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Polycystic ovary syndrome (say "pah-lee-SIS-tik OH-vuh-ree SIN-drohm") is a problem in which a woman's hormones are out of balance. It can cause problems with your periods and make it difficult to get pregnant. PCOS also may cause unwanted changes in the way you look. If it isn't treated, over time it can lead to serious health problems, such as diabetes and heart disease.
Most women with PCOS grow many small cysts on their ovaries. That is why it is called polycystic ovary syndrome. The cysts are not harmful but lead to hormone imbalances.
Early diagnosis and treatment can help control the symptoms and prevent long-term problems.
Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone.
For reasons that are not well understood, in PCOS the hormones get out of balance. One hormone change triggers another, which changes another. For example:
The cause of PCOS is not fully understood, but genetics may be a factor. PCOS seems to run in families, so your chance of having it is higher if other women in your family have it or have irregular periods or diabetes. PCOS can be passed down from either your mother's or father's side.
Symptoms tend to be mild at first. You may have only a few symptoms or a lot of them. The most common symptoms are:
To diagnose PCOS, the doctor will:
You may also have a pelvic ultrasound to look for cysts on your ovaries. Your doctor may be able to tell you that you have PCOS without an ultrasound, but this test will help him or her rule out other problems.
Regular exercise, healthy foods, and weight control are the key treatments for PCOS. Treatment can reduce unpleasant symptoms and help prevent long-term health problems.
Your doctor also may prescribe birth control pills to reduce symptoms, metformin to help you have regular menstrual cycles, or fertility medicines if you are having trouble getting pregnant.
It is important to see your doctor for follow-up to make sure that treatment is working and to adjust it if needed. You may also need regular tests to check for diabetes, high blood pressure, and other possible problems.
It may take a while for treatments to help with symptoms such as facial hair or acne. You can use over-the-counter or prescription medicines for acne.
It can be hard to deal with having PCOS. If you are feeling sad or depressed, it may help to talk to a counselor or to other women who have PCOS.
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The cause of polycystic ovary syndrome (PCOS) is not fully understood, but genetics may be a factor.
PCOS problems are caused by hormone changes. One hormone change triggers another, which changes another.
Symptoms of polycystic ovary syndrome (PCOS) tend to start gradually. Hormone changes that lead to PCOS often start in the early teens, after the first menstrual period. Symptoms may be especially noticeable after a weight gain.
Symptoms may include:
Polycystic ovary syndrome (PCOS) can affect your reproductive system and how your body handles blood sugar. It can also affect your heart.
Hormone imbalances can cause several types of pregnancy problems and related problems, including:
Insulin is a hormone that helps your body's cells get the sugar they need for energy. Sometimes these cells don't fully respond to insulin. This is called insulin resistance. It can lead to diabetes.
High insulin levels from PCOS can lead to heart and blood vessel problems. These include:
The main risk factor for polycystic ovary syndrome (PCOS) is a family history of it. Your chance of having it is higher if other women in your family have it or have irregular periods or diabetes. PCOS can be passed down from either your mother's or father's side.
A family history of diabetes may increase your risk for PCOS because of the strong relationship between diabetes and PCOS.
Long-term use of the seizure medicine valproate (such as Depakote) has been linked to an increased risk of PCOS.footnote 1
Polycystic ovary syndrome (PCOS) causes a wide range of symptoms, so it may be hard to know when to see your doctor. But early diagnosis and treatment will help prevent serious health problems, such as diabetes and heart disease. See your doctor if you have symptoms that suggest PCOS.
Call your doctor right away or seek immediate medical care if:
Call your doctor if you have:
Taking a wait-and-see approach (called watchful waiting) is not appropriate if you may have PCOS. Early diagnosis and treatment may help prevent future problems.
Health professionals who can diagnose and treat PCOS include:
No single test can show that you have polycystic ovary syndrome (PCOS). Your doctor will talk to you about your medical history, do a physical exam, and run some tests.
The medical history includes questions about your symptoms. Your doctor may ask you about changes in your weight, skin, hair, and menstrual cycle. He or she may also ask you about problems with getting pregnant, medicines you are taking, and your eating and exercise habits.
You will also talk about any family history of hormone problems, including diabetes.
The physical exam checks your thyroid gland, skin, hair, breasts, and belly. You will have a blood pressure check and a pelvic exam to find out if you have enlarged or abnormal ovaries. Your doctor can also check your body mass index (BMI).
