Polycystic ovary syndrome (PCOS) is the most common hormone abnormality of reproductive-age women, the most common cause of infertility in women and an important harbinger of metabolic disorders such as diabetes and heart disease. It affects an estimated 5 percent to 10 percent of females and is associated with an increased risk of diabetes and obesity, and possibly an increased risk of stroke and cardiovascular disease. The syndrome is generally characterized by the presence of polycystic ovaries, hyperandrogenism (the condition caused by excess male hormones or male-like traits), and irregular ovulation and menstruation. The symptoms of PCOS can vary.

1. Overview
Polycysticovarysyndrome (PCOS) isthe mostcommonhormone abnormalityof reproductive-age
women,the mostcommoncause of infertilityinwomenandanimportantharbingerof metabolic
disorderssuchas diabetesandheartdisease.Itaffectsan estimated5percentto10 percentof
femalesandisassociatedwithanincreasedriskof diabetesandobesity,andpossiblyanincreased
riskof stroke andcardiovasculardisease.The syndromeisgenerallycharacterizedbythe presenceof
polycysticovaries,hyperandrogenism(theconditioncausedbyexcessmalehormonesormale-like
traits),andirregularovulationandmenstruation.The symptomsof PCOScanvary.
The syndrome waspreviouslycalledStein-Leventhal Syndrome afterthe physicianswhofirst
characterizeditinthe 1930s. Althoughitscause remainsunknown,itusuallypresentsinyoung
womenoradolescents,andthe mainsymptomsare irregularorabsentperiodsandexcess
unwantedfacial and/orbodyhairgrowth(hirsutism).Asthe term“polycystic ovarysyndrome”
suggests,the disorderisoftenaccompaniedbyenlargedovariescontainingmultiple small painless
benign“cysts”or tinyfolliclesabout1/8 to1/4 inch indiameter.
Duringa normal menstrual cycle inwhichawomanovulates(calledanovulatorycycle),asmall
numberof folliclesbegintogrow.One becomesthe biggest,ordominant,follicle.Thisdominant
follicle thenrupturesandreleasesthe egg.
In womenwithPCOS,the hypothalamic-pituitary(inthe brain) functionsabnormally,andhighlevels
of hormonescalledandrogens(commonlyknownas“male hormones”) disturbthe ovulatory
process,haltingthe normal developmentof the sacs,calledfollicles,thatcontaineachindividual egg
(or ova).These haltedorarrestedfollicles––whose appearance(viaanultrasound) issometimes
likenedtoa“stringof pearls”onthe outside borderof the ovary––formthe “cysts”observedin
PCOS.These cystsare nottumors anddo not require removal.
Treatmentof PCOS,instead,isthroughthe use of lifestyle modificationsandmedicationtotreat
symptoms.
Many, but notall,womenwithPCOSwill have the polycystic-lookingovaries(whichare oftentwoto
five timeslargerthannormal ovaries) forwhichthe syndrome isnamed,butitispossibletobe
diagnosedwiththe syndrome withouthavingthissign.Andnotall womenwithpolycystic-appearing
ovarieswill have PCOS.

2. Many womenwithPCOSexperienceexcessinsulinproductionfromthe pancreas,whichcanresult
frominsulinresistance,meaningthattheircellsdon’trespondwelltoinsulin,sothe insulinhas
difficultyworkingintheirbodies.Hence,higherlevelsof insulinare neededtomaintainnormal
glucose andlipidlevels.Insulin,ahormone producedbythe pancreas,regulatesarange of
functions, includingcontrollingbloodsugar(glucose) andfats(lipids).
Insulinresistancecanleadtohyperinsulinismorhyperinsulinemia.Itisalsoa precursorto type 2
diabetes.Furthermore,the highlevelsof insulinhelpstimulatethe ovariestooverproduce
androgens,whichmaybe the cause of PCOSinsome women.
In additiontostimulatingthe ovariestooverproduce androgens,highlevelsof insulincancause
darkeningof the skinaroundthe neckand othercrease areas,a conditioncalledacanthosis
nigricans,oftenaccompaniedbyskintagsinthese areas.
If the pancreascan’t produce enoughinsulintocompensate forthe insulinresistance,glucose builds
up inthe blood,eventuallyleadingtotype 2 diabetes.
