Diabetes: Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common hormonal condition in which women produce a surplus of androgens. This causes irregular ovulation, or even a lack of ovulation.

Androgens are sometimes called "male hormones." Men have very high levels of androgens, which are responsible for male body changes like hair growth and muscle mass. In women, androgens are necessary to make estrogen. Women with PCOS have androgen levels in the "high normal" range (for women). The additional androgen in these women can cause excessive hair growth and acne.

Excess androgen production also leads to irregular or absent ovulation, which the women experience as irregular or absent menstrual periods. Because of the problems with ovulation, women with PCOS may have difficulty becoming pregnant.

Many women with PCOS are resistant to the action of the hormone insulin. This means that it takes larger than normal amounts of insulin to maintain normal blood sugar levels. These women are at increased risk for diabetes and heart disease. High insulin levels caused by insulin resistance can lead to excessive androgen production.

PCOS affects approximately one of every 10 women.

What Causes PCOS?

The causes of PCOS are not completely understood. It is likely that a genetics tendency (heredity) is involved.

What Are the Signs and Symptoms of PCOS?

Women with PCOS can have a wide spectrum of signs and symptoms, from very mild to severe. They may include:

• Irregular or absent menstrual periods.
• Heavy vaginal bleeding. Ovaries make progesterone for two weeks following ovulation. At the end of that two weeks, the progesterone level drops and the lining of the uterus sheds. This is a normal period. If a woman does not ovulate, she will not make progesterone. The lining of the uterus can become thick, the cells making up the lining can become crowded (a condition known as hyperplasia, which can lead to uterine cancer), and the woman can experience very heavy and prolonged bleeding.
• Oily skin and acne.
• Acanthosis nigricans (darkening and thickening of certain areas of the skin, especially in skin folds).
• Excessive hair growth on the face, chest, abdomen or thighs.
• Thinning of hair on the crown of the head.
• Type 2 diabetes.
• Obesity.
• Cardiovascular problems, including high cholesterol.
• Multiple tiny ovarian cysts. Some women with PCOS have a large number of tiny follicle cysts (visible by ultrasound) on their ovaries.

How Is PCOS Diagnosed?

The diagnosis of PCOS is made based on physical signs and symptoms. Blood tests can be used to confirm the diagnosis and to direct management. Ultrasound is not useful for making the diagnosis of PCOS.

How Is PCOS Treated?

There is no cure for PCOS. Treatment depends on the particular patient's signs and symptoms, as well as her goals. Treatment options include:

• For women who are not ready to become pregnant, birth control pills are an excellent way to replace progesterone, establish regular periods, and lower androgen levels.
• If a woman wants to become pregnant, treatment is aimed at establishing regular ovulation.
• For women with PCOS and insulin resistance, medication to improve insulin sensitivity may be useful.

Can PCOS Be Prevented?

While PCOS cannot be prevented or cured, it can be controlled, with varying degrees of success, with healthy lifestyle choices. Like all women, women with PCOS can benefit from appropriate diet and exercise choices. Many women will experience improvement in the signs and symptoms of PCOS if they are able to maintain a healthy weight.

Reviewed by a doctor in The Cleveland Clinic Obstetrics and Gynecology Department.