Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs. The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease.
Causes
- Insulin resistance - Up to 70% of women with PCOS have insulin resistance, meaning that their cells can't use insulin properly. The body may produce higher than normal amounts of insulin to compensate, which can lead to higher androgen production, causing difficulty with ovulation.
- Hormonal imbalance - Many women with PCOS have higher than normal levels of androgens (male hormones), which can prevent the ovaries from releasing an egg during the menstrual cycle and can cause extra hair growth and acne.
- Low-grade inflammation - Research has shown that women with PCOS have low-grade inflammation, which can stimulate the ovaries to produce androgens.
- Genetics - PCOS tends to run in families, suggesting there may be a genetic link. Several genes have been associated with PCOS.
- Environmental factors - Exposure to certain environmental factors during prenatal development or early life may increase the risk of developing PCOS.
- Obesity - While not all women with PCOS are overweight, obesity can worsen the symptoms of PCOS. Excess weight can increase insulin resistance and inflammation, both of which contribute to PCOS.
- Abnormal fetal development - Some research suggests that exposure to high levels of androgens during fetal development may lead to PCOS later in life.
- Autoimmune responses - Some evidence suggests that PCOS may be associated with autoimmune conditions, where the immune system attacks the body's own tissues.
- Hypothalamic-pituitary dysfunction - Abnormalities in the hypothalamus or pituitary gland, which control the release of hormones involved in the menstrual cycle, may contribute to PCOS.
- Endocrine disruptors - Certain environmental chemicals that interfere with hormone function, known as endocrine disruptors, have been proposed as potential contributors to PCOS.
Signs and Symptoms
- Irregular periods - Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods.
- Excess androgen - Elevated levels of male hormones may result in physical signs, such as excess facial and body hair (hirsutism), severe acne and male-pattern baldness.
- Polycystic ovaries - Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.
- Weight gain - Many women with PCOS struggle with weight gain or difficulty losing weight, particularly around the abdomen.
- Skin darkening - Dark patches of skin may develop in body creases, such as those on the neck, in the groin, and under the breasts.
- Skin tags - Small pieces of excess skin may develop, usually in the armpits or neck area.
- Infertility - Due to irregular ovulation or failure to ovulate, PCOS is one of the most common causes of infertility in women.
- Mood disorders - Women with PCOS have a higher incidence of depression, anxiety, and eating disorders.
- Sleep apnea - This serious sleep disorder, where breathing repeatedly stops and starts during sleep, is more common in women with PCOS, especially if they're overweight.
- Headaches - Some women with PCOS report more frequent or severe headaches, possibly due to hormonal fluctuations.
Diagnosis
Medical History and Physical Exam
Your doctor will ask about your menstrual periods, weight changes, and other symptoms. During a physical exam, your doctor will look for signs of excess hair growth, insulin resistance, and acne.
Pelvic Exam
Your doctor might check to see if your ovaries are enlarged or swollen.
Blood Tests
Blood tests can measure hormone levels. Your doctor may check for elevated levels of androgens, glucose, and other hormones to rule out possible causes of menstrual abnormalities or androgen excess that mimic PCOS.
Ultrasound
An ultrasound can show the appearance of your ovaries and the thickness of the lining of your uterus. A wandlike device (transducer) is placed in your vagina (transvaginal ultrasound), or a transducer is passed over your abdomen (abdominal ultrasound). The ultrasound can show if your ovaries are enlarged and if they contain multiple cysts.
Other Hormone Tests
Your doctor might recommend additional blood tests to rule out other possible causes of your symptoms, such as thyroid disease, congenital adrenal hyperplasia, or Cushing's syndrome.
Treatment Options
Lifestyle Changes
Weight loss through a low-calorie diet combined with moderate exercise activities can help improve the symptoms of PCOS. Even a modest reduction in your weight — for example, losing 5% of your body weight — might improve your condition. Healthy eating habits and regular physical activity are essential for managing PCOS, particularly if you're overweight or obese.