Up to 75 percentof womenwithPCOShave insulinresistance andabout10 percentdeveloptype 2
diabetesbyage 40. Insulinresistance andanincreasedriskof diabetesare majorproblemsforobese
womenwithPCOS,buttheyalsocause problemsfornormal weightwomenwithPCOS.Forobese
womenwithPCOS,treatmentplansshouldincorporate dietandexercise.
ObesityinwomenwithPCOStendstobe centeredonthe abdomen,afatdistributionpatternlinked
to increasedriskof diabetes,heartdiseaseandhighbloodpressure.
Up to 50 percentof womenwithPCOSalsohave sleepapnea,aconditionthatcausesbrief spells
where breathingstopsduringsleep.Sleepapneacanworsenthe degree of insulinresistance.
The most visible symptomsof PCOSstemfromexcessivelevelsof androgens,suchastestosterone,
producedbythe ovariesandthe adrenal glands.Androgensoftenare called“male hormones,”even
thoughtheyare foundinbothmenand women.Theyare usuallypresentathigherconcentrationsin
menand are an importantfactorindeterminingmale traits andreproductive activity.Androgens,or
androgenprecursors,include testosterone,dihydrotestosterone (DHT),androstenedione,
dehydroepiandrosterone (DHEA) orDHEA sulfate (DHEA-S).

3. Excessive levelsof these hormones,aconditioncalled hyperandrogenemia,ortheirexaggerated
action,calledhyperandrogenismcanleadtosome of the mostcommonsymptomsof PCOSin
women,including:
Excessbodyor facial hair(hirsutism)
Oilyskinandacne
Oligo-ovulation(irregularovulationandmenstruation)
Scalphair lossand balding(male patternbaldingandandrogenicalopecia)
But such symptomsalone are notenoughtosupporta diagnosisof PCOS.Theymayonlyindicate the
presence of hyperandrogenism, whichcanresultfromseveral conditions.
WomenwithPCOSovulate irregularlyand/orinfrequentlyandoftenhave irregularmenstrual
periods.Inducingaperiodisimportantbecause the hormone progesteronepromotesthe normal
sheddingof the uterine lining(i.e.,menstruation),preventingthe buildupof the uterine lining,and
reducingthe riskof endometrial (uterine) cancer.However,progesterone issecretedbythe ovaries
onlyafterovulationoccurs,soprogesterone mayneedtobe administratedtowomenwithPCOS
eitheralone regularlyoras part of a combinationhormonal contraceptive.
PCOSoftenisa cause of infertilitydue toafailure toovulate.
WomenwithPCOSare more likelytobe overweightorobese,althoughthe exactrelationshipof
PCOSand bodyweightisunknown.ExcessweightworsensPCOS,butresearchersdonotyetknow
whetherornot havingPCOSmakespatientsmore prone toobesity.
It isnot surprisingthatwomenwithPCOSoftensufferfrompoorself image andmayexperience
depressionoranxiety.
While the biochemical imbalancesthatcause symptomsare becomingbetterunderstood,the trigger
or triggersfor PCOSremainunknown.Mostbelieve PCOSresultsfromgeneticdefects,oftenin
combinationwithenvironmentalfactors.Geneticdefectsmayresultinabnormal functionof the
hormonesfromthe pituitarythatregulate ovulation(LHandFSH),inabnormal developmentof the
follicle,inincreasedproductionof male hormones(androgens),andininsulinresistance and
excessiveproductionof insulin.All these preventthe ovariesfromfunctioningnormally.

4. Because PCOSismostlya geneticdisorder,the riskof PCOSinfamilymembersishigh.Forexample,
an estimated30 percentof mothers,and50 percentof sistersanddaughtersof people withPCOS
can be affected.
To date there is nocure for PCOS.Healthcare professionalscanusuallyaddressthe most
bothersome symptoms.Because of the complexityof the hormonal interactions,youmayneedto
see an endocrinologist.Youmayalsoneedtovisita reproductive endocrinologist,especiallyif you
are infertile andtryingtoconceive.Notall physicianshave experience treatingPCOS,socheckwith
the doctor’soffice tosee if that doctor caresfor manypeople withPCOS.
