What Is Polycystic Ovary Syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a common condition that happens when the ovaries produce high levels of androgens, or male hormones. PCOS causes symptoms like irregular periods, weight gain, and fertility issues, and it may increase a woman’s risk of conditions such as diabetes and heart disease.

PCOS is a lifelong condition. While there’s currently no cure for PCOS, treatments can help people manage symptoms and find relief.

While PCOS signs and symptoms can vary, some of the most common ones include:

• Weight gain, especially around the stomach
• Unpredictable periods
• Infertility or difficulty conceiving naturally
• Acne
• Hair loss or thinning hair
• Sleep problems, including difficulty getting to sleep, feeling really tired during the day, and snoring or waking up frequently

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• Unusual or excess hair growth (hirsutism), particularly on the face, chest, and lower abdomen
• Insulin resistance, which may manifest as skin tags and darkening of the skin (acanthosis nigricans)

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• Oily skin

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• Mood disorders, such as anxiety and depression

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• Insulin resistance: Insulin resistance is when your cells don’t respond well to the hormone insulin, causing your blood sugar levels to rise. Your body will start producing more insulin to compensate — and too much insulin can cause you to make more androgens.
• Low-grade inflammation: Inflammation is the body’s natural process of healing. But when it happens over a long period of time, it can cause your body to produce androgens.
• Genetics: Having a family history of PCOS may also increase your risk of developing the condition.

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• Obesity: Research indicates that between 33 and 88 percent of women with PCOS are overweight or have obesity, which suggests a strong link between excess weight and PCOS. While the exact relationship between the two isn’t well understood, it’s thought that obesity can contribute to insulin resistance and increase your risk of developing PCOS.

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• Environmental factors: Exposure to endocrine-disrupting chemicals like bisphenol A, which is often found in medical devices, housewares, and appliances, can increase a person’s risk of inflammation and PCOS.

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  The same is true of air pollutants like nitrogen dioxide and polycyclic aromatic hydrocarbons, which are found in cigarette smoke, cooked meat, and burnt coal.

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• Lifestyle factors: Limited physical activity, a high-fat and low-fiber diet, and high stress levels may also play a role in the development of PCOS.

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• Avoiding environmental pollutants such as heavy metals, endocrine-disrupting chemicals, and cigarette smoke
• Getting regular exercise and maintaining a healthy weight for your body
• Limiting foods that can increase inflammation, such as fried foods, processed snack foods (chips, candies, cookies), and red meats

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• Taking care of your gut health and avoiding a high-sugar diet, to help lower insulin resistance and reduce high androgen levels

• Irregular periods: Having an irregular menstrual cycle is one of the most common signs of PCOS. This means that your periods may not happen at the same time each month, you might not have a period during some months, and some of your periods may be short while others may be long. You may also have heavier periods.
• High androgen levels: High levels of androgens, sometimes called male hormones, can interfere with ovulation and the creation of follicles in the ovaries. It can also lead to acne, unwanted body and facial hair, and other symptoms.
• Polycystic ovaries: Some women with PCOS have ovaries that are larger than usual, which can be seen during an ultrasound. An ultrasound test may also reveal follicles (or cysts) on the edges of the ovaries.

There’s no single test to diagnose PCOS. A doctor will evaluate your signs and symptoms and may conduct any of the following tests to rule out other conditions that present similarly:

• Physical exam: Looks for acne, excess hair growth, and weight gain
• Pelvic exam: Checks the ovaries
• Blood tests: Checks hormone levels
• Pelvic ultrasound: Looks at the uterine lining and for cysts on the ovaries

While there’s currently no cure for PCOS, the symptoms can be managed with medications, lifestyle modifications, and, in rare cases, surgery. The right PCOS treatment method for you will depend on your symptoms and whether you’re planning to become pregnant.

