Polycystic ovary syndrome (PCOS) is a hormonal imbalance that occurs when your ovaries (the organ that produces and releases eggs) create excess hormones. If you have PCOS, your ovaries produce unusually high levels of hormones called androgens. This causes your reproductive hormones to become imbalanced. As a result, people with PCOS often have irregular menstrual cycles, missed periods and unpredictable ovulation. Small follicle cysts (fluid-filled sacs with immature eggs) may be visible on your ovaries on ultrasound due to lack of ovulation (anovulation). However, despite the name "polycystic," you don’t need to have cysts on your ovaries to have PCOS. The ovarian cysts aren’t dangerous or painful.
PCOS is one of the most common causes of infertility in women and people assigned female at birth (AFAB). It can also increase your risk of other health conditions. Your healthcare provider can treat PCOS based on your symptoms and if you wish to become pregnant.
What are the signs of polycystic ovary syndrome (PCOS)?
The most common signs and symptoms of PCOS include:
Irregular periods: Abnormal menstruation involves missing periods or not having a period at all. It may also involve heavy bleeding during periods.
Abnormal hair growth: You may grow excess facial hair or experience heavy hair growth on your arms, chest and abdomen (hirsutism). This affects up to 70% of people with PCOS.
Acne: PCOS can cause acne, especially on your back, chest and face. This acne may continue past your teenage years and may be difficult to treat.
Obesity: Between 40% and 80% of people with PCOS have obesity and have trouble maintaining a weight that’s healthy for them.
Darkening of the skin: You may get patches of dark skin, especially in the folds of your neck, armpits, groin (between the legs) and under your breasts. This is known as acanthosis nigricans.
Cysts: Many people with PCOS have ovaries that appear larger or with many follicles (egg sac cysts) on ultrasound.
Skin tags: Skin tags are little flaps of extra skin. They’re often found in your armpits or on your neck.
Thinning hair: People with PCOS may lose patches of hair on their head or start to bald.
Infertility: PCOS is the most common cause of infertility in people AFAB. Not ovulating regularly or frequently can result in not being able to conceive.
Can I have PCOS but not have any symptoms?
Yes, it’s possible to have PCOS and not have any symptoms. Many people don’t even realize they have the condition until they have trouble getting pregnant or are gaining weight for unknown reasons. It’s also possible to have mild PCOS, where the symptoms aren’t severe enough for you to notice.
How is polycystic ovary syndrome treated?
Your healthcare provider will determine treatment based on your symptoms, medical history and other health conditions, and if you want to get pregnant. Treatments can include medications, lifestyle changes or a combination of both.
If you don’t plan to become pregnant, treatments include:
Hormonal birth control: Options include birth control pills, patches, shots, a vaginal ring or an intrauterine device (IUD). Hormonal birth control helps to regulate your menstrual cycle, some forms will also improve acne and help with excess hair growth.
Insulin-sensitizing medicine: Metformin is a drug used to treat diabetes. It works by helping your body process insulin. Once insulin is under control, some people with PCOS see improvements in their menstrual cycles.
Medications to block androgens: Some medications can block the effect of androgens. This helps control acne or hair growth. Talk to your healthcare provider about whether such treatment is right for you.
Lifestyle changes: Eating a nutritious diet and maintaining a body weight that’s healthy for you can have a positive effect on insulin levels.
If you want to become pregnant now or in the future, treatment for PCOS includes:
Drugs to induce ovulation (releasing an egg): A successful pregnancy begins with ovulation. Certain drugs have been proven to induce ovulation in people with PCOS. The medications clomiphene and letrozole are taken orally, while gonadotropins are given by injection.
Surgery: A surgical procedure can help restore ovulation by removing tissue in your ovaries that produces androgen hormones. With newer medications available, surgeons rarely perform this procedure.
In vitro fertilization (IVF): This is an option for people with PCOS when medication doesn’t help with ovulation. Your provider fertilizes your egg with your partner’s sperm in a lab before transferring it to your uterus.
How is polycystic ovary syndrome (PCOS) diagnosed?
In most cases, your healthcare provider can diagnose PCOS after an examination and discussing your symptoms. They may order blood tests or perform an ultrasound to help with the diagnosis.
Your healthcare provider will:
Talk to you about your symptoms and medical history.
Ask about your biological family’s medical history.
Take your weight and blood pressure.
Perform a physical exam, looking specifically for excess facial hair, hair loss, acne, discolored skin and skin tags.
Perform a pelvic exam to look for other causes of abnormal bleeding.
Order blood tests to check hormone levels and glucose levels.
Perform a pelvic ultrasound to look at your ovaries, check the thickness of your uterine lining and look for other causes of abnormal bleeding.
What are the three symptoms to diagnose PCOS?
Typically, healthcare providers diagnose PCOS if you have at least two of the three symptoms:
Irregular or missed periods. Some people with PCOS have very heavy bleeding when they do have a period.
Signs of excess androgens such as acne or excessive hair growth. Or a blood test confirming high androgen levels.
Enlarged ovaries or polycystic appearance of ovaries on ultrasound. Many people don’t develop cysts.
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