Polycystic Ovarian Syndrome (PCOS), first officially identified in 1935 by Chicago gynecologists, Stein and Leventhal is characterized by irregular menstrual periods in women, facial hair growth, acne, thinning hair, and weight gain around the abdomen. Individuals with the condition often have enlarged ovaries, containing multiple liquid-filled cysts. Recognized as an endocrine disorder affecting the balance of male and female hormones, historically doctors explored ways to treat patients, initially considered infertile.^[1] Today, according to the American Society for Reproductive Medicine, as many as 15% to 20% of women suffer with PCOS.^[4] About 40% of those women have difficulty with fertility. In fact, PCOS remains the leading cause of infertility in the United States.^[2]

What is the cause of PCOS?

Referred to as “polycystic”, meaning “many cysts” PCOS often presents with ovaries containing several small, pearl-sized cysts. These consist of immature eggs and are filled with fluid. The actual cause of polycystic ovarian syndrome (PCOS) is not fully known however. One theory suggests that some women with the condition do not respond well to insulin in the body. This, “insulin resistance” may lead to the overproduction of male hormones known as, “androgens”. These hormones are responsible for the presence of male characteristics such as facial hair growth, and male-pattern baldness. PCOS is thought to be hereditary and the chances of having polycystic ovarian syndrome are much greater if a mother, sister, or biological aunt have the condition.^[5]

PCOS Symptoms Overview

Polycystic ovarian syndrome is a collection of symptoms ranging in severity depending on the individual.

PCOS symptoms may include:

• Absence of menstrual periods/irregular menstrual periods
• Infertility
• Facial hair growth or excessive/unwanted hair growth (hirsutism)
• Male-pattern baldness/thinning hair
• Weight gain (especially in the waist)
• Acne
• Darkening of skin in neck creases, under breasts, or in the groin
• Skin tags^[3]

Secondary conditions associated with PCOS include:

• High blood sugar levels
• Insulin resistance
• Diabetes
• Issues with heart and blood vessels
• Cancer of the uterus
• Sleep apnea
• Heart disease
• Depression and anxiety
• Liver inflammation
• Gestational diabetes^[5]

How is PCOS diagnosed?

Physical exam—A healthcare practitioner may suspect PCOS based on a physical examination whereby excess unwanted hair, acne, belly fat, skin discoloration or thinning scalp hair is visibly detected.

Pelvic exam—A pelvic exam may reveal an enlarged clitoris or swollen/ enlarged ovaries.

Pelvic ultrasound (sonogram)—Sound waves are used to check the ovaries (for cysts) and the uterine lining.

Blood testing—Hormone tests may be conducted to determine the level of androgens (male hormones) in the body. Cholesterol and diabetes tests may also be run. Other hormone testing may be done to rule out other health problems such as thyroid disease.^[5]

When does PCOS begin?

Polycystic ovarian syndrome may present during first menstruation, or later after considerable weight gain. PCOS symptoms may also increase in severity with obesity as well.^[5]

What PCOS treatments are available?

Treatment for the condition is based on specific PCOS symptoms, age, and a woman’s future plans for pregnancy.

PCOS treatments may include:

• Oral contraceptives to help regulate menstruation
• Laparoscopic ovarian drilling for infertility
• Medications to promote insulin sensitivity
• Inducing ovulation through hormone therapy
• Medication to block androgens
• Medication to prevent hair growth
• Laser hair treatment
• Hair loss treatment
• Skin treatment for acne
• Skin treatment for dark patches
• Skin tag removal
• Nutrition/Weight loss^[5]

How does a healthy lifestyle help treat PCOS symptoms?

Because insulin resistance is associated with PCOS it is important to adopt a diet low in refined carbohydrates. Exercise can also be beneficial in helping to regulate blood sugar levels and maintain a healthy weight. In some instances, changes in diet and exercise may be enough to stimulate regular ovulation and menstruation.

Long-term Impact of PCOS

Although there is no cure for PCOS, the condition and many of its symptoms are treatable. In fact, most women who are infertile because of polycystic ovarian syndrome are able to successfully conceive with the help of medical treatment.

Over the course of a lifetime, more than half of women with polycystic ovarian syndrome will get diabetes. They will also be at greater risk for certain cancers and heart disease. Although menstrual cycles may stabilize as women age, the primary hormonal imbalance associated with PCOS will remain. While polycystic ovarian syndrome affects many systems throughout the body, through healthy lifestyle changes and medical intervention, most PCOS symptoms can be successfully managed.