What Is PCOS? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Since puberty, you’ve had to deal with the ebb and flow of your hormones. And when things are in balance, you generally feel good. Problems arise, though, when these hormones are imbalanced. One possible result: polycystic ovary syndrome (PCOS).

PCOS is a metabolic and hormonal disorder that affects about 10 percent of women. (1)

You’d think that with a name like PCOS, the condition would mean that women have cysts on their ovaries, but that’s not always the case. In fact, to be diagnosed with PCOS, a woman needs to meet two of the following three criteria, per guidelines from the Endocrine Society: (2)

• Androgen Excess This appears as hirsutism, which is when dark, coarse hair grows in unwanted places on the face and body; severe acne; and male-pattern hair loss.
• Ovulatory Dysfunction This the clinical name for irregular periods (most often this manifests as especially long cycles or absent cycles).
• Polycystic Ovaries Not every woman has cysts, but some women do. They are found on an ultrasound.

Unfortunately, about half of women who have PCOS have no idea. (1) Below are common symptoms of PCOS. Keep in mind that not all women have every symptom. If you’re experiencing any of the below, talk to your doctor, and ask about the possibility of PCOS:

• Irregular Periods Because of a lack of progesterone, periods don’t come regularly and the cycle is longer than it should be. (3) “Patients have unpredictable cycles and have about eight or fewer cycles per year,” says David A. Ehrmann, MD, director of the University of Chicago Center for PCOS.
• Infertility PCOS can impair the ovaries’ ability to develop and release eggs. (3) A woman may not even realize she has PCOS until she’s tried to get pregnant without success and goes to the doctor for a checkup.
• Hirsutism, Hair Loss, and Acne Excess hair growth on the face and body, male-pattern hair loss on the head, and acne may be some outward signs that tell doctors a patient has high androgen levels and she may have PCOS. (3)
• Weight Gain Half of women with PCOS gain unexpected weight or are obese. (3) Nonetheless, you don’t have to be overweight or obese to have PCOS, as it occurs in thin women as well, says Amy Medling, a certified health coach, founder of PCOS Diva in Nashua, New Hampshire, and author of Healing PCOS: A 21-Day Plan for Reclaiming Your Health and Life With Polycystic Ovary Syndrome.
• Mood Disorders Anxiety, depression, poor body image, and eating disorders are common in women who have PCOS, says Medling.
• Insulin Resistance Skin tags and dark, velvety patches of skin around the armpits, groin, and neck can be signs of insulin resistance, says Medling.
• Fatigue Sleep apnea, which can make you feel sleepy during the day, is commonly reported in women with PCOS. (3)

Learn More About Signs and Symptoms of PCOS

Considering that 10 million women around the world have PCOS, it may surprise you to know that experts still don’t know the exact cause. (3) As pointed out by Andrea E. Dunaif, MD, a professor of medicine in the Mount Sinai Health System in New York City, there’s a strong genetic link among women in families. For instance, if your sister was diagnosed with PCOS, you have about a 40 percent risk for having it, she says. Other potential causes include changes in utero, specifically exposure to a hormone called the anti-Mullerian hormone.

While factors like genetics are certainly not under your control, there are some problems and risk factors that bring out or worsen symptoms that you may be able to do something about, Dr. Ehrmann says. These include: (3,4,5)

• Stress
• Chronic inflammation
• Weight gain
• Insulin resistance
• Sleep apnea

Learn More About the Causes of PCOS: Common Risk Factors, Genetics, and More

For some patients, there’s a long road to diagnosis, in part because there’s no one test that diagnoses the condition. (6) Doctors will rule out other potential conditions to arrive at a PCOS diagnosis.

However, screening tests that may be used include a physical exam (to look for acne, excess hair growth, male-pattern hair loss, or weight gain), pelvic exam (to check the ovaries), pelvic ultrasound (to look for cysts and at the uterine lining), and blood tests (to examine hormone levels).

