All about polycystic ovary syndrome

Have you noticed that your periods are heavier or different than usual lately? Maybe you’ve also gained some weight or have acne you can’t get rid of. If these symptoms happen month after month, it’s worth mentioning to your doctor.

You could have polycystic ovary syndrome (PCOS), which is caused by an imbalance of reproductive hormones. The condition comes with unpleasant symptoms, such as heavy or irregular periods. It can also lead to infertility and long-term health issues such as Type 2 diabetes or heart disease.

Never heard of PCOS? It’s not as uncommon as you might think. In fact, PCOS affects 1 in 10 US women of childbearing age, according to the Office on Women’s Health.

Read on to understand what PCOS is, how it’s treated and what to do if you think you have it.

What exactly is PCOS?

All women make small amounts of male hormones, also known as androgens. But if your body has too many androgens, you have PCOS, says Aaron Gelfand, MD. He’s an OB-GYN with ChoicePoint in New Jersey. In women, excess androgens can stop eggs from being released and cause symptoms such as acne and excess hair growth.

Researchers aren’t sure exactly what causes PCOS. But there are some possibilities that may play a role. These include:

High level of insulin. Your pancreas makes a hormone called insulin, which lets your cells use sugar as energy. If those cells stop responding to the insulin, your blood sugar levels go up. That is known as insulin resistance — and over time it can lead to Type 2 diabetes.

In fact, more than half of women with PCOS will develop Type 2 diabetes by age 40, per the Centers for Disease Control and Prevention.

Low-grade inflammation. This is a response that can cause changes to your blood vessels and affect your blood flow. Over time, low-grade inflammation can cause tissue damage and hormonal imbalances.

Family history. A history of PCOS in the women in your family raises your risk. So if your mother or sister has PCOS, you’re more likely to have it, too.

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Signs and symptoms of PCOS

The most common sign of PCOS is an irregular menstrual cycle, says Caroline Gorn, MD. She’s an OB-GYN at Mercy Medical Center in Baltimore, Maryland. You may get too many periods, too few periods or none at all.

Having trouble conceiving is another common symptom of PCOS. The condition can prevent your ovaries from releasing an egg (ovulation).

Other symptoms of PCOS include:

• Too much hair on the face or body
• Acne on the face, chest and upper back
• Thinning hair or hair loss
• Weight gain or trouble losing weight
• Darkening of the skin
• Skin tags (small flaps of skin on the armpits or neck)

If you have PCOS, you may also have a higher risk of other health problems, including:

• Diabetes
• High blood pressure
• High cholesterol
• Sleep apnea
• Depression and anxiety
• Endometrial cancer

If your OB-GYN suspects that you have PCOS, he or she may do several tests in addition to a physical exam. A pelvic ultrasound uses sound waves to check your ovaries for cysts. And a blood test measures your androgen hormone levels.

If it turns out you have PCOS, your doctor will review your treatment options. PCOS can’t be cured, but the symptoms can be managed, Dr. Gelfand says.

Treating polycystic ovary syndrome

Medications for PCOS can control the growth of the uterine lining, Dr. Gorn explains. That helps prevent very heavy periods.

The other concern with PCOS is that as the uterine lining becomes thicker, there can be changes that may lead to uterine cancer. So keeping that lining thin is very important, Dr. Gorn adds.

Your doctor will decide the right medication for you based on your symptoms and whether you’re trying to get pregnant.

If you’re not planning to conceive, your doctor may recommend hormonal birth control and a hormonal intrauterine device, or IUD. “These keep the lining of the uterus thin and protected,” Dr. Gorn says.

Medications that block the effect of androgens may help reduce hair loss, facial hair and body hair and acne. But not all of them are approved by the US Food and Drug Administration to treat PCOS, and some of them may cause problems during pregnancy.

If you’re trying to conceive, your doctor may suggest medications such as clomiphene, letrozole (Femara^®) or metformin to help you ovulate.

Lifestyle changes that encourage weight loss may also help with PCOS. “A low-calorie diet and exercise can make your periods regular and the symptoms more manageable,” Dr. Gelfand says. Work with your doctor to create the best weight loss plan for you.

PCOS versus endometriosis

PCOS is often confused with another health condition called endometriosis. It is possible to have both at the same time. But they are different conditions with different treatments.

PCOS is a hormonal disorder. Endometriosis is a pelvic pain condition. It occurs when the lining of the uterus grows in another location outside of the uterus itself, most commonly the pelvis, according to the National Library of Medicine. Fluctuating hormone levels during menstruation may cause those areas to become inflamed and painful, Dr. Gorn says.

It’s important to visit your doctor if you notice any symptoms of PCOS (or endometriosis). With the right treatment, you can get the condition under control.

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Additional sources
PCOS statistic: Office on Women’s Health (2021). “Polycystic Ovary Syndrome”
Diabetes stat: Centers for Disease Control and Prevention (2020). “PCOS and Diabetes”
Endometriosis definition: National Library of Medicine (2022). “Endometriosis”