What Is Polycystic Ovarian Syndrome (PCOS)?

Young woman looking out window

Compassionate Eye Foundation / Digital Vision / Getty Images

Table of Contents
View All
Table of Contents

Polycystic ovarian syndrome, or PCOS, is an endocrine disorder and a common cause of infertility in women. In PCOS, hormones that affect the reproductive system are abnormal, leading to irregular or absent ovulation. PCOS is a common disorder, affecting roughly 4% to 12% of women.

Symptoms

Common signs and symptoms of polycystic ovarian syndrome include:

  • Abnormal hair growth, also known as hirsutism, found on the upper lip, chin, around the nipples, or on the abdomen
  • Acne
  • Amenorrhea (absence of monthly menstrual cycles) or oligomenorrhea (irregular monthly menstrual cycles)
  • Elevated levels of the hormone LH (making at-home ovulation tests difficult to use)
  • High levels of androgens, also known as hyperandrogenism
  • Infertility
  • Insulin resistance
  • Irregular or absent ovulation (anovulation)
  • Male pattern balding
  • Oily skin and hair
  • Obesity (though women with PCOS can be underweight or at a normal weight)
  • Presence of polycystic ovaries during ultrasound examination
  • Recurrent miscarriage

Less common signs and symptoms of PCOS include:

  • Dry skin
  • Eating disorders
  • Fatigue
  • Fatty liver
  • Headaches
  • Hidradenitis suppurativa (painful lumps under the skin)
  • High blood pressure
  • Hyperkeratosis (thickened skin)
  • Insomnia or poor sleep
  • Mood changes
  • Pelvic pain
  • Ruptured cyst
  • Sleep apnea

You do not need to have every symptom to be diagnosed. PCOS can present in different ways. For example, many women with PCOS do not have abnormal hair growth and are at a healthy weight. Some women with PCOS may not have a menstrual cycle for months at a time, while other women with PCOS may only have slightly irregular cycles.

PCOS does not present itself the same way for every woman.

You can also have PCOS-like ovaries without having a full PCOS. This condition usually presents with the internal findings on your ovaries without any of the outward, classic symptoms such as obesity, facial hair, and acne and can be pretty common.

Diagnosis

Not everyone agrees on the criteria for diagnosing PCOS, and its definition has been changed over the years. That said, the most commonly used diagnostic criteria require two out of three of the following:

  • Irregular or absent menstrual cycles, caused by chronic anovulation
  • Blood test confirmation or outward signs of high levels of androgens (abnormal hair growth, acne)
  • Presence of polycystic ovaries, as seen by ultrasound examination

In addition, other potential causes of anovulation or high androgen levels must be ruled out. This usually includes testing for congenital adrenal hyperplasia, androgen-secreting tumors, and hyperprolactinemia.

Blood work will be ordered to check levels of hormones, blood sugar (for insulin resistance), and lipids. Transvaginal ultrasound may be ordered to see if the ovaries appear polycystic.

Taking a detailed history is also an important part of PCOS diagnosis. Your doctor will want to know about how regular your menstrual cycles are, and ask about unwanted hair growth.

Because PCOS is diagnosed by looking at the greater picture, and by excluding other potential diseases that can cause similar symptoms, it's important to see your doctor for an accurate diagnosis.

You may be tempted not to mention unwanted hair growth because of embarrassment, but it's important that you tell your doctor about this problem if you have it.

Causes

The exact cause of PCOS is not known, however, most experts think that several factors,
including genetics, play a role:

  • Family history: If your mother or sister has PCOS, you are more likely to develop the condition.
  • High levels of androgens: A common finding with PCOS is abnormally high levels of androgen hormones. While androgens are found in both men and women, they are considered to be primarily male hormones. High androgen levels are associated with some of the more visibly distressing symptoms of PCOS, including acne and abnormal hair growth.
  • Insulin resistance: Women with PCOS frequently have insulin resistance, meaning their bodies do not respond appropriately to insulin. The risk of insulin resistance runs higher if you are over 40, overweight, have high blood pressure, live a sedentary lifestyle, and have high cholesterol.
  • Polycystic ovaries: Women with PCOS often have polycystic ovaries, or ovaries that have many tiny, benign, and painless cysts. However, polycystic ovaries do not always point to PCOS. Studies have found that some women have polycystic ovaries, normal ovulation, and no other signs of an endocrine disorder like PCOS.

Treatment

There is no cure for PCOS, but treatments can address its symptoms and complications. For example, medications can be used to help regulate menstruation, while lifestyle remedies (like weight loss or exercise) can help reduce related risks like metabolic syndrome. Treatment for PCOS will also depend on whether or not you're trying to get pregnant.