Prognosis of PCOS

There is no cure for PCOS. (6) Treatment includes managing symptoms, which will greatly improve your health and quality of life. This might include medications that address acne and hair growth, infertility treatments, and weight loss through a healthy diet and exercise habits. (3) If left untreated, PCOS can make it more likely that you’ll develop high blood pressure, high cholesterol, and insulin resistance, which increase your risk for heart disease and diabetes.

PCOS is expected to be a lifelong condition, given there is no cure. However, with proper treatment, it can be managed well, and some women report that their menstrual cycle becomes more regular as they approach menopause. (6) Still, you will likely experience symptoms beyond menopause as you age.

Since there is no cure for PCOS, doctors treat each symptom separately. Not every woman will receive the same treatment; it depends on which symptoms bother you the most and what your goals are, says Dr. Dunaif.

Medication Options

• Metformin (Fortamet) A medication that targets glucose production and insulin resistance, metformin is commonly prescribed as a type 2 diabetes treatment.
• Spironolactone This diuretic blocks excess male hormones. It is not safe to take in pregnancy.
• Birth Control Pills Combination (estrogen and progesterone) pills provide the right dose of hormones to regulate a woman’s cycle and help prevent complications like endometrial hyperplasia, says Dunaif.
• Clomiphene (Clomid) or letrozole (Femara) These ovarian-stimulating drugs are frequently prescribed when a woman wants to get pregnant.

Alternative and Complementary Therapies

• Weight Loss A modest amount of weight loss (about 5 percent) can help relieve symptoms and help a woman ovulate. (3)
• Anti-Inflammatory Diet Simmering inflammation can exacerbate symptoms, says Medling. A diet that features anti-inflammatory foods, such as fruits, vegetables, and omega-3s, will help calm things down, she says. A 2015 study noted that an anti-inflammatory diet helped the 100 overweight or obese participants with PCOS lose about 7 percent of their weight, which helped regulate menstrual cycles in 63 percent of the women. (7) Twelve percent also became pregnant.
• Lower Stress Chronic stress is another major player in inflammation levels, says Medling. What’s more, women diagnosed with PCOS are more likely to have depression, anxiety, and stress compared with women without PCOS. (8) Stress-reduction strategies — when used regularly — are critical for women with PCOS.
• Vitamin D Women who are deficient in vitamin D were less likely to get pregnant, research has suggested. A vitamin D supplement will get your stores back up to where they need to be. (9)
• Supplements The plant extract berberine has been shown to improve insulin resistance, as well as promote ovulation. (10) In addition, research has shown that chromium, a trace mineral, may help improve insulin sensitivity in women who are resistant to clomiphene (the ovarian-stimulating drug) after three months, while being better tolerated compared with metformin. (11) However, chromium was not superior to metformin in prompting ovulation or leading to pregnancy. Always talk to your doctor before starting any over-the-counter supplements.

Learn More About Treatment for PCOS: Medication, Alternative and Complementary Therapies, and More

PCOS Diet

What you eat can make a difference in providing a supportive environment for your body to get to a place of healing and balance, says Medling. Focus on these foods and eating strategies:

• Build your plate. Medling recommends that women eat a plate that’s half nonstarchy vegetables, one-quarter gluten-free grains, one-quarter lean protein, and a serving of healthy fat.
• Reach for omega-3s. Supplements and sources of oily fish like salmon can help reduce testosterone levels. (12)
• Grab a bigger breakfast. Eating most of your calories earlier in the day may improve insulin function. (13)
• Choose low-GI foods. Whole grains, along with fruits and veggies, are low on the glycemic index and can help keep your blood sugar steady. (14)
• Avoid food intolerances. Foods that bother your GI system will increase inflammation in your body, and a disturbance in your gut microbiome may be implicated in the development of PCOS. (15) This will be different for everyone, but gluten-containing foods, soy, and dairy are the most common sensitivities, says Medling.
• Go for a weight loss diet. Research has shown that a diet plan that helps you lose weight is more important than going high or low carb. (16)
• Work with an RD. Binge eating disorder is common among women with PCOS. (17) A registered dietitian specializing in eating disorders can help teach you strategies to build healthy eating behaviors.

