What Is PCOS?
Polycystic ovary syndrome ( PCOS) is a hormonal condition that affects your ovaries, the female reproductive organs that make eggs. It affects about 1 in every 10 women (and people assigned female at birth) who are of childbearing age. It's one of the most common causes of infertility.
- Stop your periods or make them hard to predict
- Cause acne and unwanted body and facial hair
- Raise your risk for other health problems, including diabetes and high blood pressure
Some people with PCOS have cysts (small sacs of fluid) on their ovaries. That’s why it’s called “polycystic.” But the name is a bit misleading because many people with the condition don’t have cysts. In fact, many don’t have symptoms at all. That's one reason why up to 70% of those with PCOS don’t know they have it.
The condition starts after puberty, but may not be diagnosed until you’re trying to get pregnant.
It never goes away, but symptoms usually get better after menopause. In the meantime, several treatments can relieve the symptoms or help you get pregnant.
PCOS vs. PCOD
Polycystic ovary disease (PCOD) is another, older name for PCOS. PCOS has also been called Stein-Leventhal syndrome.
Endometriosis vs. PCOS
When you have endometriosis, the type of tissue that lines your uterus grows in places it shouldn't, such as your vagina or ovaries. Each month, this tissue can break down and bleed. Like PCOS, endometriosis can cause cysts in your ovaries and may lead to infertility. Its main symptoms are cramps and pain in the belly area. Unlike PCOS, it doesn't cause symptoms such as acne or excess body hair.
Types of PCOS
Some scientists propose dividing PCOS into types based on symptoms and hormone levels:
- Non-hyperandrogenic PCOS, or type D: You have problems with ovulation (which can lead to irregular periods or loss of periods) and cysts on your ovaries. But your levels of androgens (male hormones) are normal.
- Ovulatory PCOS (type C): You have increased levels of androgens along with cysts on your ovaries.
- Non-PCO PCOS (type B): You have high levels of androgens as well as problems with ovulation.
- Full-blown PCOS (type A): You have high levels of androgens, problems with ovulation, as well as cysts on your ovaries.
Informally, you might hear people describe it using other terms that refer to its causes or symptoms:
- Insulin-resistant PCOS. Often, those who have PCOS also have insulin resistance, which is when your body makes the hormone insulin but can't use it correctly. Insulin resistance increases your risk for type 2 diabetes.
- Inflammatory PCOS. Inflammation results when your immune system tries to fight off a threat.Research has linked PCOS to low levels of inflammation throughout the body. This could cause or worsen symptoms. Conditions such as insulin resistance and obesity contribute to inflammation.
- Hidden-cause PCOS. Some websites use this term to refer to PCOS for which the cause isn't known. But this is true of PCOS in general. Scientists don't know what causes the condition, though they believe that both your genes and environmental factors play a role.
- Pill-induced PCOS or post-pill PCOS. The pill and other hormonal birth control methods don't cause PCOS. But when you stop using this type of birth control, you could temporarily have irregular periods or other symptoms that look like those of PCOS. Hormonal birth control can also mask the symptoms of PCOS. So you might not be diagnosed with it until you go off birth control. Doctors sometimes prescribe hormonal birth control to treat PCOS symptoms.
PCOS and Hormones
Your body makes many types of hormones. Hormones are chemical messengers that help control many body functions. Some affect your menstrual cycle and are tied to your ability to have a baby. When you have PCOS, your reproductive hormones are out of balance. Several hormones play a role in PCOS.
PCOS insulin resistance
Insulin is a hormone that manages your blood sugar levels. Scientists estimate that 30%-80% of those with PCOS have insulin resistance. When your body doesn't react to insulin as it should, you can end up with too much insulin in your body. Some researchers think this excess insulin plays a role in causing your body to overproduce androgens.
Other hormones involved in the syndrome include:
- Androgens. They’re often called male hormones, but everyone has them. When you have PCOS, your ovaries make more androgens than usual. This can keep your ovaries from releasing eggs on their monthly schedule and cause irregular periods. Extra androgens are responsible for many PCOS symptoms, including acne, hair loss, and unwanted hair growth.
- Follicle-stimulating hormone. This hormone helps prepare your body for ovulation and helps control your menstrual cycle.
- Luteinizing hormone. This also helps regulate your monthly cycle, triggering your ovaries to release eggs.
- Progesterone. With PCOS, your body may not have enough of this hormone. So you might miss periods for a long time or have trouble predicting when they’ll come.
- Estrogen. When you have PCOS, your levels of estrogen may be too high in relation to your progesterone levels.
What are the first signs of PCOS?
Polycystic ovary syndrome isn't actually a disease but a set of symptoms. These symptoms can vary from person to person. But the most common signs of PCOS are missed, irregular, infrequent, or too-long periods.
