What Is Polycystic Ovary Syndrome, or PCOS?
At your best friend’s baby shower, you sit among piles of gifts and stacks of baby blankets as she gushes with happiness and glows in dewy, flawless skin. Meanwhile, your repeated efforts to become pregnant have been in vain, you still have the acne you tried to hide in high school, and your hair seems to be getting thinner by the day. Your struggles may not be bad luck but instead the result of a medical condition. The reasons for your hormonal angst could be polycystic ovary syndrome (PCOS). Fortunately, it is a manageable condition.
What Is PCOS?
"Polycystic ovary syndrome (PCOS) is a very common hormonal disorder and the most common cause of ovulatory-based infertility in reproductive-aged women, diagnosed in approximately 5 to 10 percent of women," said Carolyn Alexander, MD, at the Southern California Reproductive Center.
"There is an unexplained abnormal synchrony from the brain to the ovaries resulting in an elevation in male hormone (testosterone) and lack of ovulation," added Mark P. Trolice, MD, a board-certified reproductive endocrinologist.
Though PCOS can affect women any time after the onset of puberty, it is most commonly diagnosed when women are in their 20s and 30s and want children but are having trouble getting pregnant. For the female reproductive system to function correctly, hormones must behave in a certain way. When those hormones are out of balance, as is the case with PCOS, it creates problems and can affect the ovaries, and in doing so, it can cause reproductive difficulties as well as other symptoms.
Infertility is only one of the problems caused by PCOS. In cases where you can get pregnant, you may still experience complications like preeclampsia, gestational diabetes, miscarriage, or the need for a cesarean delivery.
Stages and Types of PCOS
Like many disorders, PCOS has more than one type:
This type is the most common occurrence of PCOS. Elevated levels of insulin and leptin interfere with ovulation and cause your ovaries to produce testosterone.
Birth Control-Induced PCOS
Under normal circumstances, birth control medication stops ovulation while it’s in use. When the pill is discontinued, ovulation resumes. In some cases, however, the anovulation (absence of ovulation) continues for month or years after birth control is stopped.
Chronic stress, environmental toxins, and inflammatory foods are some factors that contribute to inflammatory PCOS, which occurs when your immune system is continuously activated, disrupting hormones and stimulating adrenal androgens (hormones that regular male characteristics, present in both men and women) that cause PCOS symptoms.
Sometimes PCOS has one specific trigger and is easily remedied by the removal of that issue. Examples include:
Symptoms and Causes
There are two categories of potential effects of PCOS, according to Dr. Trolice: reproductive and medical.
PCOS-related reproductive issues include:
- Irregular periods
- Infertility from ovulation dysfunction
- Gestational diabetes
- Possible higher [risk of] miscarriage
Other medical issues caused by PCOS include:
- Elevated body mass index
- Prediabetes and diabetes
- Unwanted hair growth, or excess body and facial hair (hirsutism)
- Elevated blood pressure or cholesterol
- Pre-uterine cancer
Other symptoms of PCOS can be seen, as well as detected in tests done by your doctor.
- Thinning hair on your head
- Ovarian cysts
- Elevated blood levels of androgens
- Metabolic syndrome
- Obstructive sleep apnea
- Pelvic pain
- Dark skin patches
There isn’t an exact known cause of PCOS. Genetics may play a role, and high levels of androgens and elevated insulin are the two main factors that create symptoms and interfere with reproductive ability.
Prevention and Risks
Preventative measures for PCOS risk factors that you can control involve managing your weight and blood sugar. Get regular exercise and eat a balanced diet that offers blood glucose stability. Avoid refined carbohydrates and starches, as well as sugary food.
A family history of PCOS is a risk factor that you can’t prevent. There is an obesity gene variant, FTO rs9939609, which has been identified as being associated with PCOS. The exact way in which they’re connected hasn’t been fully clarified, but the two are thought to be linked.
Other risk factors include:
- Family history of diabetes
- Metabolic syndrome
Diagnosis and Tests
While there isn’t a single test to diagnose PCOS, your doctor can make this diagnosis based on your symptoms, such as irregular periods and acne, combined with the results of multiple exams:
- Physical exam, to look for symptoms such as excess body hair
- Pelvic exam, which can reveal enlargement of the ovaries
- Pelvic ultrasound, to see if ovarian cysts are present
- Blood work, to test for elevated androgen hormone levels
- Ovarian biopsy, to rule out other conditions such as endometrial malignancy
Treatment, Procedures, and Medication
"The treatment is based on the interest of the patient, i.e., pregnancy or control of abnormal uterine bleeding," said Dr. Trolice. If your PCOS symptoms include irregular periods, excess body hair, and absence of ovulation, your doctor may prescribe medication, such as an oral contraceptive. If symptoms persist, your doctor may recommend an androgen blocker as well.