Diagnosis
Diagnosisbeginswithaninventoryof signsandsymptoms,the mostcommonof whichare:
Unwantedhairgrowthor hirsutism(excessbodyand/orfacial hairinamale-like pattern,particularly
on the chin,upperlip,breasts,innerthighsandabdomen)
Irregularor infrequentperiods
Obesity,primarilyaroundthe abdomen(althoughonlyabout30percentto 60 percentof patients
are obese)
Acne and/oroilyskin(particularlysevere acne inteenagersoracne that persistsintoadulthood)
Infertility
Ovarianappearance suggestingpolycysticovaries
Hair lossor balding
Acanthosisnigricans(darkeningof the skin,usuallyonthe neck;alsoa signof insulinproblems),
oftenwithskintags(small tagsof excessskin),mostoftenseeninthe armpitorneckarea
WomenwithPCOSmay have varyingcombinationsof these andothersignsandsymptoms,but
three importantfeaturesof the disorderinclude the following:
Hyperandrogenism(signsof male-like traits,suchashirsutism) and/orhyperandrogenemia(excess
bloodlevelsof androgens).Androgensare hormonessuchastestosterone thatinexcessquantities
cause such symptomsashirsutismandacne.In more severe cases,“virilization”––takingon
significantmale characteristics,includingsevere excessfacial andbodyhair,anenlargedclitoris,
baldnessatthe temples,acne,deepeningof the voice,increasedmuscularityandanincreasedsex

5. drive––mayoccur.However,virilizationismore frequentlyasignof an androgen-producingtumor,
whichshouldbe searchedfor.
Lack of ovulationorirregularovulationoftenresultinginirregularorabsentmenstruation.Women
withPCOSusuallyhave oligomenorrhea(eightorfewerperiodsperyear) oramenorrhea(absenceof
periodsforextendedperiods).
Polycysticovariesonultrasound
Expertgroupshave determinedthatawomanmustexhibitatleasttwoof these three symptomsto
be diagnosedwithPCOS.
The diagnosticprocessshouldincludeathoroughphysical examinationandhistorytocheckfor signs
and symptomsof otherdisordersthatcan have similarsignsandsymptoms,suchashypothyroidism,
Cushing’ssyndrome (ahormonal disorderinwhichthe adrenal glandsmalfunction),adrenal
hyperplasia(ageneticconditionthatresultsinmale hormoneexcessproducedbythe adrenal
glands),andandrogen-secretingtumors(of the ovary,adrenal gland,etc.).
While there isnosingle testforPCOS,a healthcare professionalmaymeasure bloodlevelsof the
following:
Thyroidhormone (symptomsof lowthyroidfunction,orhypothyroidism, includeirregular
menstruation,similartothatof PCOS)
Prolactin(highlevelsof thishormone,whichstimulatesmilkproduction,oftenresultsinirregularor
absentmensessimilartothatseeninPCOS)
Level of 17-hydroxyprogesterone,amarkerfor the mostcommon cause of adrenal hyperplasia(due
to 21-hydroxylase deficiency).If the screeninglevelishigh,yourdoctormay choose toperforman
adrenal stimulationtest.
Androgenlevels,includingtotal andfree testosteroneanddehydroepiandrosterone sulfate (DHEAS).
Androgen-producingtumors,althoughtheyare rare, canresultinsome of the masculinizing
symptomsof PCOS.If your testosteronelevel ispersistentlyveryhigh,yourhealthcare professional
may wantto investigate further.
Follicle-stimulatinghormone(FSH) andluteinizinghormone(LH) levels.FSHpromotesthe
developmentof egg-containingfolliclesinthe ovaries,whileLHstimulatesovulationaswell as
follicle ruptureandencouragesthe emptyfollicle toconverttoprogesteroneproduction.A high
ratioof LH to FSH (greaterthan2:1 or 3:1) maybe characteristicof PCOS,althoughwomenwith
PCOScan also have normal FSH andLH levelsandanormal ratio,so FSH and LH testingisnot always
useful indiagnosingPCOS.

