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It can be challenging to talk about reproductive and sexual health. That’s part of why most women don’t know they have polycystic ovary syndrome (PCOS) and only find out when struggling with fertility.
PCOS affects a female’s hormonal health, leading to irregular periods, elevated androgen hormones, and ovarian cysts.
If you’re experiencing problems with your menstrual cycle or fertility, it could be caused by PCOS.
What is polycystic ovary syndrome (PCOS)?
PCOS is the most common hormonal disorder, affecting up to 15% of women between puberty and menopause (Leon, 2021).
Those with PCOS may experience irregular periods, increased male hormone levels, and cysts in their ovaries.
Despite many women being affected by PCOS, it’s often underdiagnosed. This increases the chances of developing one of the other conditions associated with PCOS, like diabetes or metabolic syndrome.
Signs and symptoms of polycystic ovary syndrome
PCOS may develop as early as puberty or it can develop later in life. Adolescents with PCOS may be harder to diagnose since some of the symptoms are expected for that time of life, such as increased body hair, acne, and irregular periods (Leon, 2021).
Common signs and symptoms of PCOS include (Leon, 2021):
- Irregular menstrual periods
- Heavy bleeding
- Chronic anovulation (more than 35 days between ovulating)
- Excess hair growth that appears thick and dark, a condition called hirsutism
- Hair loss on the scalp (often called male pattern baldness, though it can affect men and women)
- Weight gain and obesity
- Darker patches of skin where skin creases such as around the neck, armpits, groin, under the breasts, etc.
- Ovarian cysts (fluid-filled sacs in or around the ovary)
How to lose weight with PCOS (polycystic ovarian syndrome)
Causes of PCOS
The exact cause of PCOS is unknown. Many times, women will have higher androgen hormone levels, which can impact their fertility and menstrual cycles.
A combination of factors likely causes PCOS. For some of these factors, it’s unclear whether they contribute to the development of PCOS or if they are caused by it.
Risk factors for developing PCOS include:
- Genetics: It’s believed that several genes contribute to PCOS. A family history of this syndrome increases your chances for developing it (Leon, 2021).
- Inflammation: Excess inflammation is associated with both insulin resistance and excess androgen hormone levels (Gonzalez, 2012).
- Weight gain: People with PCOS are more likely to carry excess fat in their abdomen, and trouble maintaining a healthy weight is common. Obesity is associated with higher male hormone levels and insulin resistance (Puttabyatappa, 2018).
- Insulin resistance: High insulin levels and insulin resistance affect about 65–70% of people with PCOS. It’s believed that high insulin levels are related to the excess levels of androgen hormones (Puttabyatappa, 2018).
Effects and complications of PCOS
PCOS is known to increase your chances for several conditions because of its effects on hormones, inflammation, and health. Potential complications of PCOS include (Leon, 2021):
- Challenges maintaining a healthy pregnancy
- Metabolic syndrome (a group of conditions that increase your chances for heart disease or stroke)
- Endometrial cancer (cancer in the lining of the uterus)
- Depression and anxiety
- Obstructive sleep apnea (OSA)
- Type 2 diabetes
- Liver disease
Hormonal acne: causes, types, treatment
PCOS and pregnancy
Since PCOS is often underdiagnosed, many women learn they have PCOS when seeking help for fertility issues. PCOS affects your menstrual cycle, impacting ovulation and fertility.
Even though it may be more challenging, it’s still possible to have a healthy pregnancy with PCOS. It may take help to become pregnant with PCOS, including diet and lifestyle changes and hormonal treatments to boost fertility.
Women who are pregnant and diagnosed with PCOS have a higher risk of pregnancy complications. They are more likely to experience (Leon, 2021):
- Early labor
- High blood pressure (preeclampsia)
- Gestational diabetes
It often takes time to get a PCOS diagnosis because there is no test to confirm the syndrome. It can sometimes take a year or longer before PCOS is officially diagnosed (Leon, 2021). Don’t lose hope, though. The sooner you seek help for your symptoms, the better.
When you do seek help, your healthcare provider will rule out other possible conditions. PCOS is only diagnosed after all other conditions have been considered.
Your healthcare provider will gather a history of your symptoms and medical history, as well as complete a physical exam, pelvic exam, and check for ovarian cysts. They will likely request blood tests to assess hormones, insulin, blood sugar, cholesterol, triglycerides, and other levels.
Two of the following three criteria must be present to be diagnosed with PCOS (Leon, 2021):
- Chronic anovulation: Long menstrual cycle with greater than 35 days between ovulation
- Hyperandrogenism: High levels of androgen hormones (typically considered the male reproductive hormones)
- Polycystic ovaries: Presence of cysts or fluid-filled sacs in the ovaries
Treatment for PCOS
There is no cure for PCOS. Still, you can manage the symptoms through lifestyle changes and medication.
Often, hormonal birth control containing progestin or progesterone is used to help regulate hormone levels and menstrual cycles. This can take the form of pills, patches, vaginal rings, or a hormonal IUD.
The hormone progestin helps to decrease luteinizing hormone levels, which may help lower androgen hormone levels.
Research suggests taking progestin helps (Leon, 2021; Stanosz, 2014):
- Restore and stabilize hormone balance
- Regulate ovulation
- Manage symptoms, like acne and hair changes
- Lower the risk for endometrial cancer by normalizing the uterine lining
Other medications may be used for PCOS to help manage other health problems, such as (Leon, 2021):
- Metformin: This medication helps to improve insulin resistance and lower insulin levels.
