What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a complex condition that affects 6–12% of reproductive-age women in the United States (1). Affected women may have elevated androgen levels (hyperandrogenemia) and/or small cysts on one or both ovaries (polycystic ovaries) (2).

What are the symptoms associated with PCOS?
Androgens are male sex hormones, such as testosterone. Usually, women only have low androgen levels, but elevated androgen levels are a characteristic of PCOS (2). This hyperandrogenemia can cause numerous symptoms, including:

• Problems with the menstrual cycle
• Fertility issues
• Excess body hair (e.g., on the chest, stomach, and back)
• Weight gain, especially in the abdomen
• Acne
• Male-pattern baldness
• Skin tags (excess skin on the neck or armpits)

What causes PCOS?
Both genetic and environmental factors are thought to contribute to PCOS. A family history of PCOS is relatively common, with current literature suggesting an autosomal dominant pattern of inheritance (2).

Being overweight and physically inactive can increase the risk of PCOS, but many women of normal weight have PCOS, and many overweight women don’t have PCOS (1).

Insulin resistance is a big factor linked to PCOS. Insulin-resistant people are able to make insulin but their body doesn’t respond to it very well. Usually, insulin helps to regulate ovarian function, and if there is excess insulin, the ovaries respond by producing more androgens (2). Often lifestyle choices, such as poor diet and lack of exercise, are contributing factors towards insulin resistance (1).

What serious health complications are associated with PCOS?
The insulin resistance that is a contributing risk factor for PCOS significantly increases the risk of developing type 2 diabetes. In fact, more than half of women with PCOS develop type 2 diabetes by 40 years of age, with a higher risk among those who are overweight. Gestational diabetes is another possible complication linked to PCOS, insulin resistance, and being overweight. Gestational diabetes is diabetes during pregnancy and can put the pregnancy and baby at risk, and also increase the likelihood of type 2 diabetes later in life for both the mother and child (1).

The risk of heart problems also increases for women with PCOS, again with a heightened risk for those that are also overweight. Elevated LDL (“bad”) cholesterol and low HDL (“good”) cholesterol can occur and increase the risk of heart disease. There is also an increased risk of blood clots and stroke when the elevated LDL cholesterol can cause plaques to clog the blood vessels (1).

Sleep apnea is another possible complication of PCOS. This disorder causes breathing to stop during sleep and is also linked to an increased risk of heart disease and type 2 diabetes. Depression and anxiety are also more common in women with PCOS (1).

How is PCOS diagnosed?
The symptoms of PCOS can vary from person to person, so diagnosis can be difficult and often delayed. Commonly women find out they have PCOS when they have difficulty getting pregnant, but often they have actually had PCOS for many years by this point. Generally, a doctor will check for at least two of these three symptoms for a PCOS diagnosis (1):

• Irregular periods or a lack of periods
• Elevated male hormones (e.g., testosterone) detected through blood tests such as this
• Multiple cysts on the ovaries detected by ultrasound

Blood tests can also be used to detect elevated levels of luteinizing hormone (LH), which is common in PCOS (2). We offer a test here for LH. Commonly other blood tests are also conducted to provide a broad health overview, including measuring glucose and lipid levels.

How is PCOS treated?
The treatment options for PCOS vary depending on what symptoms and other health complications are also present. If type 2 diabetes (or prediabetes) is also diagnosed, losing excess weight and increasing physical activity can help prevent and manage diabetes and delay the onset of other health problems (1). Losing weight also helps to decrease androgen and LH levels (2).

Other medications are also available to help ovulation (and enable pregnancy), reduce acne, and control hair growth (1). For women who are not aiming to get pregnant, oral contraceptives can be effective for regulating menstrual cycles, as well as reducing excess body hair, acne, and androgen levels (2).

References:
1. PCOS (Polycystic Ovary Syndrome) and Diabetes. CDC. March 2020.
2. Ndefo UA et al. (2013) Polycystic Ovary Syndrome. Pharmacy and Therapeutics. 38(6): 348-355.