6. A two-hourglucose tolerance test.Thistest,where yourbloodisdrawnbeforeyoudrinkasugary
solutionandagainone and twohoursafterward,shouldbe performedinall womendiagnosedwith
PCOS,because diabetesorprediabetesishardto detectinmanywomenwithPCOSwithoutthis
test.
Physiciansmayalsoorderteststo measure blood fat(lipid) andcholesterollevels.
These testsshouldbe interpretedcarefullybyaspecialist.The besttime tobe testedisinthe
morningjustafteryourmenstrual periodbegins(youmayneedmedicationtoinduce menstruation).
Birthcontrol pillsmightmake the testsdifficulttointerpretbecausetheychange the hormonal
balance andmay mask anyabnormalitiesthatmayexistinmale hormones.
Your healthcare professional mayorderultrasoundimagingof the ovariestolookforthe
characteristicpicture of multiplecysts.Anultrasoundmayalsobe usedtolookfor abnormalitiesin
the liningof the uterus,calledthe endometrium.
The ultrasoundtestusuallyinvolvesinsertionof aprobe intothe vagina,althoughatransabdominal
ultrasound,inwhichthe ultrasoundispassedoveryourabdomen,canbe performed,particularlyin
womenwhohave neverbeensexuallyactive.
PCOSis alsoassociatedwithanincreasedriskof diabetesandobesity,andasa result,anincreased
riskof cardiovasculardisease.If youhave PCOS,youshouldbe testedandtreatedforinsulin
resistance,type 2diabetes,highbloodpressure andelevatedbloodlipids(cholesterol and
triglycerides).WomenwithPCOSwhobecome pregnantshouldbe advisedthattheyare at
increasedriskof developinggestational diabetes.
Treatment
Treatmentof polycysticovariansyndrome (PCOS) centersonlifestyle modificationsandmedication.
Surgical procedurestodestroyorshrinkthe ovariancysts are lesslikelytobe performedtodaygiven
the successof hormonal treatments.However,if youfail toovulate withconventional treatment
(the fertilitydrugclomiphene citrate (Clomid)) andcan’t,forwhateverreason,proceedto
gonadotropinshotsorinvitro fertilization(IVF),yourdoctormayrecommendanoutpatientsurgery
calledlaparoscopicovariandrilling.
Because the primarycause of PCOSisunknown,treatmentisdirectedatthe primarysymptomsof
the disorder,whichinclude excesshairgrowth,irregularperiodsandinfertility.

7. Excesshairgrowth
For some women,the mostbothersome symptomishirsutism(excessfacialand/orbodyhair,often
dark and coarse).Thissymptom,aswell asacne and oilyskin,stemfromthe overproductionof
androgens.Forwomenwiththese symptoms,ananti-androgenmedicationlike spironolactone,
finasterideorflutamidemaybe prescribed.
Spironolactone isadiureticthatworksbyblockingthe actionof testosterone atthe hairfollicle.Side
effectsare generallymildandmayinclude heartburnandupsetstomach,sunsensitivity,increased
urinationandlowerbloodpressure causingweaknessorfaintness.Athighdoses,itcanclearoily
skinand make unwantedhairfiner.
Finastride,whichisusedtotreatenlargedprostate andbaldnessinmen,mayalsobe useful in
womenwithhyperandrogenismsymptoms,includinghirsutism.Itmayalsohelptreathairlosson
the scalp associatedwithPCOS.Finasteride,however,cancause birthdefectsinamale fetus
(pregnantwomenshouldnotevenhandle the drugincrushedtabletform).Andmanyinsurance
companieswon’tcoverthe drugfor cosmeticreasons.
Flutamide,adrugusedto treatprostate cancer inmen,isalso useful forthe treatmentof signsand
symptomsdue tohyperandrogenisminwomenwithPCOS,althoughitcarriesthe rare riskof liver
toxicity.
If you are tryingto conceive,youcannottake ananti-androgenmedicationbecause itcouldcross
the placentaand cause defectsina male fetus.Usually,anti-androgenmedicationsare usedin
combinationwithbirthcontrol pills,whichnotonlypreventunplannedpregnancies,butalso
improve the successof these medicationsonexcesshairgrowth.
None of these drugsisFDA-approvedforthe treatmentof PCOS,butclinical experienceand
scientificstudyhasshownthattheycan be effective.