- Clomiphene: This medication helps induce ovulation and may help women with PCOS become pregnant.
- Spironolactone: This medication may help lower androgen levels and is sometimes used to help with excess hair growth and acne.
How does spironolactone help treat PCOS?
Ovarian surgery is sometimes recommended to help with fertility and regulate menstrual cycles. But it’s rarely used and is only recommended when other treatment options have been unsuccessful (Legro, 2017).
Diet and lifestyles changes for PCOS
A healthy diet, weight maintenance, and exercise help to manage your PCOS symptoms (Leon, 2021). Often, these changes are recommended as the first step to managing PCOS before trying medications or hormone therapies.
There is no one diet prescribed for helping PCOS. Diet plans should be adapted to meet your needs and help manage your unique symptoms and tolerance. Typically, the goals of dietary changes are to help with insulin resistance, maintain a healthy weight, manage other symptoms, and support your health.
Diet changes often recommended for PCOS include (Moran, 2013):
- Lower carbohydrates: Insulin is a hormone that helps bring glucose (sugar) in from the blood. Since people with PCOS tend to have problems with insulin resistance, it’s recommended to limit simple carb and sugar intake. Instead, try to eat carbs high in fiber, such as legumes, oats, vegetables, fruits, and whole grains.
- Eat plenty of protein: Protein takes longer to digest and absorb, so it helps to stabilize blood sugar levels when included with meals.
- Eat monosaturated fats: Some research suggests eating monounsaturated fats aids in healthy weight management for people with PCOS.
PCOS diet: what foods to eat and what to avoid
Research suggests that physical activity is important for people with PCOS because it may help regulate menstruation and ovulation frequency. Guidelines recommend at least 150 minutes (2.5 hours) of physical activity per week (Woodward, 2020).
Potential benefits of exercise for people with PCOS include (Woodward, 2020):
- Increased heart health
- Weight maintenance
- Increased insulin sensitivity
- Lower insulin levels
Healthy weight maintenance
Weight gain is common for people with PCOS. Research suggests finding and maintaining a healthy weight may help improve insulin resistance and other symptoms (Rocha, 2019).
Maintaining a healthy weight is often challenging for people with PCOS because of hormone imbalances. Try to focus on healthy habits and talk with your healthcare provider for tips on maintaining a healthy weight with PCOS.
When to see a healthcare provider
If you’re experiencing PCOS symptoms, share your concerns with your healthcare provider as early as you can. Diagnosing PCOS early can help you better manage your symptoms and lower your risk for complications.
A healthcare provider can also support family planning if you have PCOS and you’re trying to get pregnant.
Talk with your healthcare provider if you experience:
- Heavy bleeding and severe menstrual cramps
- Frequently missed periods without becoming pregnant
- Trying to become pregnant without success for more than 12 months
Your gynecologist may refer you to an endocrinologist (a doctor specializing in endocrinology or hormonal health) to help manage your hormone levels.
With the support of your healthcare team, you can manage your PCOS symptoms. Uncontrolled PCOS can lead to an increased risk for other health problems. With diet, lifestyle, and medications, you can help manage your PCOS symptoms.
- González, F. (2012). Inflammation in polycystic ovary syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids, 77(4), 300–305. doi: 10.1016/j.steroids.2011.12.003. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309040/
- Legro, R. S. (2017). Evaluation and treatment of polycystic ovary syndrome. In: Endotext [Internet]. Feingold KR, Anawalt B, Boyce A, et al. (editors). South Dartmouth (MA): MDText.com, Inc.; 2000-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK278959/.
- Leon, L. I. R., Anastasopoulou, C., Mayrin, J. V. (2021). Polycystic Ovarian Disease. [Updated Jul 21, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459251/.
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- Moran, L.J., Ko, H., Misso, M., Marsh, K., Noakes, M., Talbot, M., et al. (2013). Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines. Journal of the Academy of Nutrition and Dietetics, 113(4), 520–545. doi: 10.1016/j.jand.2012.11.018. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23420000/
- Puttabyatappa, M., & Padmanabhan, V. (2018). Ovarian and extra-ovarian mediators in the development of polycystic ovary syndrome. Journal of Molecular Endocrinology, 61(4), R161–R184. doi:10.1530/JME-18-0079. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29941488/.
- Rocha, A. L., Oliveira, F. R., Azevedo, R. C., Silva, V. A., Peres, T. M., Candido, A. L., et al. (2019). Recent advances in the understanding and management of polycystic ovary syndrome. F1000Research, 8, F1000 Faculty Rev-565. doi:10.12688/f1000research.15318.1. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31069057/.
- Stanosz S, von Mach-Szczypiński J, Sieja K, & Koœciuszkiewicz J. (2014). Micronized estradiol and progesterone therapy in primary, preinvasive endometrial cancer (1A/G1) in young women with polycystic ovarian syndrome. The Journal of Clinical Endocrinology and Metabolism, 99(12), E2472–E2476. doi: 10.1210/jc.2014-1693. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25157541/
- Woodward A, Klonizakis M, & Broom D. (2020). Exercise and polycystic ovary syndrome. Advances in Experimental Medicine and Biology, 1228, 123–136. doi: 10.1007/978-981-15-1792-1_8. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32342454/
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.