Learn More About What to Eat for PCOS Management

Prevention of PCOS

PCOS can’t be prevented, but that doesn’t mean it’s out of your control. (18)

By managing symptoms and making healthy lifestyle choices, you can prevent the complications that arise from insulin resistance and high blood pressure, such as diabetes and heart disease.

Unfortunately for women who want to become pregnant, PCOS is a leading cause of infertility. (1) The good news is that it’s likely a treatable infertility. The hormonal imbalance impacts the development of eggs and often prevents ovulation. (3) And when you don’t ovulate, you can’t get pregnant. Because ovulation isn’t happening or seldom does, many women find that their menstrual cycles are irregular — or they won’t get their period at all. If you’re trying to get pregnant but experience especially long or absent cycles, talk to your doctor to rule out PCOS.

Remember how we said that this is treatable infertility? That’s because there are so many good treatments available. First, losing 7 percent of your body weight may be enough to balance out your hormones so that your body ovulates on its own, says Ehrmann. (Some resources suggest it’s as little as 5 percent) (3) After that, the first course of action is usually taking oral medication to stimulate ovulation. The most common is clomiphene, but the breast cancer drug letrozole is now often prescribed off-label, and research shows it may be even more effective, says Dunaif. (19) Injectable gonadotropins, which stimulate ovaries, too, are additional medication options.

Complications of PCOS also include a greater risk of diabetes due to insulin resistance. In fact, more than half of women with PCOS will have diabetes or prediabetes before age 40. High blood pressure and high cholesterol levels can increase the risk of heart disease and stroke, while sleep apnea is connected to heart disease and diabetes. Women with PCOS may be more likely to have depression and anxiety. And insulin resistance and ovulation irregularities are linked to endometrial cancer. (6)

PCOS is a common condition, affecting as many as 10 percent of adult women, or about 5 million women in the United States. PCOS can begin as early as age 11 or 12, as well as in the twenties or thirties. (20)  Research indicates that there may be two subtypes of PCOS: one that impacts hormonal levels required for ovulation and conception, and another more closely linked to metabolic problems and obesity. (21) PCOS is also a leading cause of infertility. (1)

Research published in 2018 concluded that there are no racial or ethnic influences on the prevalence of PCOS. (22) But another study, published in 2017, found that symptoms may differ among racial groups. (23) For example, compared with non-Hispanic Black women, Hispanic women were more likely to have a metabolic syndrome. Researchers concluded that Hispanic women had more severe cases, while non-Hispanic Black women had more mild disease.

PCOS is connected with other chronic health conditions. If you’re diagnosed, you’ll want to work closely with your providers to get the best treatment protocol for you, so you can reduce your risk of possible complications, including:

Obesity

Half of women with PCOS gain weight or are obese. (3) This extra weight is often carried around the waist. (20) If you are overweight or obese, losing as little as 5 percent of your body weight can make a measurable difference in your symptoms. (3) Clinicians often recommend doing this with a healthy diet and exercise plan.

Type 2 Diabetes

When you’re already dealing with a hormonal condition, the last thing you want to do is face another medical problem. But due to insulin resistance in PCOS, women with the condition have 4 times higher odds of developing type 2 diabetes, research reports. (24)

Talk to your doctor about taking a fasting glucose, A1C, or oral glucose tolerance test. Keeping your weight in a healthy range, doing strength training, and eating a diet that controls blood sugar can help prevent the development of prediabetes and diabetes. (25)

Learn More About How Type 2 Diabetes and PCOS Are Associated

Anxiety and Depression

Women with PCOS are more at risk of depression and anxiety. (9) The symptoms of PCOS are a disruption to life. For example, seeking treatment for infertility when you want to have a baby can weigh heavily on you. Acne, excess hair growth or loss, and weight gain can also be distressing.

Heart Disease

If you have PCOS, you’re also at risk for high blood pressure, high LDL (“bad”) cholesterol, and sleep apnea — all factors that contribute to heart disease. (20)

What Are Some Common PCOS Myths You Shouldn’t Believe?

There are many rumors swirling about PCOS, from what it is, to who gets it, to questionable symptoms and risky treatments.