Other possible signs of PCOS include:
- Hair loss. PCOS can cause the hair on your head to get thinner, especially if you're middle-aged or older.
- Excess face and body hair (hirsutism). At the same time, hair may grow in places you don’t want it, like your face, chest, belly, arms, fingers, and toes.
- Oily skin. Extra androgens can lead to oilier skin.
- Acne. You might have breakouts on your face, chest, and/or back.
- Darkened skin. Patches of skin that look darker than the surrounding area can show up under your breasts or arms, or on your neck.
- Skin tags. These little flaps of excess skin most often appear on your neck or armpits.
- PCOS pain. You may have pain in your lower-belly (pelvic) area during your period and occasionally at other times.
- Weight gain (PCOS belly). About 50% of those with PCOS have weight gain, especially in the abdominal (belly) area.
- Ovarian cysts. When you have an ultrasound, your doctor might notice that your ovaries look bigger or have lots of egg sac cysts (follicles).
- Mood changes. PCOS raises your risk of mood swings and feelings of depression or anxiety. This can be caused by hormonal changes as well as the strain of dealing with PCOS symptoms.
Can you have PCOS without symptoms?
Sometimes, PCOS doesn't cause any symptoms, or they're so minor that you don't notice them. For that reason, and because many other issues can cause similar period problems, it may take a while to get a PCOS diagnosis.
Doctors don’t know exactly what causes the syndrome. But things that are thought to be involved include:
- Excess weight. The link between weight and PCOS is complicated. Weight gain plays a role in the development of the condition. But PCOS can alsocontribute to weight gain.
- High levels of androgens. This condition, called hyperandrogenism, affects most people with PCOS.
- Insulin resistance. Extra insulin can affect your ovaries and their ability to release eggs (ovulate). It can also make it easier to gain weight and harder to lose it.
- Long-term, low-grade inflammation. This also contributes to your body's overproduction of androgens.
Is PCOS genetic?
The genetic link to PCOS isn't clear, but you're more likely to get it if your close relatives also have it. Some 20%-40% of those with PCOS have a mother or sister with the condition. This may be related to similar lifestyles as well as to genes.
PCOS Risk Factors
Risk factors for PCOS include:
- A family history of menstrual problems or disorders (including PCOS)
- Type 2 diabetes
- Being overweight or obese
- Fast weight gain
Transgender men (also known as female-to-male transsexual people, or FTMs) are prone to PCOS. Hormone therapy may or may not be a reason for that, as so many other factors come into play. Some studies have shown that while hormone therapy can cause changes to the ovaries of transgender men, it doesn’t necessarily cause PCOS.
What Are the Complications of PCOS?
When you have PCOS, you have higher odds of having several other health problems, such as:
- Trouble getting pregnant. Hormonal imbalances can interfere with ovulation. If no healthy egg is available to be fertilized by a sperm, you can’t get pregnant. However, you may still be able to get pregnant despite having PCOS. For that, you might need to take medicine and work with a fertility specialist.
- Pregnancy complications. Most people with PCOS can have a healthy pregnancy. But the condition raises your risk for diabetes (gestational diabetes) and high blood pressure (preeclampsia) during pregnancy. It also increases the risk of preterm delivery, a cesarean section delivery, and miscarriage.
- Insulin issues and diabetes. When you have insulin resistance, the cells in your muscles, organs, and other tissues don’t absorb blood sugar very well. So you end up with excess sugar in your bloodstream. Insulin resistance doesn't usually cause symptoms until blood sugar levels get so high that you have diabetes. More than half of those with PCOS will get type 2 diabetes by the time they're 40.
- Metabolic syndrome. This group of symptoms raises your risk of cardiovascular disease. The symptoms include high triglyceride and low HDL (“good”) cholesterol levels, high blood pressure, and high blood sugar levels.
Other possible complications include:
You may be diagnosed with PCOS if you have at least two of these symptoms:
- Periods that aren't regular
- Signs your body is making extra androgens, such as acne, excess facial and body hair, or a blood test that shows high androgen levels
- Ovarian cysts or enlarged ovaries that show up on an ultrasound
How to get tested for PCOS
No single test can diagnose PCOS. Your doctor will start by asking about your symptoms and medical history. They'll do a physical exam to look for symptoms such as acne and facial and body hair.
They may also do a pelvic exam. For this test, they place a gloved hand inside your vagina, then feel your reproductive organs to see if your ovaries are enlarged or if there are other abnormalities.
They may also do an ultrasound, an imaging test that shows them whether you have cysts and measures the lining of your uterus. For a transvaginal ultrasound, your doctor places a wand in your vagina that uses sound waves to create images of your reproductive organs.
You might also have a blood test to check your levels of androgens and other hormones.
