Polycystic ovary syndrome, widely known as PCOS, is an endocrine system disorder that affects women in their reproductive years. Small fluid-filled sacs develop on the ovaries.

It is also known as or Stein-Leventhal syndrome.

Symptoms include changes to the menstrual cycle and excess hair growth. Untreated, it can lead to infertility and other complications. The exact cause is unknown.

Early diagnosis and treatment are recommended. Weight loss may also decrease the risk of associated health risks, such as insulin resistance, type 2 diabetes, high cholesterol, heart disease, and high blood pressure.

This article looks at the causes, symptoms, diagnosis, and treatment of PCOS.

Fast facts on PCOS

Here are some key points about PCOS. More detail and supporting information is in the main article.

  • PCOS is one of the most common hormonal endocrine disorders affecting 8-20 percent of women, many of whom do not have a diagnosis.
  • PCOS is linked to the development of other medical conditions, such as insulin resistance, type 2 diabetes, high cholesterol, high blood pressure, and heart disease.
  • More than half of women with PCOS develop type 2 diabetes before the age of 40 years.
  • Around 70 percent of ovulatory fertility issues are related to PCOS.

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Most women with PCOS grow a number of small cysts, or fluid-filled sacs, on their ovaries. The cysts are not harmful, but they can lead to an imbalance in hormone levels.

Women with PCOS may also experience menstrual cycle abnormalities, increased androgen (sex hormone) levels, excess hair growth, acne, and obesity.

In addition to the many health conditions associated with PCOS, which will be discussed in this article, PCOS is the most common cause of infertility in women - because it can prevent ovulation.

Women who can conceive with PCOS have a higher incidence of miscarriage, gestational diabetes, pregnancy-induced high blood pressure, preeclampsia, and premature delivery.

Currently, there is no known cause of PCOS. However, there are associations with excess insulin, low-grade inflammation, and genetics.

Risk factors

PCOS is thought to have a genetic component. People who have a mother or sister with PCOS are more likely to develop PCOS than someone whose relatives do not have the condition. This family link is the main risk factor.

Sugar is the body's primary source of energy, and it is regulated in the body by insulin, which is secreted by the pancreas. A person with insulin resistance is unable to use insulin efficiently. This causes the pancreas to go into overdrive secreting additional insulin to meet the body's glucose needs.

Excess insulin is thought to affect a woman's ability to ovulate because of its effect on androgen production. Research has shown that women with PCOS have low-grade inflammation that stimulates polycystic ovaries to produce androgens.

Associated health risks

There are several health risks associated with PCOS.

These include:

  • type 2 diabetes
  • infertility
  • high cholesterol
  • elevated lipids
  • sleep apnea
  • liver disease
  • abnormal uterine bleeding
  • high blood pressure
  • obesity possibly leading to issues with low self-esteem and depression
  • metabolic syndrome
  • nonalcoholic fatty liver (steatohepatitis)
  • depression and anxiety

Also, there is an increased risk of endometrial cancer, gestational diabetes, pregnancy-induced high blood pressure, heart attacks, and miscarriage.

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People with PCOS can have trouble gaining or losing weight.

Apart from cysts on the ovaries, symptoms of PCOS include:

  • irregular menses
  • excess androgen levels
  • sleep apnea
  • high stress levels
  • high blood pressure
  • skin tags
  • infertility
  • acne, oily skin, and dandruff
  • high cholesterol and triglycerides
    acanthosis nigricans, or dark patches of skin
  • fatigue
  • male pattern balding
  • insulin resistance
  • type 2 diabetes
  • pelvic pain
  • depression and anxiety
  • weight management difficulties including weight gain or difficulty losing weight
    excessive facial and body hair growth, known as hirsutism
  • decreased libido

No single test can determine the presence of PCOS, but a doctor can diagnose the condition through medical history, a physical exam that includes a pelvic exam, and blood tests to measure hormone, cholesterol, and glucose levels.

An ultrasound may be used to look at the uterus and ovaries.

There is no cure for PCOS, but treatment aims to manage the symptoms that affect an individual.

This will depend on whether the individual wants to become pregnant and aims to reduce the risk of secondary medical conditions, such as heart disease and diabetes.

There are several recommended treatment options, including:

Birth control pills: These can help regulate hormones and menstruation.

Diabetes medications: These help manage diabetes, if necessary.

Fertility medications: If pregnancy is desired, these include the use of clomiphene (Clomid), a combination of clomiphene and metformin, or injectable gonadotropins, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications. In certain situations, letrozole (Femara) may be recommended.

Fertility treatments: These include in-vitro fertilization (IVF) or inseminations.

Excessive hair growth may be reduced with the drug spironolactone (Aldactone) or eflornithine (Vaniqa). Finasteride (Propecia) may also be recommended, but it should not be handled by women who may become pregnant.

Anyone using spironolactone should use birth control, due to the risk of birth defects if taken while pregnant. Breast-feeding on this medication is not recommended.

Other possible options to manage hair growth is laser hair removal, electrolysis, hormonal treatments, or vitamin and mineral use.

Surgical options include:

  • Ovarian drilling: Tiny holes made in the ovaries can reduce the levels of androgens being produced.
  • Oophorectomy: Surgery removes one or both ovaries.
  • Hysterectomy: This involves removal of all or part of the uterus.
  • Cyst aspiration: Fluid is removed from the cyst.

There is no cure for PCOS, but some home and lifestyle interventions can make a difference and relieve some symptoms.

These include:

  • eating a healthy, well-balanced diet including plenty of fruits and vegetables
  • participating in regular physical activity
  • maintaining a healthy weight, to reduce androgen levels and reduce the risk of diseases such as diabetes and heart disease
  • not smoking, as this increases levels of androgens and the risk of heart disease

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PCOS can increase certain risks for pregnant women.

Women who are affected by PCOS may experience the effects throughout their lifetime.

There may be an increased risk of miscarriage, gestational diabetes, preeclampsia, and preterm births.

After delivery, there is an increased risk of the newborn being placed in the neonatal intensive care unit or death before, during, or soon after birth. These complications are more common in multiple births, for example, twins or triplets.

Symptoms such as excessive hair growth and male pattern baldness can last beyond menopause and may become worse.

With aging also comes the risk of the secondary health complications related to PCOS, including heart disease.

Conclusions

The causes of PCOS are unclear, but early diagnosis can help relieve symptoms and reduce the risk of complications. Anyone who may have symptoms of PCOS should see a doctor.