Polycystic Ovary Syndrome (PCOS)

September is PCOS Awareness Month.  PCOS or Polycystic Ovary Syndrome is the most common hormonal condition of reproductive-aged women, which is believed to occur in approximately 10% of all women.  

What is it?

PCOS is a syndrome with multiple possible causes and varying presentations.  The key features are changes in ovulation and increases in male hormones (hyperandrogenism). Other features commonly seen with PCOS are polycystic ovaries on pelvic ultrasonography, infertility due to irregular ovulation, obesity, and insulin resistance.

What are the symptoms?

Not all women with PCOS will have all the symptoms, and each symptom can vary from mild to severe. Some women only experience menstrual irregularities or trouble getting pregnant.  Common symptoms of PCOS include:

• Irregular periods,
• Difficulty getting pregnant (irregular ovulation or anovulation),
• Hirsutism (extra hair growth) – usually on the face, chest, back or buttocks,
• Weight gain,
• Thinning hair, 
• Acne,
• Darkening of the skin at folds (acanthosis nigricans),
• Skin tags.

What causes it?

We do not know exactly what causes PCOS.  High levels of male hormones might prevent the ovaries from producing hormones and making eggs normally. Insulin resistance, genetic tendency, and inflammation have all been linked to excess androgen production.

What are some related health problems associated with PCOS?

Having PCOS can increase your chances of developing other health problems in later life including:

• Insulin resistance, prediabetes, and diabetes,
• Infertility,
• Sleep apnea,
• Endometrial cancer,
• Depression,
• Overweight or obesity.

How is PCOS Diagnosed?

One commonly accepted diagnostic tool is the Rotterdam Criteria.  According to Rotterdam Criteria, PCOS can be diagnosed by presence of two of the following criteria:  

1. Elevated male hormones,
2. Irregular or absent periods, and/or
3. Polycystic ovaries.

Note-there are other disorders that can mimic PCOS that can be ruled out including thyroid disease, hyperprolactinemia, and specific adrenal diseases. 

What are treatment options?

• Birth Control is a first line treatment for menstrual abnormalities and hair growth and acne in PCOS. 
• Clomiphene is currently a preferred therapy for infertility. 
• Metformin is beneficial for metabolic abnormalities and for improving menstrual irregularities but does not seem to have benefit in treating hair growth, acne, or infertility.
• Nutritional strategies are used to help maintain a healthy weight or lose weight, especially in the setting of insulin resistance.  Often 5-10% weight loss can help improve insulin resistance and symptoms.  A low carbohydrate diet and/or time restricted eating are possible strategies to help address insulin resistance.
• Physical Activity has been shown to be effective in weight loss and improvement of insulin resistance in PCOS.  30 minutes three times a week can make a difference with ovulation and insulin levels.

It is estimated that 70% of women with PCOS do not know they have it.  If you are worried that you may have PCOS, please discuss it with your physician.  You should consider seeing your physician especially if you have missed periods but you are not pregnant, if you have been trying to get pregnant for over 12 months without success, or if you have some of the above-mentioned symptoms of PCOS.

DISCLAIMER: Sarah Smith MD is a medical doctor, but she is not your doctor, and she is not offering medical advice on this website. If you are in need of professional advice or medical care, you must seek out the services of your own doctor or health care professional.