Medication Options

Medications to help treat PCOS symptoms include:

• Combined hormonal birth control pills: Birth control pills containing both estrogen and progestin help regulate your period and are the primary treatment for women with PCOS who are not trying to become pregnant. They can be used long term and may help reduce excess hair and acne, as well as decrease the risk of endometrial cancer.

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• Diabetes medications: Certain diabetes drugs, such as metformin, can be prescribed off-label to help your body respond to insulin, lose weight, decrease the risk of type 2 diabetes, and improve ovulation.

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• Anti-androgens: These medications can block the effects of excess androgens on your body, helping to decrease unwanted hair growth, reduce scalp hair loss, and improve acne.
• Acne treatments: Retinoids, antibacterial agents, and antibiotics are all common medications used to treat acne.

It’s important to tell your doctor if you’re trying to become pregnant, as they can help advise you on the best medications for your situation. Women who are trying to conceive need to take a special approach to treating PCOS, because they will not be able to use hormonal birth control.

Treatments for Infertility

For many women, infertility is one of the most distressing complications of PCOS. Many women with PCOS do not naturally ovulate, or only ovulate irregularly, and will struggle to conceive without treatment.

• clomiphene (Serophene)
• letrozole (Femara)
• metformin (Glucophage)
• gonadotropins

If you are overweight or have obesity, losing weight may also help improve your fertility.

If medications are unsuccessful, a doctor may recommend in vitro fertilization, or IVF. In this procedure, eggs are removed from the ovaries, fertilized outside of the body, and then placed into the uterus.

Complementary and Integrative Therapies

• Vitamin D: Taking a vitamin D supplement may help improve insulin metabolism and regulate ovulation issues. Vitamin D also has anti-inflammatory properties, so it could help if you have low-grade inflammation.
• Vitamin E: Some evidence suggests that vitamin E can improve blood sugar and cholesterol. It may also affect androgen hormones.
• Acupuncture: This complementary therapy may benefit PCOS treatment by improving symptoms related to ovulation and period irregularities.
• Probiotics and prebiotics: Your gut microbiome has a hand in many aspects of your health and is associated with PCOS. Prebiotics and probiotics can support a healthy gut, improve your hormones, and reduce inflammation.
• Folic acid: Folic acid supplements have been shown to reduce body mass index in people with PCOS. Weight gain is a common symptom of PCOS.
• Selenium: This supplement is an antioxidant and has anti-inflammatory properties. While selenium doesn’t seem to help with hormone imbalances, it may reduce cholesterol and insulin levels.

Be sure to contact a doctor before starting any new supplement, as it may interfere with the medications you’re already taking. Plus, your doctor can do a simple blood test to check your vitamin and mineral levels, showing where you may have a deficiency.

Surgery

Surgery to treat PCOS is rarely used.

PCOS can’t be prevented, but you can manage your symptoms and prevent complications.

If you manage your overall health well, take your medications, and make healthy lifestyle choices, you can reduce your symptoms and prevent the condition from worsening.

If your doctor recommends losing weight, you can work with a registered dietitian to make changes to your diet, while also incorporating more physical activity into your routine.

PCOS Diet

• Reach for omega-3s: While consuming food sources like fatty fish is the best way to reap the anti-inflammatory benefits of omega-3s, you can also take supplements.
• Choose anti-inflammatory foods: Eating more anti-inflammatory foods like berries, broccoli, spinach, nuts and seeds, whole grains, and olive oil can lower inflammation.
• Try low–glycemic index foods: Foods with a low glycemic index help keep blood sugar levels steady. Some examples of these foods are lean meats, nonstarchy vegetables, yogurt, tofu, and eggs.
• Limit processed foods: Processed foods such as packaged cookies, lunch meats, and chips often include simple carbs and lots of added sugars. Eating a lot of processed foods can lead to weight gain, which amplifies PCOS symptoms.
• Limit carbs: High carbohydrate diets can make insulin levels jump and raise your blood sugar. If you do eat carbs, opt for complex carbs because they raise blood sugar slowly.

