Polycystic ovarian syndrome (PCOS) is a condition caused by a hormonal imbalance in women. It’s one of the leading causes of infertility in women today.
The condition is also known as Stein-Leventhal syndrome.
The most common PCOS symptom is missed or irregular periods, hirsutism (male-pattern hair growth), and acne.
PCOS causes multiple cysts to develop on your ovaries. These cysts are not generally harmful, but they cause an imbalance in your hormone levels. Not all women with PCOS develop cysts on their ovaries, but most do.
You might assume the condition only affects adult women, but some research shows it can begin to manifest in childhood and persist into adulthood.
An early and accurate PCOS diagnosis is vital to help manage the condition and prevent other medical complications from developing.
The leading cause of PCOS is a hormonal imbalance. Several hormones play a role in triggering PCOS and worsening its symptoms. So far, PCOS research has identified the following hormones that are linked to the condition:
Women with PCOS produce a high level of a type of male hormone: androgens. Androgens can be found in all women, but women with PCOS typically have higher amounts.
High androgen levels prevent your ovaries from releasing an egg during your menstrual cycle.
Symptoms of excess androgen levels include hair loss, acne, and excessive male-pattern body hair growth.
Androgens include hormones like testosterone. Women with PCOS typically have high testosterone levels. High testosterone levels can affect your menstrual and ovulation cycles.
Some research shows high insulin levels could cause high androgen levels.
Not all women with PCOS have elevated testosterone levels, but they might have high androstenedione levels. High levels of androstenedione can be a sign of PCOS.
Androstenedione is also a type of androgen and is similar to testosterone. It is produced by your ovaries and adrenal glands.
Your brain releases a burst of luteinizing hormone (LH) when it’s time for your ovaries to release an egg.
Women with PCOS constantly have unusually high levels of LH. When it’s time to ovulate, they don’t get the surge in LH that would typically tell the ovaries to release an egg.
The hormonal imbalance caused by LH also contributes to unusually high testosterone levels in women with PCOS.
These two hormones play an essential role in regulating your menstrual cycle. High progesterone levels are vital for ovulation. Women with PCOS have low progesterone levels, which also helps prevent ovulation.
Insulin is responsible for regulating glucose in your blood. PCOS has long been linked to insulin resistance.
There are four main types of PCOS. They include:
Insulin-resistant PCOS is the most common form of PCOS in women today.
Many women with PCOS also develop insulin resistance. Insulin resistance prevents you from ovulating and causes your ovaries to create more male hormones, like testosterone.
Insulin-resistant PCOS also increases your risk of developing type 2 diabetes.
Post-pill PCOS is caused by hormonal birth control.
Hormonal birth control works by suppressing ovulation. Some women don’t resume ovulating after they stop taking the contraceptive pill, and PCOS develops.
Having irregular menstrual cycles for a month or two after stopping taking birth control pills is expected. However, if you continue to experience irregular menstrual cycles and no ovulation for up to a year after stopping the pill, you might have PCOS. In this case, you should schedule an appointment with your doctor to investigate why your regular cycle has not resumed.
Inflamed ovaries could cause PCOS. The inflammation causes a hormonal imbalance and prevents your body from ovulating.
High androgen levels also occur when your ovaries are inflamed. Symptoms of inflammation include joint pain, headaches, fatigue, and bowel difficulties.
Adrenal PCOS is caused by your body reacting abnormally to stress.
Your ovaries typically produce androgens. However, women with adrenal PCOS have too much of a type of androgen called adrenal androgen. This is produced by the adrenal glands. The production of adrenal androgen is typically an abnormal stress response.
Around 5–10%¹ of women aged between 15 and 44 have PCOS. It’s the most common endocrine disorder among women of reproductive age.
Many women diagnosed with the condition are typically diagnosed in their 20s or 30s. Women in this age range may be trying to get pregnant. PCOS is usually considered to be the likely culprit if infertility issues arise.
Symptoms of PCOS are different for everyone.
Younger women with the disorder experience symptoms that affect their reproduction, while older women who have passed the age of menopause experience more metabolism-related symptoms.
Some women might never experience the condition’s most telling symptoms. In such cases, PCOS is typically mild. Women with mild PCOS might not know they have the condition until they have difficulty getting pregnant.
PCOS symptoms could start to affect you at any time after puberty.
The most common PCOS symptoms include:
An irregular menstrual cycle
Unexplained weight gain and difficulty losing weight
Growing excess hair on your face and other parts of your body (also known as hirsutism or male-pattern hair growth)
Darkened skin around your neck and underneath your breasts (also known as acanthosis nigricans)
Developing ovarian cysts
Developing skin tags, typically in your armpits or around your neck
Hair loss from your head or thinning hair
Severe acne on parts of your body, such as your face, back, and chest
PCOS can lead to other medical complications, including:
PCOS is one of the most common causes of infertility in women.
