PCOS: Symptoms, Diagnosis and Treatment

Polycystic ovary syndrome, or PCOS, is a common hormone and metabolic condition^1,3. It can affect health from the teen years through later life^1,3. Symptoms and their effects may change over time^3,6.

This guide explains polycystic ovary syndrome (PCOS). It describes common symptoms, how doctors diagnose the condition, and available treatments in clear terms. It covers periods, androgen levels, fertility, metabolic health, and emotional well-being.

PCOS symptoms vary greatly between people^3,6. Some people notice mild changes, while others have major effects on daily life. Care can focus on present concerns, health risks, and pregnancy goals^1,5.

PCOS is among the most common hormone disorders in women of reproductive age^1,3. It affects an estimated 10% to 13% of reproductive-aged women^1,3. Up to 70% of affected women worldwide may not know they have it³.

PCOS can start during the teen years and last beyond the reproductive years^1,3. It has reproductive, metabolic, and mental health features¹. Each person may have a different mix of these features^1,3.

PCOS may involve high androgen activity and irregular ovulation^1,3. It may also involve insulin resistance or changes in ovarian follicles^1,3. Androgens are hormones found at lower levels in women than men.

High androgen activity can affect periods, ovulation, skin, and hair growth^3,6. Ovulation happens when an ovary releases an egg. With PCOS, eggs may not grow or leave the ovary on a regular schedule.

Insulin helps the body use sugar for energy⁸. Insulin resistance means the body does not respond well to insulin^6,8. Higher insulin levels may raise androgen production and disrupt ovulation^6,8.

PCOS can occur after puberty and may be found at many life stages^1,8. Women with PCOS may have irregular periods or infertility^3,8. A family history of PCOS or type 2 diabetes may raise the risk^3,6.

Symptoms can be mild and may go unnoticed^6,8. Some people first seek care after they have trouble becoming pregnant. Others can seek help to manage changes in their periods, skin, or hair^3,6.

The name polycystic ovary syndrome can cause confusion. Some women with PCOS do not have ovaries that look polycystic^3,8. Ovarian cysts are not required for a PCOS diagnosis³.

Ultrasound changes may show many small follicles that contain immature eggs. Large ovarian cysts are not a sign of PCOS. Doctors therefore assess more than ovarian appearance alone^3,9.

The exact cause of PCOS is not known⁸. Genes, insulin resistance, and androgen activity may play roles^6,8. These factors may affect hormone signals and ovulation^6,8.

PCOS can run in families^3,6. Having a mother or sister with PCOS may raise a woman’s risk. A family history of type 2 diabetes is also linked with greater risk³.

The body may make more insulin when its cells respond poorly. High insulin levels can lead the ovaries to make more androgens⁸. Increased androgen activity can then block normal egg release⁸.

Insulin resistance can occur without obesity. Obesity may raise insulin levels and make PCOS symptoms worse. Care should still avoid blame and weight stigma¹.

PCOS care does not always meet each person’s needs¹. Personal traits, values, culture, and needs should guide care choices¹. Shared decisions can help create a more useful care plan¹.

PCOS symptoms may affect periods, fertility, hair, skin, weight, and mood^3,6. The type and strength of symptoms can differ between people^3,6. Symptoms can also change over time^3,6.

PCOS may cause periods that are infrequent, unpredictable, or absent³. Some people have periods that are long, painful, or heavy^3,6. Periods may sometimes occur more often than expected.

Period and fertility changes may include these patterns:

Anovulation means that an ovary does not release an egg. PCOS is a leading cause of anovulation and infertility³. However, not everyone with PCOS has trouble becoming pregnant.

High androgen activity can affect body hair, scalp hair, and skin^3,6. Hirsutism means coarse, dark hair growing in a typical male pattern. It may affect the face, chest, back, stomach, or thighs^6,8.

Other PCOS symptoms can include lasting acne and oily skin^3,6. Female-pattern hair loss may cause thinning on the scalp^3,4. The pattern and strength of these signs can vary³.