Menstrual Dysfunction

If pregnancy is not a priority, birth control pills may be used to help regulate your cycles. Some women are afraid to go on birth control pills because they think it will further harm their fertility. The research on birth control hasn't found this to be true. Birth control shouldn't harm your long-term fertility.

However, it is also important to know that the pill doesn't "cure" your PCOS. You may start getting regular cycles while on the pill. These are artificially created. Once you stop taking the pill, if your cycles were irregular before, they will likely be irregular again. 

In addition to birth control pills, vaginal contraceptive rings and intrauterine devices (IUDs) containing progesterone can also help treat menstrual dysfunction.

Infertility

The abnormal hormone levels associated with PCOS lead to problems with ovulation. These irregularities in ovulation are the main cause of infertility.

PCOS is also associated with a higher risk of early miscarriage. Research on PCOS has shown that the miscarriage rate may be as high as 30% to 50%, which is twice as high as in the general population. It's not exactly clear why miscarriage is more common in women with PCOS, but some theories include the following:

  • Poor egg quality, related to premature or late ovulation
  • Insulin resistance
  • Less-than-favorable environment for an embryo to implant in the uterine lining (due to abnormal hormone levels associated with PCOS)

For those trying to get pregnant, the treatment for PCOS is similar to the treatments used for treating anovulation, including:

  • Clomid (clomiphene citrate): The first line of treatment for women with PCOS, Clomid can help stimulate ovulation.
  • Femara (letrozole): This cancer medication is sometimes used off-label to stimulate ovulation in women with PCOS. Some research, however, suggests that Femara may offer significantly higher rates of pregnancy within this population than Clomid.
  • Glucophage (metformin): A commonly prescribed diabetes drug, metformin is used to treat insulin resistance and is also used on people who are Clomid-resistant (which means the drug does not work for them), with or without insulin resistance.
  • Gonadotropins: Injectable hormones comprised of follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH), gonadotropins are commonly used when Clomid or Femara fail to induce ovulation.

Acne and Abnormal Hair Growth

Women with PCOS frequently have to deal with cosmetic issues like acne or unwanted hair, especially on the face. Thankfully, there are a number of medications and possible interventions today that can help you deal with this.

Drugs and topical preparations used to treat PCOS-induced acne include:

  • Benzoyl peroxide, which works by introducing oxygen into the pores, which kills the bacteria that are associated with acne
  • Hormonal treatments, such as birth control pills and CaroSpir (spironolactone)
  • Salicylic acid, which works as an exfoliant, helping your skin shed dead skin cells more effectively
  • Topical antibiotics, which target the skin bacteria that are associated with acne 
  • Topical retinoids, which exfoliate the skin, keeping your pores unclogged and preventing comedones

Some acne treatments are not safe to be used when you're trying to get pregnant, so be sure to tell your doctor if you are trying to conceive.

Drugs used to treat hyperandrogenism either block androgen production or counteract the effects of abnormal hair growth. These include:

  • Aldactone (spironolactone), a diuretic that exerts anti-androgenic effects
  • Propecia (finasteride), used off-label to treat hair loss in women with PCOS
  • Vaniqa (eflornithine hydrochloride), a topical cream used to block hair growth

Home remedies like shaving, waxing, and depilatory creams as well as in-office electrolysis or laser therapy can also help with abnormal hair growth. Speak with your dermatologist about the best option for you.

It's important to note that some of the medications listed for this symptom of PCOS are contraindicated for fertility treatment and pregnancy. So if you are seeking fertility care or attempting to get pregnant please be sure to discuss this goal with your medical team and they can advise you if the medication is safe to take or not.

Insulin Resistance

Roughly 50% to 70% of women with PCOS develop diabetes or prediabetes due to the onset of insulin resistance, a condition influenced by imbalances in estrogen production.

Diabetes drugs commonly used to treat insulin resistance in women with PCOS include:

  • Actos (pioglitazone), which is used to reduce high blood sugar
  • Avandia (rosiglitazone), an oral drug of the same class as pioglitazone
  • Avandamet, a combination of rosiglitazone and metformin
  • Glucophage (metformin), which can help control diabetes while promoting weight loss
  • Victoza (liraglutide), an injectable drug used to control insulin and glucose levels

Weight Loss

Some studies have shown that women who are overweight with PCOS may be able to restart ovulation naturally by losing just 10% of their weight. A healthy diet and regular exercise may also help bring back regular ovulation in some, but not all, women with PCOS. 