Electrolysis,andpossiblylasers,canremove anyremaininghairspermanently.
Eflornithinehydrochloride cream(Vaniqa) mayalsohelpslow the hairgrowthonthe face.It works
well inaboutone-thirdtoone-half of womenusingit. The medicationisappliedtothe face twice a

8. day like amoisturizer.Itworksbyblockingakeyenzyme thatmakeshairgrow.Noticeable results
take about six toeightweeks.Itmustbe usedregularlyorthe hair will grow backafterabout eight
weeks.
Bear inmindthat itcan take up to nine monthstosee effectsonhairgrowthand a yearor longerto
achieve peakeffect.The hairwill still be there,butitwill generallygrow more slowlyandbe lighter
and finer.
Irregularperiods
If irregularand/orinfrequentmenstruationisaproblem, birthcontrol pillsthatcontainestrogenand
progestincangenerallyregulate yourcycles.Restoringregularperiodsisessentialsince itensures
that the liningof the uterusisshed,protectingagainstuterinecancer.Birthcontrol pillsalsoreduce
the productionof androgensbythe ovaries.
Rare side effectsof birthcontrol pillsincludemigraines,nauseaandheadaches,and,rarelyblood
clots(especiallyamongsmokersandwomenwithpersistenthighblood pressure),gallbladder
disease andhighbloodpressure.
If you don’twantto take a dailymedication,talktoyourdoctor abouta course of progestogen
(progesterone-like drugs) several timesayeartostart your periods.Itisimportantto have at least
six to eightperiodsayearto promote sheddingof the endometriallining;buildupcanleadtocancer.
However,periodicprogesteronealone doesnothelpreduceunwantedhairgrowthasbirthcontrol
pillsdo.
Anotherdrugthat helpsregulate periodsinsome womenwithPCOS,althoughlesseffectivelythan
birthcontrol pills,isthe insulin-sensitizingdrugmetformin(Glucophage).Metforminregulatesblood
glucose (sugar) levelsbyreducingthe amountof glucose the liverproduces,reducingthe amountof
glucose absorbedfromfoodandreducingthe levelsof insulininthe bloodbyhelpingthe insulinthat
your bodyproducesworkbettertoreduce the amountof glucose alreadyinyourblood.
The drug is notFDA-approvedforPCOS,butresearchdone sofar showsithelpsmodestlyimprove
ovulationandmayreduce androgenlevels.If youare amongthe 10 percentor so of womenwith
PCOSwhoalreadyhave type 2 diabetes,metforminisalsoagoodtherapeuticoption.Expertsaren’t
sure,however,if metforminisas effectiveatpreventingendometrialcancerinwomenwithPCOSas

9. birthcontrol pillsorprogesterone.Inaddition,some expertsdonotrecommendmetforminfor
womenwithPCOSwhohave excesshairgrowth(hirsutism).
If you are prescribedmetformin,be sure toinformyourhealthcare professionalof all other
medicationsyouare taking,includingover-the-countermedicines,topreventdruginteractions.
Infertility
Infertilityoftenisaconsequenceof PCOS.If youare overweightorobese,the firstline of treatment
isweightloss;evenlosingalittle bitof weightmaystimulate ovulation.Weightlosscanalsoboost
the effectivenessof otherinfertilitytreatments.
The secondline of treatmentisthe ovulation-stimulatingdrugclomiphene citrate,which isusedto
treat infertile womenwithovulationproblems.Itworksbyhelpingthe pituitaryglandsend
hormonal signalstostimulate the developmentof more eggsinthe ovaries.Clomiphenestimulates
ovulationinabout80 percentof womenwithPCOS,andabouthalf of these womenbecome
pregnant.
AnotheroptionforwomenwithPCOSwhodonotovulate isletrozole,amedicationFDA-approved
for breastcancer treatment.Letrozoleissometimesusedoff label toinduce ovulation.Some studies
have shownlive birthratesinobese womenwithPCOSwhotake letrozoleare higherthaninobese
womenwithPCOSwhotake clomiphene.
If clomiphene doesn’twork,yourdoctormaysuggestusingmetforminincombinationwith
clomipheneorgonadotropinsinjections.