People often remove unwanted hair before a medical visit. Their reports about hair growth still deserve close attention. Signs of high androgen activity may differ across ethnic groups⁹.

A blood test may show high androgen levels without clear physical signs^3,9. Physical signs may also appear when blood androgen levels seem normal. Doctors consider both visible signs and test results^3,9.

Some women with PCOS gain weight, often around the abdomen^3,7. PCOS is linked with insulin resistance and a higher type 2 diabetes risk³. High blood pressure and high cholesterol can also occur³.

Acanthosis nigricans is dark, thick, or velvety skin in body folds^6,8. It can appear on the neck, groin, armpits, or beneath the breasts^6,8. This skin change may be a sign of insulin resistance.

PCOS is also linked with obstructive sleep apnea^1,3. A clinician may screen for this sleep condition during follow-up. Screening needs depend on the person’s symptoms and health history.

PCOS can affect mood and quality of life^1,3. Anxiety, depression, eating disorders, and poor body image may occur³. Stigma around weight, infertility, acne, or unwanted hair may add distress³.

No single test confirms every case of PCOS. A PCOS diagnosis uses health history, an exam, blood tests, and selected imaging. Doctors must also rule out other causes^3,4.

Adults generally need two of three features after other causes are ruled out^3,4,9. The first feature is irregular ovulation or menstrual cycles^3,9. The second is clinical or biochemical hyperandrogenism^3,9.

Clinical hyperandrogenism means visible signs of high androgen activity⁹. These signs may include hirsutism, acne, or female-pattern hair loss³. Biochemical hyperandrogenism means blood tests show high androgen levels^3,9.

The third feature involves ovarian follicles^1,9. It may appear on ultrasound or through a high anti-Müllerian hormone level^1,9. Anti-Müllerian hormone is often shortened to AMH.

The three main diagnostic features are listed below:

A doctor may ask about periods, fertility, medicines, and weight changes. The exam may check hair growth, acne, scalp hair, and insulin resistance signs. A pelvic exam may check the reproductive organs for other changes.

Blood tests may measure total and free testosterone^1,9. These tests help assess high androgen levels in the blood^1,9. A free androgen index can estimate free testosterone.

Other androgen tests may be considered when testosterone levels are normal⁹. These can include androstenedione and dehydroepiandrosterone sulfate⁹. The second hormone is often called DHEAS.

A progesterone blood test can help confirm a lack of egg release^4,9. This test may help when cycles seem regular despite possible ovulation problems. The choice of tests depends on the signs being assessed.

A pelvic ultrasound can view the ovaries and uterine lining. In adults, it may show an ovarian follicle pattern linked with PCOS^3,9. A vaginal ultrasound gives the most accurate view of the ovaries⁹.

Ovarian follicles can be assessed by ultrasound⁹. In some adults, an AMH test may replace ultrasound^1,9. For adults, the ultrasound follicle-count cutoff is at least 20 follicles in an ovary⁹.

Ultrasound or AMH is not needed in some adults^4,9. This applies when irregular cycles and hyperandrogenism are both clear^4,9. In that setting, those two features can support diagnosis after other causes are excluded^4,9.

PCOS is a diagnosis of exclusion. This means doctors check for other causes before confirming PCOS. Thyroid disease, high prolactin, and certain adrenal disorders can cause similar signs².

Tests used to check for other causes may include:

PCOS diagnosis is harder during the teen years⁹. Irregular periods can be part of normal puberty during the first year⁹. Doctors consider the time since the first period when judging cycle changes^1,9.

Teen diagnosis requires both ovulation problems and high androgen signs. The androgen signs may be clinical or found through blood tests. Both features must be present for a diagnosis.

Ultrasound and AMH are not advised for teen diagnosis^4,9. Standards for ultrasound findings during these years are unclear⁹. Teens with some PCOS features may need checks over time⁹.

