Polycystic Ovary Syndrome (PCOS)
Frequently Asked Questions: Gynecologic Problems
Common signs of polycystic ovary syndrome (PCOS) include the following:
- Irregular menstrual periods—Menstrual disorders can include absent periods, periods that occur infrequently or too frequently, heavy periods, or unpredictable periods.
- Infertility—PCOS is one of the most common causes of female infertility.
- Obesity—As many as 4 in 5 women with PCOS are obese.
- Excess hair growth on the face, chest, abdomen, or upper thighs—This condition, called hirsutism, affects more than 7 in 10 women with PCOS.
- Severe acne or acne that occurs after adolescence and does not respond to usual treatments
- Oily skin
- Patches of thickened, velvety, darkened skin called acanthosis nigricans
- Multiple small fluid-filled sacs in the ovaries
Although the cause of PCOS is not known, PCOS may be related to many different factors working together. These factors include insulin resistance, increased levels of hormones called androgens, and an irregular menstrual cycle.
Insulin resistance is a condition in which the body’s cells do not respond to the effects of insulin. When the body does not respond to insulin, the level of glucose in the blood increases. This may cause more insulin to be produced as the body tries to move glucose into cells. Insulin resistance can lead to diabetes mellitus. It also is associated with acanthosis nigricans.
When higher than normal levels of androgens are produced, the ovaries may be prevented from releasing an egg each month (a process called ovulation). High androgen levels also cause the unwanted hair growth and acne seen in many women with PCOS.
Irregular menstrual periods can lead to infertility and, in some women, the development of numerous small fluid-filled sacs in the ovaries.
PCOS affects all areas of the body, not just the reproductive system. It increases a woman’s risk of serious conditions that may have lifelong consequences.
Insulin resistance increases the risk of type 2 diabetes and cardiovascular disease. Another condition that is associated with PCOS is metabolic syndrome. This syndrome contributes to both diabetes and heart disease.
Some women with PCOS develop a condition called endometrial hyperplasia, in which the lining of the uterus becomes too thick. This condition increases the risk of endometrial cancer.
Women with PCOS also may be at higher risk of sleep disorders, such as sleep apnea. The risk of depression also is higher with PCOS.
A variety of treatments are available to address the problems of PCOS. Treatment is tailored to each woman according to symptoms, other health problems, and whether she wants to get pregnant.
Combined hormonal birth control pills can be used for long-term treatment in women with PCOS who do not wish to get pregnant. Combined hormonal pills contain both estrogen and progestin. These birth control pills regulate the menstrual cycle. They also can reduce hirsutism and acne. And they can decrease the risk of endometrial cancer.
For women who are overweight, weight loss alone may regulate the menstrual cycle. Even a small loss of weight may be helpful in making menstrual periods more regular. Weight loss also has been found to improve cholesterol and insulin levels and relieve symptoms such as excess hair growth and acne.
Insulin-sensitizing drugs used to treat diabetes frequently are used in the treatment of PCOS. These drugs help the body respond to insulin. In women with PCOS, they can help decrease androgen levels and improve ovulation. Restoring ovulation may help make menstrual periods regular and more predictable.
Successful ovulation is the first step toward pregnancy. For women who are overweight, weight loss may accomplish this goal. Medications also may be used to cause ovulation. Surgery on the ovaries has been used when other treatments do not work. But the long-term effects of these procedures are not clear.
Acanthosis Nigricans: Patches of skin that are thicker, darker, and like velvet.This condition is associated with diabetes or prediabetes.
Androgens: Hormones made by the body that cause male characeteristics, such as a beard and deepening voice.
Cardiovascular Disease: Disease of the heart and blood vessels.
Cells: The smallest units of a structure in the body. Cells are the building blocks for all parts of the body.
Cholesterol: A natural substance that is a building block for cells and hormones. This substance helps carry fat through the blood vessels for use or storage in other parts of the body.
Depression: Feelings of sadness for periods of at least 2 weeks.
Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.
Endometrial Cancer: Cancer of the lining of the uterus.
Endometrial Hyperplasia: A condition in which the lining of the uterus grows too thick.
Estrogen: A female hormone produced in the ovaries.
Glucose: A sugar in the blood that is the body's main source of fuel.
Hirsutism: Excessive hair on the face, abdomen, and chest.
Hormones: Substances made in the body that control the function of cells or organs.
Infertility: The inability to get pregnant after 1 year of having regular sexual intercourse without the use of birth control.
Insulin: A hormone that lowers the levels of glucose (sugar) in the blood.
Menstrual Periods: The monthly shedding of blood and tissue from the uterus.
Metabolic Syndrome: A combination of problems, that can lead to diabetes and heart disease. These problems include high blood pressure, waist circumference of 35 inches or greater (in women), higher-than-normal blood sugar level, lower-than-normal levels of “good” cholesterol, and high levels of fats in the blood (triglycerides).
Obesity: A condition characterized by excessive body fat.
Ovaries: The organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.
Ovulation: The time when an ovary releases an egg.
Progestin: A synthetic form of progesterone that is similar to the hormone made naturally by the body.
Sleep Apnea: A disorder that causes interruptions of breathing during sleep.
If you have further questions, contact your obstetrician–gynecologist.
FAQ121. Copyright June 2020 by the American College of Obstetricians and Gynecologists
This information is designed as an educational aid to patients and sets forth current information and opinions related to women’s health. It is not intended as a statement of the standard of care, nor does it comprise all proper treatments or methods of care. It is not a substitute for a treating clinician’s independent professional judgment. Read ACOG’s complete disclaimer.