The condition affects the way your body produces and releases eggs. It could cause you to stop ovulating or do so irregularly, which makes falling pregnant increasingly difficult.
Some women with PCOS develop insulin resistance. Insulin resistance occurs when your body stops responding to insulin correctly.
Insulin is a hormone produced by your pancreas which helps control glucose levels in your body. Insulin allows your body’s cells to take up glucose and use it as an energy source. Untreated, insulin resistance could result in type II diabetes.
Over 50%¹ of women who have PCOS also develop type II diabetes by the age of 40.
Women with PCOS should regularly check for diabetes and modify their lifestyle to prevent type 2 diabetes.
PCOS has been shown to increase the risk of developing endometrial cancer.
Some research² shows women with PCOS are more likely to develop high blood pressure than women without the condition.
High blood pressure is a condition that makes it difficult for your heart to pump out blood to the rest of your body.
PCOS not only makes it difficult for you to conceive, but it can also cause pregnancy difficulties in the women who do get pregnant.
Pregnancy difficulties, such as premature delivery, miscarriage, and preeclampsia have been linked to PCOS.
One of the most prominent symptoms of PCOS is obesity. In children, childhood obesity has been linked³ to developing the condition in adolescence and adulthood.
Obesity is a common health condition in the US. Over one in four women in the US have obesity.
Women who have PCOS are more likely to develop obesity than those who aren’t. However, it’s not clear whether obesity triggers the development of PCOS or if PCOS is responsible for the development of obesity.
Research⁴ shows women with PCOS are seven times more likely to develop heart disease than women who don’t have PCOS.
Sleep apnea is a condition that causes difficulty breathing while sleeping. Symptoms of sleep apnea include fatigue, excessive snoring, and daytime sleepiness.
Research⁵ shows women with PCOS have a much higher risk of developing obstructive sleep apnea.
Women with PCOS are often diagnosed with depression and anxiety at high rates.
A 2018 study⁶ of women with PCOS revealed that 38.6% of the participants had anxiety and 25.7% had depression.
PCOS (polycystic ovary syndrome) and diabetes | Centers for Disease Control and Prevention
Hypertension risk in young women with polycystic ovary syndrome: A nationwide population-based cohort study (2020)
Childhood obesity and its impact on the development of adolescent PCOS (2015)
Cardiovascular risk in women with polycystic ovarian syndrome (PCOS) (2003)
Increased risk of obstructive sleep apnoea in women with polycystic ovary syndrome: a population-based cohort study (2019)
Anxiety, depression, and quality of life in women with polycystic ovarian syndrome (2018)
Exactly what causes or triggers PCOS is unclear. Possible causes include:
Genetics (you are more likely to develop PCOS if you have a family history of the condition)
High androgen levels
There is not one single test or exam to diagnose PCOS. Diagnosing PCOS typically involves a series of tests and exams to help rule out other conditions that could be responsible for your symptoms.
Your doctor will also ask you about your medical and family history to better understand your symptoms. If you have a family history of PCOS, you are more likely to develop the condition.
Before an accurate diagnosis can be made, your doctor will ask you to discontinue your hormonal contraceptives (if you take them).
Tests typically carried out to help diagnose PCOS include:
Ultrasound: Your doctor may perform a pelvic ultrasound to check for ovarian cysts and examine the lining of your uterus.
Pelvic exam: A pelvic exam can help your doctor determine if you have any traits that could suggest you have excess male hormones in your body. These include swollen ovaries or any cysts on your ovaries.
Blood tests: Women with PCOS typically have higher androgen levels than usual. A blood test will help determine this. A blood test could also be done to check your glucose levels. Women with PCOS often have insulin resistance, which can cause high blood glucose levels.
Physical exam: Your doctor will perform a physical exam to check for physical symptoms of PCOS, such as excessive hair, darkened skin, and skin tags.
You must have at least two of the following symptoms to be diagnosed with PCOS:
An irregular menstrual cycle
Excess androgen levels
There is currently no cure for PCOS, but there are effective ways to treat and manage the condition’s more debilitating symptoms.
PCOS treatment options also depend on whether or not you intend to get pregnant. Specific treatments can make it more challenging to fall pregnant, while others can make pregnancy more likely.
Your doctor might prescribe medications to help treat and manage your PCOS symptoms, such as:
Hormonal birth control (including oral pills, intrauterine devices, patches, vaginal rings, and birth control implants) may be prescribed by your doctor to help regulate your menstrual cycle.
