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Polycystic ovary syndrome (PCOS)

What is PCOS?

Polycystic ovary syndrome (PCOS), also known as Stein-Leventhal syndrome or hyperandrogenic anovulation, is a hormone disorder causing the female body to make an elevated amount of male hormones called androgens, including the hormone testosterone.

High levels of these hormones in the ovaries can cause a woman’s eggs to not develop properly. Instead of releasing an egg, the ovary’s follicles containing the developing eggs remain small and immature.

Polycystic ovaries disrupt normal ovulation and the menstrual cycle, causing infertility and additional symptoms related to hormonal imbalance, such as weight gain, high blood pressure, adult acne and diabetes (due to high insulin levels).

PCOS is considered to be the most common hormonal imbalance disorder in reproductive-aged women. The American Society for Reproductive Medicine estimates that PCOS affects up to 1 in 10 women.

Polycystic ovary syndrome (PCOS) at a glance
  • PCOS is a common reproductive and hormonal disorder in women, affecting as many as 1 in 10 women of childbearing age in the United States.
  • PCOS can cause infertility by inhibiting ovulation, the production and release of an egg from a woman’s ovary for fertilization.
  • Other symptoms of PCOS include problems with menstrual periods, weight gain, excessive hair growth and acne.
  • There is no cure for PCOS, but lifestyle changes and medications can manage symptoms, and fertility treatments such as in vitro fertilization (IVF) can help PCOS patients conceive.

Cause of PCOS

The cause of PCOS is unknown, but many experts think that genetics may be a factor. PCOS can result from an increased production of androgens, male hormones such as testosterone, that may be linked to a decreased efficiency of insulin hormone regulation.

Insulin is responsible for converting sugars and other foods into energy. If this process does not work correctly, the body can create excess insulin, which pushes the body to compensate by increasing the amount of male hormones.

The overproduction of androgen hormones negatively impacts the growth and release of eggs from the woman’s ovary, which is why hormonal imbalance is the core cause of infertility in PCOS patients.

PCOS can also be treated with lifestyle changes that would reduce obesity or high blood sugar, as these conditions can lead to further overproduction of insulin and androgen hormones. If the patient shows signs of pre-diabetes or diabetes, she can also be treated with insulin-sensitizing agents such as Metformin.


Symptoms of PCOS

PCOS is a hormonal disorder, so the symptoms are widespread throughout the body. The symptoms can be classified into the main categories of infertility, menstrual, metabolic and dermal. PCOS and the associated symptoms can also cause anxiety, depression and sleep apnea.

Infertility symptoms of PCOS include:
  • Lack of ovulation (anovulation) or problems ovulating, the leading causes of infertility in women.
  • Cysts in the ovaries (diagnosed via ultrasound).
Menstrual symptoms of PCOS can include:
  • Infrequent menstrual periods (ooligo-amenorrhea).
  • Irregular or inconsistent menstrual periods.
  • Heavy menstrual periods (hypermenorrhea).
  • The absence of menstrual periods (amenorrhea).
Metabolic symptoms of PCOS are caused by insulin resistance, which can lead to:
  • Obesity, especially in the upper body.
  • Type 2 diabetes.
Dermal PCOS symptoms can appear as:
  • Excessive body and facial hair (hirsutism).
  • Acne.
  • Male pattern baldness or thinning hair.
  • Dark patches of skin or skin tags (excess flaps of skin).

Treatment of PCOS

Polycystic ovary syndrome cannot be cured. However, symptoms can be managed with treatment, which usually targets infertility, menstrual, metabolic and/or dermal problems.

Fertility Treatment

To treat infertility caused by PCOS, the first approach is usually weight loss through diet and exercise, which can sometimes prompt a natural resumption of ovulation by helping balance insulin and other hormone levels.

For women who are still not ovulating after weight loss (or who are already at an ideal weight), the next treatment is medication. Ovulation-stimulating medications, such as Clomiphene citrate, letrozole and follicle-stimulating hormone (FSH), are used to promote ovulation.

For women who don’t respond to lifestyle changes or oral medications, a fertility specialist will recommend assisted reproductive technology (ART). Mild controlled ovarian stimulation so mature eggs can be retrieved from the ovary for use during in vitro fertilization (IVF) is often the best option.

Menstrual cycle treatment

If fertility restoration is not a concern, a hormone-based contraceptive pill can address some PCOS symptoms and restore regular menstruation (although still restricting ovulation).

Metabolic treatment

For PCOS-related insulin problems, one of the most common treatment options is weight loss, exercise and a healthy diet to promote more balanced insulin levels, which can decrease PCOS symptoms.

Medications, such as Metformin, can also improve sugar metabolism and lower risks of metabolic syndrome.

Dermal treatment

Treating skin symptoms caused by PCOS can be done through hormone-based medication or alternate therapies for specific issues, such as skin-care or hair-management products.

In women of child-bearing age, hormone-based contraceptive pills are usually effective in reducing excess hair growth and acne. Other medications, such as spironolactone to limit androgen hormone activity or a hair-growth inhibitor like eflornithine, can also decrease hair follicle growth in unwanted places.

All PCOS treatments should be discussed with a specialist to outline treatment goals and discuss the best options.