You may have a pelvic ultrasound, which might show enlarged ovaries with small cysts. These are signs of PCOS. But many women with PCOS don't have these signs.
You may have blood tests to check for:
Diabetes. If you have PCOS, experts recommend that you have blood glucose testing for diabetes by age 30. footnote 3You may have this done at a younger age if you have PCOS and other risk factors for diabetes (such as obesity, lack of exercise, a family history of diabetes, or gestational diabetes during a past pregnancy). After this, your doctor will tell you how often to have testing for diabetes.
Heart disease. Your doctor will regularly check your cholesterol and triglycerides, blood pressure, and weight. This is because PCOS is linked to higher risks of high blood pressure, weight gain, high cholesterol, heart disease, hardening of the arteries (atherosclerosis), heart attack, and stroke.
Uterine (endometrial) cancer. Regular menstrual cycles normally build up and "clear off" the uterine lining every month. When the uterine lining builds up for a long time, precancer of the uterine lining (endometrial hyperplasia) can grow. If you have had infrequent menstrual periods for at least 1 year, your doctor may use a transvaginal ultrasound and/or endometrial biopsy to look for signs of precancer or cancer.footnote 4
Regular exercise, a healthy diet, weight control, and not smoking are all important parts of treatment for polycystic ovary syndrome (PCOS). You may also take medicine to balance your hormones.
Treatments depend on your symptoms and whether you are planning a pregnancy.
There is no cure for PCOS, but controlling it lowers your risks of infertility, miscarriages, diabetes, heart disease, and uterine cancer.
For more information, see Home Treatment.
If weight loss alone doesn't start ovulation (or if you don't need to lose weight), your doctor may have you try a medicine such as metformin or clomiphene to help you start to ovulate.
If you aren't planning a pregnancy, you can also use hormone therapy to help control your ovary hormones. To correct menstrual cycle problems, birth control hormones keep your endometrial lining from building up for too long. This can prevent uterine cancer.
Hormone therapy also can help with male-type hair growth and acne. Birth control pills, patches, or vaginal rings are prescribed for hormone therapy. Androgen-lowering spironolactone (Aldactone) is often used with combined hormonal birth control. This helps with hair loss, acne, and male-pattern hair growth on the face and body (hirsutism).
You can use other methods to treat acne and remove excess hair. For more information, see Home Treatment.
Taking hormones doesn't help with heart, blood pressure, cholesterol, and diabetes risks. This is why exercise and a healthy diet are key parts of your treatment.
To learn more about hormones, see Medications.
If weight loss and medicine don't restart ovulation, you may want to try other treatments. For more information, see the topic Fertility Problems.
Regular checkups are important for catching any PCOS complications, such as high blood pressure, high cholesterol, uterine cancer, heart disease, and diabetes.
Polycystic ovary syndrome (PCOS) cannot be prevented. But early diagnosis and treatment helps prevent long-term complications, such as infertility, metabolic syndrome, obesity, diabetes, and heart disease.
Home treatment can help you manage the symptoms of polycystic ovary syndrome (PCOS) and live a healthy life.
Eat a balanced diet. A diet that includes lots of fruits, vegetables, whole grains, and low-fat dairy products supplies your body's nutritional needs, satisfies your hunger, and decreases your cravings. And a healthy diet makes you feel better and have more energy.
You may see a registered dietitian who has special knowledge about diabetes.
For more information, see the topic Healthy Eating.
Make physical activity a regular and essential part of your life. Choose fitness activities that are right for you to help boost your motivation. Walking is one of the best activities. Having a walking or exercise partner that you can count on can also be a great way to stay active. For more information, see the topic Fitness.
Stay at a healthy weight. This is the weight at which you feel good about yourself, have energy for work and play, and can manage your PCOS symptoms.
If you need to lose weight, doing so will lower your risks for diabetes, high blood pressure (hypertension), and high cholesterol.footnote 2
A modest weight loss can improve high androgen and high insulin levels and infertility. Weight loss of as little as 5% to 7% over 6 months can reduce androgen levels enough to restore ovulation and fertility in more than 75% of women who have PCOS.footnote 5
Losing weight can be hard, but you can do it. The easiest way to start is by cutting calories and becoming more active. For help, see the topic Weight Management.
If you smoke, consider quitting. Women who smoke have higher levels of androgens than women who don't smoke. footnote 1Smoking also increases the risk for heart disease. For more information, see Quitting Smoking.
