What is Polycystic Ovary Syndrome (PCOS)?
Polycystic ovary syndrome (PCOS) is a common condition that many women experience. If you have PCOS, know that you're not alone—this affects around 5-10% of women. The symptoms can vary but may include irregular periods, changes in weight, increased hair growth on the face and body, acne, and challenges with fertility. Remember, there are treatments and support available to help manage these symptoms and improve your quality of life. Take things one step at a time, and don't hesitate to reach out for help and support when you need it.
Diagnosing Polycystic Ovary Syndrome (PCOS)
If you think you might have PCOS, your doctor will help you through the diagnosis process, which usually involves checking for two or more of the following:
- Irregular or absent ovulation
- Elevated testosterone levels
- Ovaries with multiple cysts
During diagnosis, your healthcare team will do a physical exam to look for excessive hair growth and check for other reasons you may be growing hair on your face or body. They will take down your medical history, including whether your periods are regular or heavy. An ultrasound may be done to see if your ovaries are enlarged or have multiple cysts. Additionally, a blood test will check hormone levels, such as androgens like testosterone, and screen for high blood sugar or high cholesterol levels.
View the PCOS Fact Sheet with infographicsRisk Factors for Polycystic Ovary Syndrome
Hirsutism
Excessive hair growth on the face and body is often due to higher levels of androgens, such as testosterone. While both men and women produce androgens, men typically have much higher levels. In women, these hormones are produced by the ovaries and adrenal glands. To some degree, estrogen reduces the effect of androgens in women. Androgens can cause some fine hairs to become coarser and darker. Once this change happens, the hair usually doesn't revert back to its finer state.
Acne
Higher levels of androgens can also increase the production of sebum, leading to oily skin and acne.
Irregular Periods
PCOS can cause irregular or missed periods, or long gaps between periods. Excess androgens may prevent ovulation, disrupting your hormone cycle and causing the lining of the uterus to thicken too much, which can lead to abnormal bleeding. This can also increase the risk of uterine cancer and make it more challenging to become pregnant.
Weight Gain
Many women with PCOS experience weight gain, particularly around their midsection. Fatty tissues produce excess estrogen, which can disrupt normal ovulation and worsen PCOS symptoms. Additionally, obesity can increase insulin resistance, leading to higher androgen production by the ovaries.
Metabolic Syndrome
Around 70% of women with PCOS have decreased insulin sensitivity, often due to increased weight. This can cause the body to produce more insulin, which can in turn lead to higher androgen levels. Women with PCOS are at a higher risk of developing conditions such as type 2 diabetes, high blood pressure, high cholesterol, and heart disease. These risks are present even in young or thin women with PCOS.
Additional Resources:
Hirsutism and Polycystic Ovary Syndrome Patient Education Booklet
Managing PCOS
There are effective treatments available to help manage the symptoms of PCOS, and it's important to find the right approach that works for you. Remember, you're not alone in this journey, and there are ways to feel better and stay healthy.
Hormonal Treatment
If you’re not trying to conceive, hormonal treatment might be the best option for you. Birth control pills help by decreasing the production of ovarian hormones and reducing the effects of excessive androgens. However, if you smoke and are over 35, this may not be the best option for you. For hirsutism, your doctor might prescribe spironolactone alone or in combination with birth control pills. In some rare cases, GnRH analogs might be used to reduce ovarian androgen production. Hormonal treatment can be very effective in managing the symptoms of PCOS. However, if the treatment is stopped, the symptoms may return.
Managing Excess Hair and Acne
Excess hair and acne can be treated with medications that lower male hormones. Hair removal methods such as plucking, shaving, electrolysis, and laser treatment can also be effective.
Weight Management
Losing weight can lower androgen levels and reduce the risk of diabetes for many women with PCOS. Even a small amount of weight loss can make a significant difference.
PCOS and Fertility
If you're trying to get pregnant, there are several options available to help you ovulate and increase your chances of conception. Your doctor will work with you to find the best approach for your situation.
Medications to Stimulate Ovulation
The first step often involves taking medication to stimulate ovulation. Clomiphene citrate, an oral medication, is usually tried first. Letrozole, another oral medicine, can also be very helpful for women with PCOS. If these are not successful, your doctor may prescribe injected fertility medications called gonadotropins to help stimulate the growth of an egg. It's important to be closely monitored while taking gonadotropins to ensure you are responding appropriately and to minimize the risk of side effects, such as ovarian hyperstimulation and multiple pregnancy (twins or triplets).
Weight Management
If you are overweight, losing some weight can help improve your ovulation patterns and overall fertility.
Insulin-Sensitizing Medicines
Medications like metformin can help your body use insulin more effectively, which can improve ovulation and lower the risk of developing diabetes or metabolic syndrome.
Surgical Options
In very rare cases, if ovulation is not achieved with medication, ovarian surgery may be considered. Procedures such as ovarian drilling, performed through laparoscopy, can help stimulate ovulation. However, these surgeries are generally a last resort due to potential risks, such as the formation of adhesions (scar tissue) which can affect future fertility.
In Vitro Fertilization (IVF)
If other treatments do not work, IVF may be an option to help you conceive. IVF has helped many women with PCOS achieve pregnancy when other methods have not been successful.
Read the Patient education booklet "Medications for Inducing Ovulation"
View the Patient Fact Sheet "Ovarian Drilling for Infertility"
In Vitro Fertilization Treatment Patient Journey
Real Life Experiences
Listen to a PCOS patient story on the SART Fertility Experts podcast
As the most common hormonal disorder in women, PCOS is a disruptive problem that impacts many aspects of a woman’s health including getting pregnant. In this episode, Brittany discusses how PCOS has affected her life and shares the story of her challenging journey to parenthood, with Dr. Mark Trolice, a reproductive endocrinologist.
Subscribe to SART Fertility Experts
Visit the Society for Assisted Reproductive Technology (SART) Website
FIND AN EXPERT
ASRM can help you find a reproductive endocrinologist in your area that is knowledgeable on the subject of Polycystic Ovary Syndrome and who can help you on your PCOS journey..
Polycystic Ovary Syndrome (PCOS)
Conditions Treated with Surgery on the Fallopian Tubes and Ovaries
Surgery can be used to treat problems with the ovaries or fallopian tubes, such as cysts, endometriosis, or infections. View the Fact Sheet
Weight and fertility
One of the easiest ways to determine if you are underweight or overweight is to calculate your body mass index (BMI). View the fact sheet
SART Fertility Experts - PCOS
Ovarian drilling for infertility
Often, women with polycystic ovary syndrome (PCOS) do not have regular menstrual periods. View the fact sheet
Hirsutism and Polycystic Ovary Syndrome (PCOS) (booklet)
Polycystic ovary syndrome (PCOS) is a condition in which the ovaries contain many cystic follicles associated with chronic anovulation (lack of ovulation) and overproduction of androgens (male hormones). View the booklet
