What Is Polycystic Ovarian Syndrome (PCOS)?

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.

PCOS and hormones

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:

Androgens

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.

Androstenedione

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.

Luteinizing hormone (LH)

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.

Progesterone and estrogen

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

Insulin is responsible for regulating glucose in your blood. PCOS has long been linked to insulin resistance.

Types of PCOS

There are four main types of PCOS. They include:

Insulin-resistant PCOS

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

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.

Inflammatory PCOS

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

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.

Statistics

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

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 complications

PCOS can lead to other medical complications, including: 

Infertility

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.

Type II diabetes

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.

Endometrial cancer

PCOS has been shown to increase the risk of developing endometrial cancer.

High blood pressure

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.

Pregnancy difficulties

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.

Obesity

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.

Heart disease

Research⁴ shows women with PCOS are seven times more likely to develop heart disease than women who don’t have PCOS.

Sleep apnea

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.

Depression and anxiety

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.

Causes

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

  • Insulin resistance

  • Low-grade inflammation

  • Premature puberty

Diagnosis

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

  • Ovarian cysts

Treatments

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.

Medications

Your doctor might prescribe medications to help treat and manage your PCOS symptoms, such as:

Birth control

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.

Androgen blockers

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

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.

Treatment for women trying to get pregnant

PCOS treatment is slightly different if you are trying to become pregnant.

Treatments typically offered to women trying to get pregnant include:

Medication

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.

In vitro fertilization (IVF)

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.

Surgery

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.

Lifestyle changes

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.

Weight management

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. 

Regular exercise

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).

Healthy diet

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.

Managing PCOS during pregnancy

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.

Doctors & specialists

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.

FAQs

Below are some of the frequently asked questions about PCOS.

Does menopause stop 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.

Can you get pregnant with PCOS?

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.

Can you cause PCOS?

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.

Can weight gain cause PCOS?

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.


Clinical trials for polycystic ovarian syndrome (pcos)

Actively recruiting
Saroglitazar Magnesium 4 mg in the Treatment of NAFLD in Women With PCOS (EVIDENCES VII)
AZ, CA, CO, FL and 3 more locations (US)
Actively recruiting
Treating Inflammation in Polycystic Ovary Syndrome to Ameliorate Ovarian Dysfunction
CA, IL, MD, TX (US)
Actively recruiting
Comparing the Effects of Oral Contraceptive Pills Versus Metformin
PA (US)