Acne treatment may include nonprescription or prescription medicines that you put on your skin (topical) or take by mouth (oral). Some women notice an improvement in their acne after using estrogen-progestin hormone pills. For more information, see the topic Acne.
Excess hair growth (hirsutism) slows when high androgen levels decrease. In the meantime, you can remove or treat unwanted hair with:
Hair removal methods differ in cost and long-term effectiveness. Before trying one, ask your doctor about risks of infection and scarring.
As part of polycystic ovary syndrome (PCOS) treatment, medicines can be used to help control reproductive hormone or insulin levels.
Medicines to treat reproductive or metabolic problems include:
Eflornithine (such as Vaniqa) is a prescription skin cream that slows hair growth for as long as you use it regularly. Talk to your doctor about whether it is right for you.
Treatment for acne includes nonprescription and prescription medicines that are applied to the skin (topical) or taken by mouth (oral). For more information, see Acne.
Combination hormone pills may improve acne that is related to high androgen levels.footnote 4
Surgical treatment is sometimes used for women with infertility caused by polycystic ovary syndrome (PCOS) who do not start ovulating after taking medicine. During surgery, ovarian function is improved by reducing the number of small cysts.
Surgery for PCOS may be recommended only if you have not responded to any other treatment for PCOS. Each woman will want to discuss the risks and benefits of this surgery with her doctor. Surgery is less likely to lead to multiple pregnancies than taking fertility medicines. It is not known how long the benefits from surgery will last. There is some concern that ovarian surgery can cause scar tissue, which can lead to pain or more fertility problems.
Keefe K, Pal L (2014). Polycystic ovary syndrome. In EG Nabel et al., eds., Scientific American Medicine, chap. 66. Hamilton, ON: BC Decker. https://www.deckerip.com/decker/scientific-american-medicine/chapter/66. Accessed date April 13, 2017.
Fritz MA, Speroff L (2011). Chronic anovulation and the polycystic ovary syndrome. Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 495-531. Lippincott Williams and Wilkins.
American Association of Clinical Endocrinologists (2005). Position statement on metabolic and cardiovascular consequences of polycystic ovary syndrome. Endocrine Practice: 11(2): 126-134.
Ehrmann DA (2005). Polycystic ovary syndrome. New England Journal of Medicine, 352(12): 1223-1236.
Huang I, et al. (2007). Endocrine disorders. In JS Berek, ed., Berek and Novak's Gynecology, 14th ed., pp. 1069-1135. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
American College of Obstetricians and Gynecologists (2009). Polycystic ovary syndrome. ACOG Practice Bulletin No. 108. Obstetrics and Gynecology, 114(4): 936-949.
Cahill DJ, O'Brien K (2015). Polycystic ovary syndrome (PCOS): Metformin. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1408/overview.html. Accessed September 22, 2015.
Dronavalli S, Ehrmann DA (2007). Pharmacologic therapy of polycystic ovary syndrome. Clinical Obstetrics and Gynecology, 50(1): 244-254.
Hall J (2007). Neuroendocrine changes with reproductive aging in women. Seminars in Reproductive Medicine, 25(5): 344-351.
Polycystic Ovary Syndrome Writing Committee (2005). American Association of Clinical Endocrinologists position statement on metabolic and cardiovascular consequences of polycystic ovary syndrome. Endocrine Practice, 11(2): 125-134.
Practice Committee of the American Society for Reproductive Medicine (2006). The evaluation and treatment of androgen excess. Fertility and Sterility, 86(4, Suppl): S241-S247.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2003). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility, 81(1): 19-25.
Setji T, Brown AJ (2007). Polycystic ovary syndrome: Diagnosis and treatment. American Journal of Medicine, 120(2): 128-132.
Thatcher SS, Jackson EM (2006). Pregnancy outcome in infertile patients with polycystic ovary syndrome who were treated with metformin. Fertility and Sterility, 85(4): 1002-1009.
ByHealthwise StaffPrimary Medical ReviewerPatrice Burgess, MD, FAAFP - Family MedicineKathleen Romito, MD - Family MedicineMartin J. Gabica, MD - Family MedicineKirtly Jones, MD - Obstetrics and Gynecology, Reproductive Endocrinology
Current as ofOctober 6, 2017
Current as of:
October 6, 2017
Patrice Burgess, MD, FAAFP - Family Medicine
& Kathleen Romito, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology, Reproductive Endocrinology
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