Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS)Skip to the navigationTopic OverviewWhat is polycystic ovary syndrome (PCOS)?
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. What are hormones, and what happens in PCOS?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 sex hormones get out of balance.
Normally, the
ovaries make a tiny amount of male sex hormones (androgens). In PCOS, they start making slightly more
androgens. This may cause you to stop
ovulating, get acne, and grow extra facial and body
hair.
- The body may have a problem using
insulin, called
insulin resistance. When the body doesn't use insulin
well, blood sugar levels go up. Over time, this increases your chance of
getting diabetes.
What causes PCOS?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. What are the symptoms?Symptoms tend to be mild at
first. You may have only a few symptoms or a lot of them. The most common
symptoms are: - Acne.
- Weight gain and trouble
losing weight.
- Extra hair on the face and body. Often women get
thicker and darker facial hair and more hair on the chest, belly, and
back.
- Thinning hair on the scalp.
- Irregular periods.
Often women with PCOS have fewer than nine periods a year. Some women have no
periods. Others have very heavy bleeding.
- Fertility problems. Many
women who have PCOS have trouble getting pregnant (infertility).
- Depression.
How is PCOS diagnosed?To diagnose PCOS, the
doctor will: - Ask questions about your past health,
symptoms, and
menstrual cycles.
- Do a physical exam to
look for signs of PCOS, such as extra body hair and
high blood pressure. The doctor will also check your
height and weight to see if you have a healthy
body mass index (BMI).
- Do a number of
lab tests to check your blood sugar, insulin, and other hormone levels. Hormone
tests can help rule out thyroid or other gland problems that could cause
similar symptoms.
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. How is it treated?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. - Try to fit in
moderate activity and/or
vigorous activity often. Walking is a
great exercise that most people can do.
- Eat heart-healthy foods.
This includes lots of vegetables, fruits, nuts, beans, and whole
grains. It limits foods that are high in saturated fat, such as meats,
cheeses, and fried foods.
- Most women who have PCOS can benefit from losing weight. Even
losing 10 lb (4.5 kg) may help
get your hormones in balance and regulate your menstrual cycle.
- If you smoke, consider quitting. Women who smoke
have higher androgen levels that may contribute to PCOS symptoms.footnote 1
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. Frequently Asked QuestionsLearning about PCOS: | | Being diagnosed: | | Getting treatment: | | Ongoing concerns: | | Living with PCOS: | |
CauseThe 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. SymptomsSymptoms 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: - Menstrual problems. These can include few or no
menstrual periods or heavy, irregular bleeding.
- Hair loss from the scalp and
hair growth (hirsutism) on the face, chest, back, stomach, thumbs, or toes.
- Acne and oily skin
- Fertility problems, such as not releasing an egg (not ovulating) or repeat miscarriages.
- Insulin resistance and too much insulin (hyperinsulinemia), which can cause things like upper body obesity and skin tags.
- Depression or mood swings. For more information, see the topic
Depression or
Depression in Children and Teens.
- Breathing problems while sleeping (obstructive sleep apnea). This is linked to both obesity and insulin resistance.
What HappensPolycystic ovary syndrome (PCOS) can affect your reproductive system and how your body handles blood sugar. It can also affect your heart. Reproductive problemsHormone imbalances can cause several types of pregnancy problems and related problems,
including: - Infertility. This happens when the ovaries
aren't releasing an egg every month.
- Repeat miscarriages.
- Gestational diabetes during pregnancy.
- Increased blood pressure during
pregnancy or delivery, having a larger than normal or smaller than normal baby,
or having a premature baby.
- Precancer of the uterine lining (endometrial hyperplasia). This can happen when you
don't have regular menstrual cycles, which normally build up and "clear off"
the uterine lining every month.
- Uterine (endometrial) cancer. Risk during the
reproductive years is 3 times greater in women who have PCOS than in women who
ovulate monthly.footnote 2
Problems with blood sugarInsulin 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. Heart problems and stroke High insulin levels from PCOS can lead to heart and blood vessel problems. These include: - Hardening of the arteries (atherosclerosis).
- Coronary artery disease and
heart attack.
- High
blood pressure.
- High cholesterol.
- Stroke.
What Increases Your RiskThe 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 When To Call a DoctorPolycystic 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: - You have severe vaginal bleeding. You are soaking through your usual pads or tampons every hour for 2 or more
hours.
Call your doctor if you have: - More vaginal bleeding, or bleeding is more
irregular.
- Regular menstrual
cycles but you have been trying unsuccessfully to become pregnant for more than
12 months.
- Any symptoms of
diabetes, such as increased thirst and frequent
urination (especially at night), unexplained increase in appetite, unexplained
weight loss, fatigue, blurred vision, or tingling or numbness in your hands or
feet.
