Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders among women of reproductive age. An estimated 10%-20% of reproductive-aged women suffer from this condition (4, 5, 8), which causes enlarged ovaries with small cysts on the outer edges (1, 2). Symptoms can include menstrual irregularity, infertility, acne, excess hair growth, insulin resistance, and obesity.
There is no specific cure for this very complex condition (5). It’s one of the most common causes of infertility and treatment is available to reverse infertility in most cases. Other treatments are available to help control symptoms and potentially slow the disease process to keep it from worsening.
However, standard therapies can cause side effects and may not work for every woman. Research continues to look for alternative and complementary treatments to give women who have not been helped by standard treatments additional options (1, 3).
What causes PCOS?
A specific cause of PCOS is not clear, but a combination of genetic, endocrine, and environmental factors is the most likely cause. Several factors play a causal role in PCOS, including excessive insulin, inflammation, heredity, and excess androgen hormones (6).
Insulin resistance is common for women with PCOS, and some experts believe elevated insulin is the underlying imbalance causing PCOS (11). If the body doesn’t use insulin well, glucose levels increase. As insulin resistance increases, it can lead to type 2 diabetes, and an abnormally high level of androgens, which can prevent ovulation (1, 2).
Low-grade inflammation, common in women with PCOS, can cause an overproduction of androgens. Polycystic ovaries produce too much androgen, causing infertility and leading to cardiovascular problems (6).
Obesity, a problem for about 80% of women with PCOS, also increases insulin levels, and usually makes PCOS symptoms worse, including irregular menstrual cycles (1, 2, 6).
PCOS may have a hereditary connection. It’s common for several women in a family to have PCOS (1).
Metabolic syndrome, cardiovascular disease, and high blood pressure are associated with PCOS (2). Metabolic syndrome, a combination of high blood pressure, high glucose levels, excess body fat around the waist, and abnormal cholesterol levels, increases your risk of heart disease, stroke, and diabetes.
What are the symptoms of PCOS?
PCOS symptoms can develop when a woman has her first menstrual periods during puberty. It can also develop later, possibly cause by substantial weight gain (6). Symptoms may include (1, 9, 10):
Missed periods, irregular periods, or very light or heavy periods
Enlarged ovaries with many small, fluid-filled cysts on the edges of the ovaries
Excess body hair on the face, chest, stomach, upper thighs, and back – about 70% of women have this symptom
Weight gain, especially around the abdomen – 80% of PCOS patients are overweight
Carbohydrate cravings and binges
Food sensitivities and constipation
Acne or oily skin that doesn’t respond to standard treatments
Thinning hair or male-pattern baldness
Skin tags (small pieces of excess skin) on the neck or armpits
Patches of thick, velvety, darkened skin on the back of the neck, armpits, and under the breasts (acanthosis nigricans)
Endometrial hyperplasia along with PCOS can cause the uterine lining to thicken, increasing the risk of endometrial cancer (2).
Women with PCOS have an increased risk of sleep disorders, sleep apnea, depression, anxiety, low self-esteem, and eating disorders (2, 6).
Because PCOS can affect many other systems in the body (2), it can cause a higher risk of type 2 diabetes, high blood pressure, heart problems, sleep apnea, endometrial or uterine cancer, a greater risk of miscarriage and premature birth, and depression and anxiety (1, 5, 6, 8).
How is PCOS diagnosed?
Diagnosis includes a physical and pelvic exam. The pelvic exam can check for any abnormalities such as an internal mass or growth. Because some PCOS symptoms can also be caused by other health problems, your doctor will likely order additional tests, including an ultrasound and blood tests. Ultrasound can assess the size of the ovaries, check for cysts, and assess the thickness of the uterine lining (1, 2). Blood tests can check androgen and other hormone levels, as well as blood glucose and cholesterol levels.
A diagnosis of PCOS can be confirmed if you have at least two of these symptoms: irregular periods, excess androgen hormones, or ovaries with multiple cysts (6).
What are the standard treatments for PCOS?
Treatment will depend on your age, overall health, how severe your symptoms are, and if you are planning a pregnancy. Standard treatments focus on managing your symptoms and may include hormone therapy, surgery, procedures to remove excess hair, medications such as metformin (to prevent prediabetes from progressing to type 2 diabetes), or statin medications to control high cholesterol (1).
Birth control pills can regulate periods and help reduce premenstrual pain. However, they do not lower the risks associated with PCOS because they mask or hide PCOS symptoms rather than addressing the condition’s underlying cause. While hormones cannot cure PCOS, they usually reduce symptoms (1). Birth control pills may contain both estrogen and progestin, or progestin alone. Side effects associated with these medications include a higher risk of a multiple birth, and ovarian hyperstimulation, which causes the ovaries to release too many hormones. Excess hormones can cause stomach bloating and pelvic pain (1, 2).
Other hormone therapies will be prescribed to increase fertility by causing ovulation if you are planning a pregnancy (6, 9).
These therapies include:
Clomiphene, an oral anti-estrogen medication, is taken in the first part of your menstrual cycle (6).
Letrozole (Femara), a medication for breast cancer, will also stimulate the ovaries to ovulate.
Metformin is taken for type 2 diabetes to lower insulin levels, improve insulin resistance, and reduce androgen levels. It may also slow the growth of body hair and induce more regular periods. It can be used with Clomiphene to increase the chance of pregnancy. Patients with prediabetes can potentially prevent, or at least slow, their progression to type 2 diabetes. It also helps with weight loss (6).
Gonadotropins are hormones given by injection (6).