Treatmentwithgonadotropins—purifiedsolutionsof follicle-stimulatinghormone (FSH) withor
withoutluteinizinghormone(LH)—maybe administeredbyinjection.Becausemanywomenwith
PCOShave elevatedLH,some doctorsmayrecommendtreatmentwithFSHalone.
But treatmentwithgonadotropins,while effective,ismore challengingtomanage andmore
expensive.Some womenalsohave some trouble self-administeringthe injections.Risksinclude
multiple birthsandovarianhyperstimulationsyndrome.Inmanypatientsmild signsandsymptoms
of hyperstimulationmayoccur,includingbloating,fluidretention,weightgainanda tender

10. stomach.In more severe casesfluidfromthe bloodstreamleaksintothe abdominalcavity,causingit
to swell,andmakingthe bloodthicker.Thismayleadtobreathingdifficulties,temporarykidney
failure andbloodclots.Thus,gonadotropinsshouldonlybe prescribedbycliniciansspecifically
trainedintheiruse.
Anotheroptionforwomenwhofail toovulate withclomiphene ormetformintherapy,orwhoare
unwillingorunable touse gonadotropins(orcan’taffordtouse them),isa surgical procedure known
as laparoscopicovariandrilling.
Duringthisprocedure,asurgeonmakesa small incisioninyourabdomenandinsertsalaparoscope
(a telescope-like instrumentattachedtoa tinycamera).The surgeonthenmakesothersmall
incisionsandinsertssurgical equipmentthatuseselectrical orlaserenergytoburnsmall holesinthe
enlargedfolliclesonthe surface of yourovaries.The goal of the procedure istostimulate ovulation
by reducingLH andandrogenlevels.
Additionally,manywomenwhofailedtoovulate withclomipheneormetformintherapyare able to
ovulate withthese medicationsafterovariandrilling.The successratesfor laparoscopicovarian
drillingappeartobe betterforpatientsator near theirideal bodyweight,asopposedtothose who
are obese.Interestingly,womeninthese studieswhoare smokersrarelyimprovedwiththe drilling
procedure.Side effectsare rare, primarilyadhesions,althoughlaparoscopicovariansurgeryrequires
general anesthesia,whichcarriesitsownrisks.
OtherApproaches
Long-term,nonmedical treatmentisgearedtowardmodifyingyourriskfactorsforhealthproblems
oftenassociatedwithPCOS,includingdiabetes,uncontrollable weightgainandheartdisease.A
healthy,low-sugar,low-starchdietandanexercise programtostabilizeyourweightcanreduce the
riskof these conditions.
You can manage some problemsassociatedwithPCOSwithoutmedication.Excesshaircanbe
removedbyshaving,tweezing,waxingorusingdepilatorycreams,orbyelectrolysisorlaser
techniquesadministeredbyatrainedprofessional.Sincelasersworkbyattackingaskinpigment,
theyshouldbe usedwithcaution bydarker-skinnedwomen.
If you are overweightandhave PCOS,youneedtolose weight.Losingevenjustasmall amountof
weightcanlowerandrogenandinsulinlevels,reducingyourriskof insulinresistance anddiabetes.

11. Some obese womenwithPCOSfind losingjust5to 10 percentof theirbodyweighthelpstheir
periodsbecome more regular.
Exercise alone,evenwithoutweightloss,isalsobeneficial sinceithelpsimprove insulinsensitivity.
It seemsthatsome PCOSsymptomsimprove aswomennearmenopause,butsome of the
complicationsmaypersistintoorbeyondmenopause,particularlymale patternbaldnessorthinning
hair,whichsometimesgetsworse aftermenopause.The riskforheartattack,stroke and diabetes
alsoincreasesinmenopause inwomen withPCOS.Incaseswhere PCOSsymptomspersist,the best
recommendationistomonitorcholesterol,triglyceridesandbloodpressure,aswellasglucose and
insulinlevels.
Prevention
There isno knownwayto preventpolycysticovarysyndrome (PCOS).Researchersare still workingto
understandthe underlyingcauses.However,if youhave PCOSthere isa highlikelihoodthatyour
daughteror sisterwill have the disorder.There are stepsyoucantake to preventsome of the worst
consequencesof the disorder––diabetes,uterine cancer,highbloodpressure andhighlevelsof
bloodlipids(ariskfactorfor heartdisease).
