Polycystic ovary syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a common condition among women of reproductive age. Globally, researchers estimate that PCOS affects 4-20% of all women between puberty and menopause. While science hasn’t yet come up with many answers to the questions of PCOS, health care providers know more about the condition than they did in the past and are better prepared to manage women living with it. Understanding what is happening to your body is the first step to managing PCOS and making informed decisions about testing, treatments, and lifestyle changes.
What is PCOS?
The term “polycystic ovary” refers to the growth of multiple cysts (fluid-filled sacs) on one or both ovaries. Most, but not all, women with numerous cysts on their ovaries have symptoms of PCOS.
PCOS is primarily an endocrine (hormonal) disorder that results from an imbalance in your hormones. Hormones are chemical substances produced and secreted by specific glands or organs in your body. The glands and organs that secrete them make up the endocrine system. Hormones have no activity of their own. Instead, they circulate in the blood and impact the function of other parts of the body.
Reproductive hormones affect your body’s reproductive activity and the development of secondary sex characteristics. Estrogen and progesterone are the primary reproductive hormones in females. Androgens are known as male reproductive hormones because they are mainly responsible for male traits and reproductive activity and because males make and use high levels of them. Testosterone is the main androgen. Females produce androgens as well but in smaller amounts and for different purposes.
One of the primary characteristics of PCOS is the excessive production of androgens (mainly testosterone) by the ovaries. The presence of high levels of androgens in females is known as hyperandrogenism, and your body’s responses to this hormonal imbalance cause most PCOS symptoms.
What are the symptoms of PCOS?
The type and severity of symptoms vary widely among women with PCOS. However, most women who are diagnosed with PCOS have some or all of the following symptoms:
How is PCOS diagnosed, and what should I expect from my doctor?
PCOS is often diagnosed when a woman visits her doctor to treat symptoms such as the excessive growth of body hair, weight gain, menstrual irregularities, and infertility. Because these symptoms are similar to those seen in many other conditions and no test gives a definitive diagnosis, PCOS can be difficult to diagnose. Thus, the first step in diagnosing PCOS is identifying a group of common symptoms and ruling out any other conditions that may be causing them.
A diagnostic workup has three components:
Your doctor will take a thorough medical history, including questions about menstruation, reproduction, and weight gain. Additionally, they will complete a pelvic examination to determine the size of your ovaries and visually inspect your skin for excessive hair growth, acne, or other changes.
A physical exam may be enough for your doctor to determine that you have a high level of androgens, such as testosterone. If not, your doctor can perform blood tests to measure hormone levels.
Your doctor may also look at your ovaries using ultrasound, especially if the ovaries feel enlarged during your pelvic examination. An ultrasound is a diagnostic imaging test that can evaluate the size and shape of your ovaries. If your doctor performs this test, it may show multiple ovarian cysts.
How is PCOS treated?
Women with PCOS are often treated by a gynecologist (a doctor who treats female reproductive disorders) or a reproductive endocrinologist (a doctor who treats endocrine disorders and infertility).
PCOS treatment varies depending upon which symptoms are most bothersome and whether a woman desires pregnancy but usually consists of lifestyle changes, medication, and hair removal. Surgical treatment of PCOS is also possible if other treatments are ineffective, but this is uncommon.
Lifestyle changes
Research shows that maintaining a healthy lifestyle can improve PCOS symptoms and reduce the risk of health complications from PCOS. For this reason, health care providers often recommend lifestyle changes before trying other treatments. Lifestyle changes are behaviors in your daily routine, such as healthy eating, exercise, and weight loss, that help prevent health problems. Making these changes can restore regular menstrual cycles, improve fertility, and improve your health in other ways, too.
Medication
For women who still have PCOS symptoms after making lifestyle changes, medication can help.
Medication options for women who do not wish to become pregnant may include oral contraceptive pills, antiandrogens, or both. Oral contraceptive pills help restore regular menstrual periods, reduce excessive hair growth, reduce acne, and lower androgen levels. Antiandrogens help treat unwanted hair, hair loss, and acne by lowering androgen levels but do not affect fertility. Treatment of excessive hair growth with oral medication is long-term, and it may take up to a year or longer to see improvement.
If you are having difficulty getting pregnant and desire to become pregnant, your doctor may write medication to help you become pregnant by stimulating the ovaries to release an egg (ovulation). Other treatments can help lower testosterone levels, restore regular menstrual cycles, and restore fertility.
Additional treatment options for acne may include antibiotics, vitamin A, and other medications.
Hair removal
Techniques such as shaving, tweezing, waxing, or cosmetic laser treatment are additional options for removing unwanted hair. Women can use these treatments alone or in combination with medications.
Common concerns
Is PCOS curable?
Although there is no cure for PCOS, treatment can improve symptoms and prevent complications.
What are the possible complications of PCOS?
While PCOS on its own is not life-threatening, women who have it are more likely to develop serious health complications such as type 2 diabetes, heart disease, and endometrial cancer.
What is the best diet plan or lifestyle change for PCOS?
No single PCOS diet plan or lifestyle change is known to be more effective than another in reducing PCOS symptoms. That’s why it’s essential to talk to your health care provider about the best diet to follow for PCOS or other lifestyle changes specific to your health status and needs.
Can women with PCOS get pregnant?
It’s natural to have concerns about PCOS and pregnancy. Although PCOS is one of the primary causes of female infertility, women with PCOS can still get pregnant naturally or with fertility treatment. In most cases, infertility due to PCOS is treatable through lifestyle changes, medications, or both.
What is the prognosis for PCOS?
Fortunately, with early and appropriate treatment, most PCOS symptoms improve or go away.
When to call a professional
If you have any PCOS symptoms, especially if you have had irregular or absent periods for more than six months, schedule an appointment with your primary care provider. In addition to a general well-being check, your provider can help answer any questions or concerns you may have about PCOS.
Sources:
Deswal, R., Narwal, V., Dang, A., & Pundir, C. S. (2020). The prevalence of polycystic ovary syndrome: A brief systematic review. Journal of Human Reproductive Sciences, 13(4), 261–271. https://doi.org/10.4103/jhrs.JHRS_95_18
Ndefo, U. A., Eaton, A., & Green, M. R. (2013). Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P& T: A Peer-Reviewed Journal for Formulary Management, 38(6), 336–355. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737989/
Pinkerton, J. A. V. (2020). Polycystic ovary syndrome (PCOS) - gynecology and obstetrics. Merck Manuals Professional Edition. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/menstrual-abnormalities/polycystic-ovary-syndrome-pcos
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