- Depression or mood swings. Many women may have
emotional problems related to the physical symptoms of PCOS, such as
excess hair, obesity, or infertility.
Watchful waitingTaking 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. Who to seeHealth professionals who can diagnose and treat PCOS
include: To prepare for your appointment, see the topic Making the Most of Your Appointment. Exams and TestsNo 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. Medical historyThe 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. Physical examThe
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). Ultrasound 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. Lab testsYou may have blood tests to check for: Testing for problems from PCOSDiabetes. If you
have PCOS, experts recommend that you have
blood glucose testing for diabetes by age 30.footnote 3 You 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 Treatment Overview 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. Healthy lifestyle- If you are overweight, weight
loss may be all the treatment you need. A small amount of
weight loss is likely to help balance your hormones and start up your menstrual
cycle and ovulation.
- Eat a balanced diet that
includes lots of fruits, vegetables, whole grains, and low-fat dairy products.
- Get regular exercise to help you control or lose weight and feel better.
- If you smoke, consider quitting. Women who smoke have
higher levels of androgens than women who don't smoke.footnote 1
For more information, see Home Treatment. Hormone therapy 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 checkupsRegular checkups are important for catching any PCOS complications, such as
high blood pressure,
high cholesterol,
uterine cancer,
heart disease, and
diabetes. PreventionPolycystic 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 TreatmentHome treatment can help you
manage the symptoms of
polycystic ovary syndrome (PCOS) and live a healthy
life. Healthy eating and exerciseEat 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. - Healthy Eating: Recognizing Your Hunger Signals.
- Healthy Eating: Getting Support When Changing Your Eating Habits.
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. - Fitness: Adding More Activity to Your Life.
Weight control and weight lossStay 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. Don't smokeIf you smoke, consider quitting. Women
who smoke have higher levels of androgens than women who don't smoke.footnote 1 Smoking also increases the risk for heart disease. For more information, see Quitting Smoking. Caring for skin and hairAcne 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: - Laser hair removal, in which the hair follicle
is destroyed by a laser beam.
- Electrolysis, in which your hair is
permanently removed by electric current applied to the hair
root.
- Depilatories, which are chemical hair removal products
applied to the skin.
- Waxing, which pulls the hair out by the
root.
- Shaving.
- Tweezing.
- Bleaching.
Hair removal methods differ in cost and long-term
effectiveness. Before trying one, ask your doctor about risks of infection and
scarring. MedicationsAs part of
polycystic ovary syndrome (PCOS) treatment, medicines
can be used to help control reproductive hormone or insulin levels. Medicine choicesMedicines to treat reproductive or metabolic problems include: - Combination estrogen and progestin hormones in birth control pills, vaginal rings, or skin patches. These
hormones correct irregular menstrual bleeding or absent menstrual cycles. They
may also improve your
androgen-related acne problems, male-type hair growth,
and male-pattern hair loss.
- Synthetic progestin. If you are not able to use
the hormone estrogen, talk to your doctor about using progestin shots or pills
for part of your cycle. The progestin makes your endometrial lining build up
and shed, similar to a menstrual period. This monthly shedding is what prevents
uterine cancer.
- Androgen-lowering
spironolactone (Aldactone), which is a
diuretic. It is often used with estrogen-progestin
therapy. This reduces hair loss, acne, and abnormal hair growth on the face
and body (hirsutism).
- Metformin (Glucophage). This diabetes
medicine is used for controlling
insulin, blood sugar levels, and androgen levels.
- Clomiphene (Clomid, Serophene) (fertility
medicines) and
gonadotropin injections (LH and FSH).
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 Surgery 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 choices- Ovarian wedge resection is the surgical
removal of part of an ovary. This is done to help regulate menstrual cycles and
start normal ovulation. It is rarely used now because of the possibility of
damaging the ovary and creating scar tissue.
- Laparoscopic ovarian drilling is a surgical treatment
that can trigger ovulation in women who have PCOS and who have not responded to weight
loss and fertility medicine. Electrocautery or a laser is used to destroy
portions of the ovaries.
What to think aboutSurgery 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. Other Places To Get HelpOrganizationAmerican Congress of Obstetricians and Gynecologists
(ACOG) www.acog.org ReferencesCitations- 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.
CreditsByHealthwise Staff Primary Medical ReviewerPatrice Burgess, MD - Family Medicine Kathleen Romito, MD - Family Medicine Martin J. Gabica, MD - Family Medicine Specialist Medical ReviewerKirtly Jones, MD - Obstetrics and Gynecology Current as ofApril 28, 2017 Current as of:
April 28, 2017 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. Last modified on: 8 September 2017
|
|