What is PCOS?
Polycystic ovary syndrome (PCOS) is a condition that affects the ovaries due to a hormonal imbalance. When a woman doesn’t produce enough hormones needed for ovulation, multiple small fluid-filled sacs (cysts) can develop on the ovaries. These sacs produce androgens, which are hormones that are typically found in higher levels in men, though women also have them in smaller amounts. Women with PCOS tend to produce higher levels of androgens, leading to an imbalance in reproductive hormones. This imbalance can disrupt the menstrual cycle and cause other symptoms.
What Causes PCOS?
Experts do not know the exact cause of PCOS, but genetics may play a significant role. Additionally, other factors may contribute to the development of PCOS.
Factors
Androgen level imbalances. High levels of androgens can interfere with normal ovarian function. Elevated androgens disrupt ovulation, causing irregular menstrual cycles and preventing the regular release of eggs. This can lead to the formation of small, fluid-filled sacs on the ovaries. Excess androgens also contribute to symptoms such as hirsutism (excessive body or facial hair) and acne.
Insulin resistance. Insulin, a hormone made by the pancreas, helps cells use glucose for energy. In insulin resistance, the body doesn't respond properly to insulin, leading to elevated blood glucose levels. To compensate, the body produces more insulin, which can stimulate the ovaries to release excess androgens. High androgen levels suppress ovulation, leading to irregular menstrual cycles and other symptoms of PCOS. Insulin resistance may contribute to weight gain, increased appetite, and dark, velvety skin patches on areas like the neck, armpits, groin, or under the breasts. While not everyone with insulin resistance has high blood glucose or diabetes, the condition can increase the risk of developing these issues.
Low-grade inflammation. In response to infection or injury, substances are made by white blood cells (WBC). This response of the WBC is called low-grade inflammation. People with PCOS often experience chronic low-grade inflammation, which can contribute to the production of androgens by the ovaries. This persistent inflammation may play a role in developing symptoms of PCOS and increases the risk of heart and blood vessel problems. Healthcare providers can detect inflammation through blood tests that measure levels of C-reactive protein (CRP) and white blood cells, which are substances released during the body's response to injury or infection.
Symptoms
Symptoms of PCOS may start around the time of the first menstrual period, but may develop after experiencing periods for a while. The symptoms of PCOS also may vary depending on the person, and a person does not need to have all symptoms to be diagnosed with PCOS.
Irregular periods. Irregular menstruation is very common in women with PCOS and may involve missing periods, heavy bleeding, or having more than usual.
Abnormal hair growth. Excess facial, arm, chest, or abdomen hair (hirsutism) is prevalent in people with PCOS.
Darkening of the skin. The skin commonly has dark patches on the neck, underarms, groin, or under the breasts, often linked to insulin resistance.
Infertility*. Difficulty conceiving due to irregular ovulation or lack of ovulation may result from PCOS.
Obesity. Hormonal imbalances and insulin resistance can lead to excess weight or difficulty losing weight.
Acne. Women with PCOS may experience persistent or severe acne caused by excess androgen levels, typically appearing on the face, chest, or back.
*PCOS is one of the most common causes of infertility, however, many people with PCOS can still get pregnant.
Diagnosing PCOS
Mostly, a healthcare provider can diagnose PCOS through discussing the patient and their family's medical history and performing a physical exam where signs of excess androgen such as hirsutism or acne are checked.
Some symptoms of PCOS may be caused by other conditions, so other tests such as an ultrasound or blood tests are also common in diagnosing PCOS. Ultrasounds are used to see if the ovaries have cysts, and can show the thickness of the endometrium (uterus lining) which would confirm the PCOS diagnosis. Blood tests are also commonly ordered to check for high levels of androgens and blood glucose levels.
Treatment
Lifestyle Changes
A healthy, nutritious diet and physical activity to lose and/or maintain weight can help reduce symptoms and decrease risk for future health problems. Changing diet and activity can also improve the body’s ability to use insulin, reduce blood sugar levels, and potentially support ovulation.
Medication
Birth control. Hormonal birth control would help regulate the menstrual cycle and may improve acne and help with hirsutism.
Anti-androgen medicines. These medications can block the effect of androgens by controlling acne and unwanted hair growth.
Insulin-sensitizing medicines. This is often used to improve insulin resistance in PCOS. It may also help reduce androgen levels, slow hair growth, and help with ovulating more regularly.
Acne medicines. Medications in the form of pills, cream, or gel.
Medicines to cause ovulation. Medicines can help the ovaries to regularly release eggs, however, they also come with the risk of ovarian hyperstimulation which is where the ovaries release too many hormones.
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“What Is Polycystic Ovary Syndrome?” Cleveland Clinic, 18 Oct. 2024, https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos. Accessed 1 Jan. 2025.
“Polycystic Ovary Syndrome (PCOS) - Symptoms and Causes.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439. Accessed 1 Jan. 2025.
“Polycystic Ovary Syndrome.” MedlinePlus, https://medlineplus.gov/polycysticovarysyndrome.html. Accessed 1 Jan. 2025. Assessed and Endorsed by the MedReport Medical Review Board