PCOS treatment options depend on symptoms, health risks, and pregnancy plans. Care may target periods, androgen effects, fertility, or metabolic health^3,5. Shared decisions should include personal needs, values, and treatment risks^1,9.

Healthy lifestyle care is an important part of PCOS treatment^1,9. Care should support health without weight stigma or blame¹. Healthy lifestyle care should meet the needs of people with PCOS¹.

Regular physical activity can improve blood sugar control. Aerobic exercise and strength training can both lower blood sugar. Activity may also help with weight and insulin resistance.

Research has not found one best PCOS diet for weight loss. A registered dietitian can help build a personal eating plan. The plan should match the person’s health needs and goals.

People with overweight or obesity may receive tailored weight support. Losing a small amount of weight may improve PCOS symptoms. It may also support more regular egg release.

Metformin helps insulin lower blood sugar. It may be used in selected patients with obesity and metabolic risk factors⁹. It is mainly considered for people with obesity or metabolic risk factors⁹.

Combined oral contraceptives can make periods more regular^5,9. They can also reduce hirsutism, acne, and irregular bleeding. These medicines are an option when pregnancy is not wanted.

Periodic progestin can cause regular bleeding and protect the uterine lining. Progestin is a medicine that acts like the hormone progesterone. Periodic progestin alone does not prevent pregnancy.

A progestin-only pill can help prevent pregnancy. A device containing progestin may also provide birth control. A clinician can help compare these choices with combined pills.

Spironolactone blocks androgen effects on the skin. It may improve acne and unwanted male-pattern hair growth. Effective birth control is needed because spironolactone can cause birth defects.

Hair removal can be used with medical care. Electrolysis and laser treatment may help manage unwanted hair. Treatment should focus on the symptoms that matter most to the person³.

Irregular egg release can make conception harder^3,8. Medicines may help the ovaries release eggs. The choice depends on health needs, goals, and treatment response.

Letrozole and clomiphene are first-line drug choices for PCOS infertility². Growing evidence suggests letrozole may work better than clomiphene². Letrozole helps the body make a hormone needed for egg release.

Gonadotropins are hormone medicines given as injections. Medicines that cause ovulation can raise the chance of multiple births. They may also cause the ovaries to overreact.

In vitro fertilization may be another option. It is often called IVF. A fertility specialist can explain the possible benefits and risks of each treatment.

PCOS is linked with insulin resistance and type 2 diabetes^2,3. It is also linked with high blood pressure and abnormal cholesterol³. Regular follow-up can help find these concerns.

Follow-up may include these health checks:

Infrequent periods may raise the risk of endometrial hyperplasia³. Endometrial hyperplasia means abnormal growth of the uterine lining³. PCOS is also linked with a higher risk of endometrial cancer³.

PCOS raises the risk of diabetes and high blood pressure during pregnancy³. The condition is also linked with other pregnancy problems^1,2. Pregnancy care should reflect each person’s health history and risks¹.

Mental health deserves attention during PCOS follow-up¹. Depression, anxiety, eating disorders, and body-image concerns may occur³. Healthcare teams may screen for depression and anxiety.

Seek medical care if periods stay irregular or stop. An assessment is also appropriate for new acne, excess hair, or scalp hair loss. A doctor can check whether PCOS or another condition may explain these changes.

Contact a healthcare professional in the following situations:

Virilization means the development of marked male-pattern physical changes. Voice deepening is not common with PCOS. These signs can point to very high androgen levels and need further study.

Polycystic ovary syndrome affects reproductive-aged women and can involve irregular periods; guidelines address its diagnosis and treatment^1,3. Care should reflect current symptoms, health risks, emotional needs, and pregnancy goals^1,5. The plan can change as a person’s needs change.

Early assessment can address cycle changes, androgen signs, and fertility concerns^3,5. Ongoing checks can track blood sugar, blood pressure, blood fats, sleep, and mood^3,5. Shared decisions and regular follow-up can support better health and care experiences¹.