Polycystic ovarian syndrome, or PCOS, is a condition in which a woman’s levels of the sex hormones estrogen and progesterone are out of balance. This leads to the growth of ovarian cysts (benign masses on the ovaries). PCOS can cause problems with a women’s menstrual cycle, fertility, cardiac function, and appearance.
According to the U.S. Department of Health and Human Services, between 1 in 10 and 1 in 20 women of childbearing age suffers from PCOS. The condition currently affects up to 5 million women in the United States.
While the exact cause of PCOS is unknown, doctors believe that hormonal imbalances and genetics play a role. Women are more likely to develop PCOS if their mother or sister also has the condition.
Overproduction of the hormone androgen may be another contributing factor. Androgen is a male sex hormone that women’s bodies also produce. Women with PCOS often produce higher-than-normal levels of androgen. This can affect the development and release of eggs during ovulation. Excess insulin (a hormone that helps convert sugars and starches into energy) may cause high androgen levels.
Symptoms of PCOS typically start soon after a woman begins to menstruate. The type and severity of symptoms varies from person to person. The most common characteristic of PCOS is irregular menstrual periods.
Because PCOS is marked by a decrease in female sex hormones, this condition may cause women to develop certain male characteristics, such as:
- excess hair on the face, chest, stomach, thumbs, or toes
- decrease in breast size
- deeper voice
- thin hair
Other symptoms include:
- weight gain
- pelvic pain
- anxiety or depression
While not symptoms of the disease, many women with PCOS have other concurrent health problems, such as diabetes, hypertension, and high cholesterol. These are linked to the weight gain typical in PCOS patients.
There is no definitive test for PCOS. To make a diagnosis, your doctor will review your medical history and symptoms and perform tests to rule out other possible conditions. Your doctor will perform a physical and pelvic examination to look for signs of PCOS, such as swollen ovaries or a swollen clitoris.
Blood tests to measure hormone levels are typically ordered, as well as:
- thyroid function tests to determine how much of the thyroid hormone your body produces
- fasting glucose tests to measure your blood sugar levels
- lipid level tests to assess the amount of cholesterol in your blood
A vaginal ultrasound allows your gynecologist to create real time images of your reproductive organs. A pelvic laparoscopy is a surgical procedure in which your doctor makes a small incision in your abdomen and inserts a tiny camera to check for growths on your ovaries. If growths are present, your doctor may take a small tissue sample (biopsy) for further examination.
Treatment for PCOS is not curative. Treatment focuses on controlling symptoms and managing the condition to prevent complications. The treatment will vary from woman to woman, depending on specific symptoms.
A healthy diet and regular exercise is recommended for all women with PCOS, particularly those who are overweight. This can help to regulate your menstrual cycle and lower your blood glucose levels.
Women who don’t want to become pregnant may be prescribed birth control pills. These can help treat acne, regulate the menstrual cycle, and lower levels of male hormones, such as testosterone, in the body. If a woman with PCOS is suffering from infertility, fertility drugs may be administered to aid in ovulation.
Anti-androgens are drugs that reduce male hormone levels. These can help stop excess hair growth and reduce acne. Diabetes medications may also be prescribed to lower blood glucose and testosterone levels.
Surgery may be recommended for some women with PCOS. Ovarian drilling is a procedure in which your doctor punctures your ovary with a small needle that carries an electric current, in order to destroy part of the ovary. This is a short-term solution that can promote ovulation and reduce male hormone levels.
Women with PCOS have a higher risk of developing:
- hypertension (high blood pressure)
- high cholesterol
- anxiety and depression
- sleep apnea (when a person stops breathing periodically during sleep)
- endometrial cancer (cancer caused by thickening of the lining of the uterus)
- heart attack
- breast cancer
If you become pregnant, your doctor may refer you to a doctor who specializes in high-risk pregnancies. Women with PCOS have a higher rate of miscarriage, gestational diabetes, and premature delivery. They may need extra monitoring during pregnancy.
The earlier your PCOS is diagnosed and treated, the lower your risk of developing these complications. Avoiding tobacco products and participating in regular exercise can also reduce your risk of some of these comorbidities. Talk with your doctor about what PCOS means for your overall health and how you can prevent serious complications.