"Women trying to conceive have several options, including medical therapy for ovulation induction or laparoscopic ovary drilling," said Dr. Alexander.
Medications used to treat PCOS include:
Other options include selective estrogen receptor modulators, topical hair removing agents, and topical acne medication.
If necessary, there are surgical options that can help to restore ovulation, such as laparoscopic ovarian drilling, which strategically destroys tiny portions of the outer layer of the ovary, thus reducing testosterone production and triggering ovulation.
Healthy Lifestyle Tips
Changes to your lifestyle can have a positive impact on PCOS, and this approach is often recommended by doctors. What you eat, how much you exercise, and how much you weigh can all impact your hormones.
Diet and exercise are both factors that can determine body weight, which in turn impacts how your body uses insulin. Since elevated insulin levels can cause an increased production of androgens, which contribute to PCOS, managing body weight to stabilize insulin levels can help to reduce symptoms. Even a 10 percent reduction in body weight that is too high can help to regulate menstrual cycles and increase the odds of achieving a successful pregnancy.
Food- and Nutrition-Based Approaches to Prevention and Management
Since high insulin levels contribute to PCOS, keeping your insulin levels stable through dietary management can help treat this condition. Your blood insulin level increases after you eat, but the increase is higher and faster from simple carbohydrates and refined sugar. Instead, choose items that will help to keep your insulin level lower.
Items to have less often include:
- Sweetened juice and soda
- Starchy vegetables like potatoes and corn
- Refined grains like boxed cereal and white bread
- Treats like cake, chips, candy, and cookies
Items to have more often include:
- Fresh fruit and vegetables
- Whole grains
- High-fiber foods like shredded wheat and popcorn
What Type of Doctors to See
Your family doctor can assess your symptoms and may refer you to a specialist for testing and diagnosis. Some of the practitioners involved in diagnosing and treating this condition include:
- Endocrinologist (who treats hormonal imbalances)
- Reproductive endocrinologist (who specializes in reproductive hormones)
- Obstetrician-gynecologist (who specializes in female reproductive anatomy)
- Registered dietitian or nutritionist
- Ultrasound technician
- Surgeon (to perform biopsies and laparoscopic ovarian drilling)
If you’re having trouble getting pregnant or have other symptoms and think you might have PCOS, you should see your doctor to discuss diagnosis and treatment options. Ask about hormone regulation to ease your PCOS symptoms and to establish regular ovulation. Although PCOS is a leading cause of female infertility, it’s also treatable and doesn’t have to change your plans to have a successful pregnancy.
Looking for a new provider? Get started with our provider search where you can find a doctor near you that fits your needs.
About the Expert Contributors
Mark P. Trolice, MD, FACOG, FACS, FACE is the Director of Fertility CARE: THE IVF Center as well as Clinical Associate Professor in the Department of Obstetrics & Gynecology (OB/GYN) at the University of Florida in Gainesville and the University of Central Florida in Orlando. He is double Board Certified in REI and OB/GYN while maintaining annual recertification in these specialties.
Carolyn Alexander, MD, FACOG, of the Southern California Reproductive Center in Los Angeles, is board-certified in both Obstetrics and Gynecology as well as Reproductive Endocrinology and Infertility. Dr. Alexander’s main clinical interests include the treatment of polycystic ovary syndrome, endometriosis, unexplained infertility and recurrent pregnancy loss. Additionally, she works closely with oncologists on the fertility preservation of patients who are about to undergo chemotherapy.
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- Mayo Clinic: Polycystic Ovary Syndrome
- Women's Health: Polycystic Ovary Syndrome
- Medscape: Polycystic Ovarian Syndrome
- American Pregnancy Association: Polycystic Ovarian Syndrome
- Center for Young Women's Health: PCOS: Insulin and Metformin
- Center for Young Women's Health: PCOS: Nutrition Basics
- PLOS ONE: Common Variant rs9939609 in Gene FTO Confers Risk to Polycystic Ovary Syndrome
- Family Doctor: Polycystic Ovary Syndrome
- Lara Briden's Healthy Hormone Blog: Treatment for 4 Types of PCOS. Treat the Cause