Medications for Menstrual Cycle Regulation
To regulate your menstrual cycle, your doctor might recommend combination birth control pills — pills that contain estrogen and progestin. These decrease androgen production and regulate estrogen, which can lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth, and acne. Alternatively, taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer.
Medications for Ovulation Induction
If you're trying to become pregnant, you may need medications to help you ovulate. These include clomiphene, letrozole, metformin, and gonadotropins. Your doctor might recommend a specific medication based on your situation, whether you have other health conditions, and your risk of multiple births.
Home Remedies
Regular Exercise
Physical activity helps lower blood sugar levels, improves insulin sensitivity, and can help with weight management. Aim for at least 30 minutes of moderate-intensity exercise most days of the week. Both aerobic exercises (like walking, swimming, or cycling) and strength training are beneficial.
Balanced Diet
Focus on a diet rich in whole foods, including fruits, vegetables, whole grains, and lean proteins. Limit processed foods, refined carbohydrates, and added sugars, which can worsen insulin resistance. Some women with PCOS find that a low-glycemic index diet or a diet low in inflammatory foods helps manage symptoms.
Maintain a Healthy Weight
If you're overweight, losing even 5-10% of your body weight can help regulate your menstrual cycle and improve PCOS symptoms. This weight loss can also improve cholesterol levels, lower insulin, and reduce the risk of diabetes and heart disease.
Stress Management
Chronic stress can worsen PCOS symptoms by increasing cortisol levels, which can affect hormone balance. Practices like yoga, meditation, deep breathing exercises, or spending time in nature can help manage stress.
Adequate Sleep
Poor sleep can affect hormone levels and increase insulin resistance. Aim for 7-9 hours of quality sleep per night. Establish a regular sleep schedule, create a relaxing bedtime routine, and make your bedroom conducive to sleep by keeping it dark, quiet, and cool.
Preventive Care
- Maintain a healthy weight through regular exercise and a balanced diet.
- Manage blood sugar levels through diet, exercise, and medications if prescribed.
- Have regular gynecological check-ups to monitor your reproductive health.
- Monitor for symptoms of depression and anxiety, which are common in women with PCOS.
- Check blood pressure, cholesterol, and glucose levels regularly to monitor cardiovascular health.
- Consider hormonal contraception to regulate periods and reduce the risk of endometrial cancer if not trying to conceive.
- If planning pregnancy, work with healthcare providers to optimize fertility and ensure a healthy pregnancy.
- Be aware of the increased risk of diabetes and heart disease associated with PCOS and take preventive measures.
- Manage excessive hair growth with safe hair removal methods and prescribed medications if necessary.
- Join a support group or seek counseling to help cope with the emotional aspects of living with PCOS.
Surgical Options
Laparoscopic Ovarian Drilling
A minimally invasive surgical procedure that can trigger ovulation in women with PCOS who haven't responded to fertility medications. During this procedure, a surgeon makes a small incision in your abdomen and inserts a laparoscope. The surgeon then uses heat or a laser to make several small holes in the surface of your ovaries, which may reduce the amount of androgens produced and can help restore normal ovulation.
Learn More About This ProcedureBariatric Surgery
For women with PCOS who are obese and haven't been able to lose weight through diet and exercise, weight-loss (bariatric) surgery may be an option. This surgery can improve insulin resistance, correct hormone levels, and restore ovulation and fertility. The decision to undergo bariatric surgery should be made carefully in consultation with your healthcare team.
Learn More About This ProcedureAssisted Reproductive Technology (ART)
For women with PCOS who are trying to conceive and haven't been successful with medications, procedures such as in vitro fertilization (IVF) might be an option. These techniques involve retrieving eggs from the ovaries, fertilizing them in a lab, and then transferring the embryo(s) into the uterus.
Learn More About This ProcedureSchedule a Consultation
If you're experiencing symptoms of polycystic ovary syndrome (pcos), our expert team is here to help you find the right treatment approach for your specific needs.