While some studies claim that a low-carb diet is best for PCOS, the important thing is to make sure your diet is focused on nutrient-rich foods and adequate protein, while being low in high-sugar and processed foods. A healthy diet for PCOS, even if your weight is normal, should include:

  • Limited fruits (too many may negatively affect insulin resistance due to high fructose levels)
  • Plenty of vegetables
  • Moderate amounts of high-fiber, unprocessed, low-glycemic index grains (such as oats and quinoa)
  • Foods rich in omega-3 fats, such as fish (salmon, mackerel, sardines), nuts, and seeds

Diet alone isn’t enough to properly manage PCOS. Aim for 30 minutes of cardiovascular exercise most days of the week, and two days of weight training weekly. Women with PCOS have higher testosterone levels and tend to build muscle more easily than those without the condition. By building muscle mass, you can help your body use insulin more effectively.

Pregnancy With PCOS

Women and babies born to women with PCOS do have an increased risk for some complications, including:

The reason for these increased risks may come from PCOS-related obesity or insulin resistance. The best way to reduce these risks is to reach a healthy (or healthier) weight before pregnancy (if possible), be sure to get regular prenatal care, and eat a healthy diet. Of course, you can do all the right things and still experience complications. 

Coping

Coping with the many symptoms of PCOS may mean working with a variety of doctors, including a gynecologist, a dermatologist, an endocrinologist, or a fertility specialist known as a reproductive endocrinologist. These specialists can coordination with your primary care physician or any other specialist you may be seeing to help you better manage your condition.

Since PCOS can become emotionally overwhelming—roughly 40% of women with PCOS experience depressive symptoms—building a support network that may include friends and family, support groups, or a professional therapist is also important. Finally, do your best to educate yourself about this condition so that you can play an active role in monitoring your health and avoiding complications.

Was this page helpful?
Article Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: A systematic review and meta-analysisHum Reprod. 2016;31(12):2841-2855. doi:10.1093/humrep/dew218

  2. Meier RK. Polycystic ovary syndromeNursing Clinics of North America. 2018;53(3):407-420. doi:10.1016/j.cnur.2018.04.008

  3. Helvaci N, Karabulut E, Demir AU, Yildiz BO. Polycystic ovary syndrome and the risk of obstructive sleep apnea: A meta-analysis and review of the literatureEndocr Connect. 2017;6(7):437-445. doi:10.1530/EC-17-0129

  4. Meier RK. Polycystic ovary syndromeNursing Clinics of North America. 2018;53(3):407-420. doi:10.1016/j.cnur.2018.04.008

  5. Centers for Disease Control and Prevention. PCOS (polycystic ovary syndrome) and diabetes. March 24, 2020.

  6. Rojas J, Chávez M, Olivar L, et al. Polycystic ovary syndrome, insulin resistance, and obesity: Navigating the pathophysiologic labyrinthInt J Reprod Med. 2014;2014:719050. doi:10.1155/2014/719050

  7. Group of interest in Reproductive Endocrinology (GIER) of the Spanish Fertility Society (SEF), Bellver J, Rodríguez-Tabernero L, Robles A, et al. Polycystic ovary syndrome throughout a woman’s lifeJ Assist Reprod Genet. 2018;35(1):25-39. doi:10.1007/s10815-017-1047-7

  8. Talukdar N, Bentov Y, Chang PT, Esfandiari N, Nazemian Z, Casper RF. Effect of long-term combined oral contraceptive pill use on endometrial thickness. Obstet Gynecol. 2012;120(2 Pt 1):348-54. doi: 10.1097/AOG.0b013e31825ec2ee

  9. Kamalanathan S, Sahoo J, Sathyapalan T. Pregnancy in polycystic ovary syndromeIndian J Endocr Metab. 2013;17(1):37. doi:10.4103/2230-8210.107830

  10. Diamond MP, Legro RS, Coutifaris C, et al. Letrozole, gonadotropin, or clomiphene for unexplained infertility. N Engl J Med. 2015;373(13):1230-40. doi:10.1056/NEJMoa1414827

  11. Pasquali R, Zanotti L, Fanelli F, et al. Defining hyperandrogenism in women with polycystic ovary syndrome: A challenging perspectiveJ Clin Endocrinol Metab. 2016;101(5):2013-22. doi:10.1210/jc.2015-4009

  12. Frankfurter D. Getting pregnant with PCOS. In: Davies T, editor. A Case-Based Guide to Clinical Endocrinology. New York: Springer; 2015:317-326. doi:10.1007/978-1-4939-2059-4_38

  13. Faghfoori Z, Fazelian S, Shadnoush M, Goodarzi R. Nutritional management in women with polycystic ovary syndrome: A review study. Diabetes Metab Syndr. 2017;11 Suppl 1:S429-S432. doi:10.1016/j.dsx.2017.03.030

  14. Sadeeqa S, Mustafa T, Latif S. Polycystic ovarian syndrome-related depression in adolescent girls: A reviewJ Pharm Bioallied Sci. 2018;10(2):55–59. doi:10.4103/JPBS.JPBS_1_18

Additional Reading