Other tests you might get
If your doctor thinks you have PCOS, they may want you to get checked for other health conditions that aren't linked to PCOS. This might involve:
- Blood pressure testing
- Blood tests for sugar, cholesterol, and triglyceride levels
- Mental health screening
- Screening for sleep apnea
There's no cure for PCOS. The medical treatment that your doctor recommends to manage your symptoms depends on whether you're trying to get pregnant. It's important to talk to your doctor about this because certain medications can harm a developing baby.
They might prescribe:
- Hormonal birth control. If you aren’t planning to get pregnant, your doctor might prescribe hormonal birth control, such as the patch, pill, shot, or hormonal IUD. They might contain estrogen, progesterone, or both. They can get your periods on track, help with acne and extra body hair, and lower your risk of endometrial cancer.
- Progestin therapy. This hormone can help normalize your menstrual cycle and reduce your odds of uterine cancer. It doesn't prevent pregnancy or reduce levels of androgens.
- Insulin-sensitizing medications. Metformin, a drug used to treat type 2 diabetes, helps lower insulin and androgen levels. While it's not FDA-approved to treat PCOS, it can help with ovulation and period problems.
- Androgen blockers. These drugs block the effects of the extra male hormones that cause issues such as unwanted hair growth and acne. But don't take them if you're pregnant or plan to get pregnant, because they can cause birth defects. While you're on them, you should use two different types of birth control.
If you have acne that bothers you, a dermatologist can prescribe creams and/or pills to treat and prevent breakouts.
Excessive hair growth
If you want to reduce facial or body hair, other options include:
Electrolysis or laser therapy: Electrolysis removes individual hairs with an electric current that destroys the root. Laser therapy destroys hair follicles. You'll need several sessions. While some hair may come back, it should be finer and less noticeable.
Depilatories: These over-the-counter creams, gels, and lotions break down the protein structure of hair so it falls out of the skin. Follow the directions on the package.
PCOS and Pregnancy
Getting pregnant with PCOS
It's possible to get pregnant when you have PCOS. But you might need medication to help you ovulate or use fertility technologies such as in vitro fertilization.
Medicines to help you ovulate
If you need help ovulating to get pregnant, certain medicines may help:
- Clomiphene (Clomid, Serophene), an antiestrogen drug you take at the beginning of your cycle.
- If clomiphene doesn’t help with ovulation, you may be prescribed the diabetes drug metformin.
- If clomiphene and metformin don’t work, your doctor may prescribe hormonal medications called gonadotropins. You get this medicine in a shot.
- Letrozole (Femara), which is sometimes used when other medications don’t work.
Other options to improve your fertility are:
Surgery: A procedure called ovarian drilling might make your ovaries work better when ovulation medications don't. But doctors do it less often than they used to, as better medications are available now. The surgeon makes a small cut in your belly and removes the parts of your ovaries that make too many androgens.
In vitro fertilization, or IVF: In this procedure, your doctor removes one of your eggs from your body and combines it with sperm from your partner or a donor. They then place the fertilized egg back inside your uterus. This may be the most effective way to get pregnant when you have PCOS, but it can be expensive.
Talk to your doctor about how you could increase your chances for a healthy pregnancy, including lifestyle changes before you conceive.
Diet and Lifestyle Changes for PCOS and Fertility
A healthy lifestyle that includes weight control, regular exercise, and blood sugar control can help improve your PCOS symptoms and your fertility.
Not everyone who has PCOS is overweight, but many are. Gaining a lot of weight can affect your hormones. If you’re obese or overweight, losing weight may help get your hormones back to normal levels. Losing just 10% of your body weight may help your menstrual cycle become more predictable.
Your doctor may recommend choosing foods lower in calories and fat and controlling portion sizes. But losing weight isn't easy. A nutritionist or dietitian may be able to help. Also, some people find that keeping a journal or using an app to track meals and snacks can make things easier.
To manage your blood sugar, your doctor may suggest focusing on foods that are lower in sugar and certain carbohydrates (carbs). Some carbs are good for you, such as those in high-fiber vegetables and fruits. But it's best to limit refined carbs, such as those found in white flour, white rice, white potatoes, sugar, and highly processed foods. These foods have a high glycemic index, which means they make your blood sugar rise quickly.
Other healthy foods, such as poultry and other lean meats, fish, and whole grains, can help with your blood sugar levels, too. Try to have regular meals, as sticking to a schedule helps your body maintain consistent insulin levels.
Regular exercise burns calories and increases muscle mass. This can help decrease insulin resistance, which can lower your androgen levels and help with symptoms. Exercise can also boost your mood and self-esteem.
