kills the bacteria that are associated with acneHormonal treatments, such as birth control pills and CaroSpir (spironolactone)Salicylic acid, which works as an exfoliant, helping your skin shed dead skin cells more effectivelyTopical antibiotics, target the skin bacteria that are associated with acne Topical retinoids, exfoliate the skin, keeping your pores unclogged and preventing comedones
Drugs used to treat hyperandrogenism either block androgen production or counteract the effects of abnormal hair growth. These include:
Aldactone (spironolactone), a diuretic that exerts anti-androgenic effectsPropecia (finasteride), used off-label to treat hair loss in women with PCOSVaniqa (eflornithine hydrochloride), a topical cream used to block hair growth
Home remedies like shaving, waxing, and depilatory creams as well as in-office electrolysis or laser therapy can also help with abnormal hair growth. Speak with your dermatologist about the best option for you. It’s important to note that some of the medications listed for this symptom of PCOS are contraindicated for fertility treatment and pregnancy. So, if you are seeking fertility care or attempting to get pregnant please be sure to discuss this goal with your medical team and they can advise you if the medication is safe to take or not.
Insulin Resistance
Roughly 50% to 70% of women with PCOS develop diabetes or prediabetes due to the onset of insulin resistance, a condition influenced by imbalances in estrogen production. Diabetes drugs commonly used to treat insulin resistance in women with PCOS include:
Actos (pioglitazone), which is used to reduce high blood sugarAvandia (rosiglitazone), an oral drug of the same class as pioglitazoneAvandamet, a combination of rosiglitazone and metforminGlucophage (metformin), can help control diabetes while promoting weight lossVictoza (liraglutide), an injectable drug used to control insulin and glucose levels
Weight Loss
Some studies have shown that people who are overweight with PCOS may be able to restart ovulation naturally by losing just 10% of their weight. A healthy diet and regular exercise may also help bring back regular ovulation in some, but not all, people with PCOS. While some studies claim that a low-carb diet is best for PCOS, the important thing is to make sure your diet is focused on nutrient-rich foods and adequate protein, while being low in high-sugar and processed foods. A healthy diet for PCOS, even if your weight is normal, should include:
Foods rich in omega-3 fats, such as fish (salmon, mackerel, sardines), nuts, and seedsLimited fruits (too many may negatively affect insulin resistance due to high fructose levels)Moderate amounts of high-fiber, unprocessed, low-glycemic index grains (such as oats and quinoa)Plenty of vegetables
Diet alone isn’t enough to properly manage PCOS. Aim for 30 minutes of cardiovascular exercise most days of the week, and two days of weight training weekly. People with PCOS have higher testosterone levels and tend to build muscle more easily than those without the condition. By building muscle mass, you can help your body use insulin more effectively.
Pregnancy With PCOS
Pregnancy for people who have PCOS has increased risk for some complications, including:
Gestational diabetes NICU care after birth Pregnancy-related high blood pressure Preeclampsia Preterm labor
The reason for these increased risks may come from PCOS-related obesity or insulin resistance. The best ways to reduce these risks are to reach a healthy (or healthier) weight before pregnancy (if possible), get regular prenatal care, and eat a healthy diet. Of course, even with these interventions, you may still experience complications.
Coping
Coping with the many symptoms of PCOS may mean working with a variety of doctors, including a gynecologist, a dermatologist, an endocrinologist, and/or a fertility specialist known as a reproductive endocrinologist. These specialists can coordinate with your primary care physician or any other specialist you may be seeing to help you better manage your condition. Since PCOS can become emotionally overwhelming—roughly 40% of women with PCOS experience depressive symptoms—building a support network that may include friends and family, support groups, or a professional therapist is also important. Finally, do your best to educate yourself about this condition so that you can play an active role in monitoring your health and avoiding complications.