If you do notmenstruate,inducingmenstruationwithaprogesterone-likeagentshouldbe atop
priority.Duringmenstruation,the endometrial liningisshedinresponse towithdrawalof the
progesterone hormone.Withoutthisshedding,yourriskof uterine cancerrisessignificantly.Birth
control pills,whichcombine estrogenandprogestin,canrestore regularperiods.If youdon’twant
to take a dailymedication,acourse of progesterone,suchasmedroxyprogesterone acetate,
micronizedprogesteroneornorethindrone acetate,takenfor10 to 14 dayseveryone tothree
months,mayhelp.
If you are overweight,losingweightisabigsteptoward loweringyourriskfordiabetesandheart
disease.Losingweightcanhelprestore regularperiodsandimprove otherhormonalimbalances,but
weightlossisoftenanincomplete solutiontoPCOS.
Facts to Know

12. Polycysticovarysyndrome (PCOS) isthe mostcommonendocrine disturbance inwomenof
reproductive age,affectinganestimated5percentto 15 percentof all women.
No one knowsexactlywhatcausesPCOS,althoughevidence suggestsadefinite geneticlinktothe
disorder.
Many womenwithPCOSwill have polycysticovaries,butitispossible tobe diagnosedwiththe
syndrome withoutthissign,andnotall womenwithpolycystic-appearingovarieswill have PCOS.
Many PCOSsymptomsare the resultof highlevelsof androgens.These hormonesare oftencalled
“male hormones”eventhoughtheyare foundinbothmenandwomen.Androgensinclude
testosterone,DHT,androstenedione andDHEA.Otherhormonescanbe convertedintotestosterone
or DHT.
Abouthalf of womenwithPCOSexperience gradual weightgainand obesity.Insome womenwith
PCOS,obesitydevelopsaroundthe time of puberty.
PCOSis stronglylinkedtoinsulinresistance(aprecursortotype 2 diabetesandheartdisease).For
womenwithPCOSwhoare obese,the treatmentplanshouldincorporateadiet andexercise
program.By age 40, about35 percentof womenwithPCOSwhoare obese have impairedglucose
tolerance (pre diabetes),andabout10 percenthave type 2 diabetes.However,notall womenwho
have PCOSare insulin-resistantordiabetic.
WomenwithPCOSare at increasedriskfordevelopingtype 2diabetesandobesity,andasa result
have an increasedriskof cardiovasculardisease.
If you are overweight,losingweightisamajorsteptoward loweringyourriskfordiabetesandheart
disease.Losingweightcanhelprestore regularperiodsandimprove otherhormonalimbalances,but
weightlossisoftenanincomplete solutiontoPCOS.
If irregularand/orinfrequentmenstruationisaproblem, birthcontrol pillsorperiodiccoursesof a
progestinalone canprobablygetyouonschedule again.Duringmenstruation,the liningof the
uterusisshed,providingprotectionagainstuterine cancer,sorestoringregularperiodsisimportant.
Occasionally,PCOSsymptomsare the resultof an androgen-producingtumor.If symptomsare
severe orprogressrapidly,oryourtestosterone levelisveryhighoryourcortisol level iselevated,
your healthcare professional maywanttoinvestigate further.
KeyQ&A
What ispolycysticovarysyndrome (PCOS)?PCOSisahormonal disorderlinkedtohyperandrogenism
(a conditioncausedbyexcessandrogenssuchastestosterone)andirregularovulation.Visiblesigns
and symptomsmayinclude hirsutism(excessbodyand/orfacial hair);irregularorinfrequent
periods;;acne and/oroilyskin(particularlysevere acne inteenagersoracne that persistsinto
adulthood);infertility;insulinresistance (oftenresultinginimpairedglucose tolerance,afrequent
precursorto type 2 diabetes);hairlossorbalding;darkeningof the skin,usually onthe neck;and

13. skintags inthe armpit or onthe neck.WomenwithPCOSmayalsohave,as the name suggests,
ovariancysts,whichare benign,small andnumerous.