Getting enough sleep
Lack of sleep can play a role in hormone imbalances, insulin resistance, and weight gain. Set the stage for restful sleep by:
- Going to sleep and waking up at about the same time each day
- Avoiding screens close to bedtime
- Making sure your bedroom is dark, cool, and quiet
If you often have trouble getting at least 7 hours of sleep a night, talk to your doctor.
A condition such as PCOS can be stressful. In turn, stress might make PCOS symptoms worse. Your body makes cortisol (the so-called stress hormone) from progesterone and other hormones. This can upset the balance of these hormones in your body. Stress can also contribute to weight gain and depression, which are common challenges for people with PCOS. Exercise can help, and so can stress-management techniques such as breathing exercises and mindfulness meditation.
While moderate levels of caffeine (up to about 4 cups of coffee a day) are fine, more than that might affect your sleep and maybe even your hormonal balance. Ask your doctor whether you should cut back on caffeine.
Avoiding endocrine disruptors
Chemicals called endocrine disruptors are thought to cause hormone imbalances and might even be linked to PCOS. Some common ones are biphenols (including BPA), parabens, phthalates, and triclosan. They’re found in plastics, cosmetics, industrial chemicals, and pesticides. They can also contaminate food, water, soil, and air. It's difficult to avoid these common chemicals. But some possible ways to reduce your exposure include:
Avoid products that contain fragrance
Store food in glass or stainless steel containers instead of plastic ones
Avoid food from cans lined with BPA
Wash your hands often, especially before you eat
Use a vacuum with a HEPA filter
Alternative Medicine for PCOS
While no alternative treatments have been proven to help with PCOS symptoms, a few studies have found evidence that some might have benefits.
Herbs and supplements
A 2014 review of 33 studies found some evidence that these herbal medicines might help with PCOS symptoms:
- Chaste tree berry
- Black cohosh
- Tribulus terrestris, a plant used in Eastern medicine
- Licorice plant
- Licorice plant combined with Chinese peony
The findings were strongest for chaste tree berry and black cohosh. But the researchers noted that we need more and better research into these possible benefits.
A 2017 review of 24 studies looked at 11 herbs and supplements to see whether they might help with PCOS symptoms or complications.
It found possible benefits for:
- Inositol, a type of sugar found in many plant foods
- Omega-3 fish oil supplements
However, the researchers warned that the scientific evidence for these is weak.
The review found little evidence of benefits for:
- Vitamin D
- Vitamin D plus calcium
- Vitamin B complex
- Black cohosh
- Chamomile tea
- Green tea
A few other studies have found that berberine, a compound found in plants such as goldenseal, may help improve fertility and insulin resistance in people with PCOS. But we need more and better research into this.
Keep in mind that the FDA doesn't regulate dietary supplements for effectiveness or safety. Always talk to your doctor before starting a new supplement. Ask about their potential side effects, interactions with medications you take, and the latest research about their effectiveness.
Spearmint tea for PCOS
Some studies have found that regularly drinking tea made from spearmint leaves could help balance hormone levels in those with PCOS. It may also reduce the growth of excess facial and body hair. The tea is caffeine-free, so you might try drinking 2-3 cups a day to see if it helps with your symptoms. But talk to your doctor first, especially if you're pregnant, trying to get pregnant, or have other health conditions.
Acupuncture for PCOS
Acupuncture is a type of complementary medicine in which a practitioner inserts thin needles into specific points on your body. Some studies have found it may help regulate hormones and ovulation and reduce insulin resistance in those with PCOS. But other researchers say there's not yet enough good evidence that it works as a treatment for PCOS.
PCOS and Menopause
Period-related PCOS symptoms often improve as menopause approaches. Your ovaries no longer work after menopause, so your androgen levels go down. And because you don't have periods anymore, irregular ones aren't a problem.
But your androgen levels might still be higher than normal, so you might still have other symptoms. Further, your odds of developing PCOS complications such as diabetes and metabolic syndrome go up as you get older.
Polycystic ovary syndrome (PCOS) is a hormonal condition that affects the ovaries. It interferes with your menstrual cycle and is a common cause of infertility. However, treatments can improve symptoms and help you conceive.
How would I know if I have PCOS?
The most common symptoms are irregular periods, acne, excessive hair growth, and trouble getting pregnant. But some people don’t have any of these symptoms. If you think you might have PCOS, talk with your doctor.
Does PCOS go away?
PCOS never fully goes away, but the symptoms can improve over time or with treatment. For example, menopause can cause hormonal changes that relieve PCOS symptoms.
Can I get pregnant with PCOS naturally?
Those with PCOS often have a hard time getting pregnant, but several treatments can help. When you have PCOS, you still release eggs (and get periods) occasionally, but this can be irregular and hard to time. That makes it difficult, but not impossible, to get pregnant without the help of treatment.