In the end, the most important thing is to eat a nutritious, balanced diet full of whole foods. This can help you maintain or lose weight, balance your blood sugar, and lower inflammation levels.

Physical Activity

Getting more exercise can also improve symptoms of PCOS and help with weight loss.

In addition, people with PCOS may want to do strength training activities on two nonconsecutive days of the week to build muscle and help prevent weight gain.

Other Changes

• Treating underlying sleep disorders: People with PCOS have a higher risk of sleep disorders, due to hormonal imbalances — and poor sleep can contribute to mood disorders and other mental health conditions.
• Improving your emotional well-being: There is a higher prevalence of anxiety, depression, and disordered eating in people with PCOS. Weight gain may contribute to poor body image, which can contribute to depression. Cognitive behavioral therapy, mindfulness meditation, and counseling may help reduce stress and improve symptoms of these mental health conditions.

PCOS currently has no cure, but it can be managed well. Work with your healthcare team to manage your symptoms and make lifestyle changes, such as eating a balanced diet and losing weight, if your doctor advises you to do so. This can help prevent complications.

Risks of PCOS-related complications, such as diabetes and heart attacks, can also increase with age.

One of the biggest complications of PCOS is that it can affect your ability to become pregnant. However, there are ways to treat fertility issues, and many women with PCOS have healthy pregnancies.

• Diabetes
• Gestational diabetes
• Heart disease
• Endometrial cancer
• Obstructive sleep apnea
• High blood pressure

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• High cholesterol

It’s important to attend your yearly checkups and undergo any screenings your doctor recommends.

Research suggests that PCOS presents differently in people of different racial and ethnic backgrounds.

In addition, PCOS can have varying metabolic effects on people of different racial and ethnic backgrounds, possibly due to genetic differences and socioeconomic, cultural, and environmental factors:

• Hispanic women with PCOS are more likely to have high fasting insulin levels, which are associated with an increased risk of diabetes, compared with non-Hispanic white women.

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  Hispanic women with PCOS may also have a higher risk of developing certain mental health issues, such as postpartum depression.
• Black women with PCOS were found to have both higher fasting insulin levels and higher systolic blood pressure, compared with white women, and may have a higher risk of metabolic symptoms like insulin resistance.
• Asian women with PCOS had much lower rates of obesity, compared with other racial groups. However, they were more likely to develop diabetes than white women.

Most previous research on PCOS has focused on white populations, so more research is needed on diverse populations to better understand the unique ways that PCOS affects people of various racial and ethnic backgrounds.

PCOS is related to several conditions, especially diabetes and obesity. Women with obesity and type 2 diabetes are more likely to develop PCOS, and vice versa.

• Heart-related conditions, such as high blood pressure, heart disease, and stroke
• Mental health challenges, such as depression, anxiety, and eating disorders

PCOS Awareness Association

This organization shares information to help people with PCOS ease their symptoms and prevent complications. You can connect with them on social media or visit their website to find a list of resources that may help make your life easier.

RESOLVE: The National Infertility Association

If you have PCOS and are experiencing fertility issues, RESOLVE can help you find a support group in person or online; locate mental health professionals, genetic counselors, reproductive endocrinologists, and more with their directory; or learn more with resources and advice. You can even find tools for financial resources to help you build your family.

The National Polycystic Ovary Syndrome Association

Also known as PCOS Challenge, this organization promotes awareness and helps people with PCOS find information, support groups, grants, and health screenings.

• Polycystic ovary syndrome, or PCOS, is a common hormonal condition in women of reproductive age. Symptoms can include irregular periods, weight gain, mood changes, and fertility issues.
• Infertility is a common sign and complication of PCOS, but treatment can dramatically increase your odds of getting pregnant.
• PCOS is not curable, but medications, complementary treatments, and lifestyle changes can help you manage symptoms.
• Losing weight is one of the top recommendations for managing PCOS.