How isPCOSdiagnosed?A healthcare professional will take athoroughhistoryanddoa complete
physical examinationandmaydoa seriesof bloodteststocheck forhormone imbalances
characteristicof PCOS.Ultrasoundimagingof the ovariesmayalsobe performed.Mostwomenwith
PCOSwill have irregularorabsentmenstrual periods.
Whichhealth care professional shouldIsee?Mostcasesrequire the expertise of anendocrinologist
or reproductive endocrinologist.
ShouldItry an insulinsensitizertotreatPCOS?Certainly,if youhave insulinresistanceortype 2
diabetesaninsulinsensitizerwouldbe anacceptable approachtotreatment.Inwomenwith
irregularperiods,the firstlineof treatmentisusuallyhormonal birthcontrol,suchasbirthcontrol
pillsorthe birthcontrol patch.In womenwhocannottake hormonal birthcontrol,one alternative is
to take the insulin-sensitizingdrugmetformin.A progestin(forexample oral micronized
progesterone ormedroxyprogesterone acetate) isusuallyprescribedtogetherwithmetforminforsix
monthsor until menstrual cyclesbecomeregular.
What can I do if I can’t conceive?The firstline of treatmentisusuallyweightlossinwomenwith
PCOSwhoare overweightorobese.If awomanisunable tolose weightorif modestweightloss
doesnotrestore ovulation,anovulation-stimulatingdrugsuchas clomiphene citrate isprescribed.
Potential side effectsinclude hotflashes,ovarianswellingthatgoesdownwiththe onsetof your
periodandan increasedpossibilityof twins.If clomiphene alone doesn’twork,the nextstepmaybe
a combinationof clomiphene and metformin,injectablegonadotropinsorlaparoscopicovarian
drilling.
Do I have to take birthcontrol pillsif Ihave PCOS?Birthcontrol pillsare frequentlyprescribedto
returnyour menstrual cyclestonormal,butyoucan insteadtake a course of progesterone,suchas
medroxyprogesteroneacetate,micronizedprogesteroneornorethindrone acetate periodically.You
take it forsevento14 dayseveryone tothree months.Progesterone-inducedmenstruationis
essential,because itsloughsoff the endometriallining,helpingpreventuterine cancer.Cyclic
progestindoesnotsuppressmale hormoneslevels,whilebirthcontrol pillswill.
My ovarieshave beenremoved.CanIstill have PCOS?Youcanstill have PCOSbecause PCOSisa
conditionthatnotonlyaffectsthe ovariesbutalsothe adrenal glandand the regulationof insulin.
However,withoutovaries,the hyperandrogenicsymptomsof PCOSare lessened.
I’ve beentakingmedicationasprescribedforweeksandhave seennoimprovement.WhatshouldI
do?Stickwiththe programa while longer.Itmaytake six monthsor longertobeginto see effectsof
spironolactone onhairgrowth,forexample.Metformin,likewise,takestwotothree monthsto
reach full effectoninsulinlevels.Consideraddingaweight-reductionprogramaswell,if thisisan
issue.
Do the symptomsof PCOSeversuggestanythingmore serious?Yes,the possibilitiesincludean
androgen-producingtumor,Cushing’ssyndrome,hyperprolactinemia,adrenalhyperplasia,or

14. hypothyroidism.A thoroughdiagnosisisimportant,especiallyif yourlevelsof testosterone are
above a certainlevel,oryouhave symptomsof “virilization”suchasfacial beard,clitoromegaly
(enlargedclitoris),baldingatthe temples,deepeningvoice ormuscle enlargement.
ShouldIbe testedfordiabetesif Ihave PCOS?Due tothe linkbetweeninsulinabnormalitiesand
PCOS,everywomandiagnosedwithPCOSshouldhave aglucose tolerance testtocheckforpre
diabetesordiabetes.Insulinlevelsmayalsobe checkedtoassessforhyperinsulinemia,asasignof
insulinresistance.A two-hourglucose tolerance test,where youdrinkasugarysolutionandyour
bloodisdrawnbefore andone and twohours afterward,isbestfortestingwomenwithPCOS.If you
have diabetes,itisimportanttobegintreatmentandmonitoringearlytoavoidcomplications.