Here are the top PCOS myths you should be aware of:

Myth You have to have polycystic ovaries to have PCOS.

Fact Many women with PCOS don’t have cysts on their ovaries. The reverse is true, too: If you have cysts, you don’t necessarily have PCOS, says Ehrmann. That’s part of the reason why some experts have made a push to rename PCOS as the “reproductive metabolic syndrome,” he says.

Myth Every woman grows hair where they don’t want it.

Fact This differs widely between women, depending on their ethnicity, says Loren Wissner Greene, MD, a clinical professor at NYU Langone Health in New York City. In addition, not every woman has every PCOS symptom.

Myth You can’t get pregnant if you have PCOS.

Fact Fertility treatments can give women with PCOS a chance at having the families they want. What’s more, some of these women get pregnant naturally.

Myth If your menstrual cycle is irregular, you have PCOS.

Fact There are other reasons for a cycle that runs too long or is absent, including breastfeeding, extreme dieting, overexercising, pelvic inflammatory disease, uterine fibroids, and thyroid disorders. (26)

Myth If you’re not looking to get pregnant, you don’t have to worry about PCOS.

Fact PCOS increases the risk of complications like type 2 diabetes, high blood pressure, poor cholesterol levels, sleep apnea, depression and anxiety, and endometrial cancer. (27)

Myth Women with PCOS can lose weight like anyone else.

Fact Women with PCOS often have more trouble losing weight. A doctor who tells a woman to simply diet and exercise is taking too narrow of a view. Talk to your doctor about whether medication options are right for you.

Myth You need an ultrasound to be diagnosed.

Fact Because cystic ovaries are not necessary for a diagnosis, you don’t always need an ultrasound.

Myth Everyone with PCOS is overweight.

Fact While weight gain is often a problem, there are thin women with PCOS, says Medling. The belief that all women with PCOS are overweight or obese makes it more likely that a normal-weight woman will go undiagnosed.

Myth Insulin resistance in PCOS causes weight gain.

Fact Experts aren’t exactly sure why women with PCOS are often overweight, says Ehrmann. But it’s important to know that weight gain contributes to insulin resistance — not the other way around.

Myth You always know if you have PCOS.

Fact So many of the symptoms — acne, hair loss, mood disorders — can happen for all sorts of reasons. And if you see multiple doctors for each concern, it’s common that PCOS may be missed.

Myth Every woman with PCOS should go on birth control pills.

Fact It may not be right for every woman, and it’s not a magic pill that will fix all symptoms, especially if you’re looking to get pregnant.

Myth PCOS is a life sentence.

Fact The hard truth is that there is no cure, but Medling says that with some work and focus on caring for yourself, you can feel better and live more in harmony with PCOS.

Learn More About Common Misconceptions About PCOS

Favorite Orgs for PCOS Info

PCOS Awareness Association

This is the first resource to check out for a comprehensive overview of PCOS, as well as information on receiving a diagnosis and available treatments.

American College of Obstetricians and Gynecologists

Its website’s FAQ section is filled with a wealth of important info, including breaking down (often complex) hormonal info, fertility options, and the role of hormonal birth control pills in managing PCOS symptoms.

Favorite Online Support Network

PCOS Challenge (National PCOS Association)

Locate PCOS support and resources. PCOS Challenge connects you to forums, groups, blogs, videos, and healthy living advice for women living with the syndrome. Go here for help coping with PCOS in an empowering way.

Favorite Book About PCOS Management

Healing PCOS: A 21-Day Plan for Reclaiming Your Health and Life With Polycystic Ovary Syndrome by Amy Medling

If you’ve felt down about your diagnosis, this book will help you regain your power. Learn to make necessary diet and lifestyle changes, with an emphasis on anti-inflammatory eating and stress reduction strategies, that will help ease your symptoms.

Favorite App About PCOS

AskPCOS

Developed by Monash University, in part with experts and women with PCOS, this app includes a self-diagnostic quiz, information on PCOS, expert videos and infographics, and a list of questions to use when talking to your doctor.