It can also help reduce the severity of your physical symptoms, such as excessive hair growth and acne.
Systemically absorbed hormonal contraception options, such as pills or implants, work best for PCOS.
Your doctor may recommend taking medications to regulate androgen production, but these drugs are not suitable for everyone.
Androgen blockers are known to cause side effects, such as fatigue, sexual dysfunction, and nausea.
Insulin sensitizers are typically used to treat type II diabetes, but can also be prescribed off-label to help women with PCOS.
Metformin is a drug developed for the treatment of diabetes. However, it is sometimes prescribed off-label to women with PCOS. Researchers believe the medication can help regulate your menstrual cycle.
Thiazolidinediones are a type of drug that is also used. This medication can help with insulin regulation. However, not all doctors prescribe thiazolidinediones as they are linked¹ to an increased risk of developing bladder cancer.
PCOS treatment is slightly different if you are trying to become pregnant.
Treatments typically offered to women trying to get pregnant include:
Certain medications have been developed to help trigger ovulation in women with PCOS. Drugs such as letrozole (Femara), clomiphene (Clomid or Serophene), and gonadotropins have been well researched and proven to help.
Research² also shows metformin increases the rate of ovulation and pregnancy in women with PCOS. Although it’s not a fertility drug, metformin is typically considered the first line of treatment if you have PCOS and you are trying to get pregnant.
IVF is a procedure used to help women with infertility. It can be used for women with PCOS and women who are infertile due to other reasons.
IVF involves coupling your egg with your partner’s sperm or donor sperm in a lab to fertilize it. The fertilized egg is then put into your uterus, and if successful, it will develop into a fetus.
A procedure called ovarian drilling may be recommended if you’re trying to get pregnant with PCOS.
Ovarian drilling involves removing the tissues in your ovaries that produce the androgen hormone.
Researchers have recently developed medications to perform this function. As a result, this surgery is a lot less common than it used to be.
In addition to medications, specific lifestyle changes can also help you manage your condition.
Scientists have been unable to determine what exactly causes PCOS. As a result, there’s no proven way to prevent the condition. However, the following management tips can help reduce the severity of your symptoms and help you get on with daily life.
Obesity has been linked to PCOS development and the worsening of symptoms in people who already have the condition.
Some research shows weight loss can help improve fertility and regulate testosterone levels and insulin production — all things that affect women with PCOS.
Exercising regularly can help with weight management and lower insulin resistance. It has also been proven to have psychological and physical benefits (also in women who don’t have PCOS).
While maintaining a healthy diet is essential for everyone, it’s even more important for women with PCOS.
More research needs to be done to understand how your diet can affect your symptoms. However, maintaining a healthy diet has no downsides and is vital for your overall health.
The condition can become even more complicated during pregnancy and, in some instances, could affect the health of your child.
To help manage the pregnancy risks associated with PCOS, maintain a healthy weight throughout your pregnancy. You can do this by exercising regularly and eating healthily. Check with your doctor before exercising to ensure it is safe for you and your baby.
Your family doctor can oversee your PCOS diagnosis and treatment. You might also need to see other specialists, such as an endocrinologist who can help treat metabolic symptoms and/or an obstetrician if you are trying to become pregnant.
It is rare for a child or teenager to show PCOS symptoms, but in these cases, your doctor might refer your child to a pediatrician. A pediatrician has specialist knowledge about handling PCOS treatment and managing the condition in young people.
PCOS is a condition that requires long-term medical care. Speak to your doctor as soon as you start showing symptoms. Early diagnosis of PCOS is key to treating and managing it effectively.
Below are some of the frequently asked questions about PCOS.
An irregular menstrual cycle is the most common PCOS symptom. While you no longer menstruate during menopause, menopause doesn’t stop PCOS causing a hormonal imbalance in your body. This means you might continue to have other metabolic symptoms of the condition.
PCOS interferes with your ovulation which can make it difficult to get pregnant. However, it is possible to get pregnant with PCOS with the right treatments and management techniques.
Metformin, clomiphene, and IVF are the most commonly recommended treatment options for women with PCOS who are trying to get pregnant.
One of the most important things to know about this condition is that there is nothing you can do to cause it.
Several factors, from genetics to a hormonal imbalance, have been linked to triggering the condition. These are all out of your control. However, if a close family member has PCOS, you are more likely to develop it.
Again, it’s unclear what exactly causes PCOS. Some studies have linked PCOS to obesity, and maintaining a healthy weight is essential for managing the condition. However, any woman can develop PCOS, regardless of their weight.