Polycystic ovary syndrome (PCOS)

Also known as polycystic ovarian syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a hormonal condition that can cause irregular, infrequent periods and affect your skin, hormones, fertility and mental and emotional wellbeing.

Key points

  1. PCOS is the most common hormonal condition for women of childbearing age.
  2. Many women don’t find out they have PCOS until they have difficulty getting pregnant.
  3. Symptoms range from mild to severe. They can include obesity, irregular or heavy periods, acne and too much hair growth.
  4. If you have PCOS, you are at greater risk of developing type 2 diabetes, heart disease, depression, mood swings and infertility.
  5. There is no cure for PCOS, but lifestyle changes make a difference and there are also treatments available.
  6. It can be challenging to live with PCOS, so getting good support and taking care of your emotional wellbeing is important.

What is PCOS?

Women of childbearing age generally produce an egg from an ovary every month. This process requires a fine-tuned response from a complex hormonal system. In women with PCOS too much testosterone and insulin is produced during this process. This then stops the release of eggs from your ovary, but it doesn't stop them being produced. Eggs continue to build up in your ovaries, which is why the condition is referred to as polycystic ovaries (many cysts in your ovaries).

Who gets PCOS?

PCOS can begin at puberty or even in early to mid-20s. It is the most common hormonal condition affecting women of childbearing age. About 8–13 out of every 100 women of childbearing age are affected.

Many women with PCOS don't know they have it until they have difficulty getting pregnant.

What causes PCOS?

The cause of PCOS is not yet known but it might run in families. If any of your relatives (mother, aunts, sisters) are affected with PCOS, your risk of developing it may be increased.

The symptoms are related to increased hormone levels, mainly testosterone and insulin.

  • Testosterone is a hormone produced by the ovaries in all women. Women with PCOS have significantly higher than normal levels of testosterone and this is associated with many of the symptoms of PCOS.
  • Insulin is a hormone that controls the level of glucose (a type of sugar) in your blood. If you have PCOS, your body may not respond to insulin (this is known as insulin resistance), so the level of glucose is higher. To try to prevent the glucose levels becoming higher, your body produces even more insulin. High levels of insulin can lead to weight gain, irregular periods, fertility problems and higher levels of testosterone.

What are the symptoms of PCOS?

The symptoms vary from woman to woman. Some women have very few or mild symptoms, while others are affected more severely by a wider range of symptoms.

Common symptoms of PCOS
  • irregular, infrequent or absent periods
  • oily skin, acne
  • excessive hair growth on your face, chest or abdomen (hirsuitism)
  • hair loss or thinning of hair on your head (in a classic 'male baldness' pattern)
  • being overweight, experiencing a rapid increase in weight or having difficulty losing weight.

Women with PCOS may also develop:

Depression and mood problems

Women with PCOS have a greater risk of mental health issues, such as low self esteem, poor self-image, anxiety and depression. This may be due to a combination of hormonal influences and dealing with the symptoms of PCOS. These feelings can affect your overall quality of life. Read more about PCOS and emotional wellbeing.

How is PCOS diagnosed?

There is no easy test for PCOS, so your doctor will need to assess your symptoms, medical history and physical appearance. 

If your doctor suspects you have PCOS, they will send you for tests to confirm it and rule out other medical conditions. These may include blood tests to check your levels of testosterone and other hormones, prolactin, thyroid stimulating hormone (TSH), glucose and cholesterol, liver function tests and other tests as required.  

To make diagnosis of PCOS, 2 out of 3 of the following are required:

  • Not having menstrual periods or only having them irregularly.
  • Excess body or facial hair, acne or high levels of testosterone.
  • Polycystic ovaries on ultrasound (only if you have been having periods for 8 years  or more). Your doctor won't ask for an ultrasound if you are younger than this.

If the first 2 criteria are both present, an ultrasound scan is not required.

How is PCOS treated?

PCOS is treatable, but not curable. The key is learning what you can do to help yourself. Your doctor and PCOS support groups are good sources of information. 

Exercise and weight loss

Exercise and weight loss (if you are overweight as most people with PCOS are) are the best treatments for managing PCOS. If you are overweight, losing and keeping it off can help relieve PCOS-related symptoms and lead to more regular periods, less acne, a decrease in excess hair growth and improved mood and self-esteem.

Losing weight may also help to lower your blood glucose levels, improve the way your body uses insulin, help your hormones reach normal levels and increase your chance of becoming pregnant. Learn more about healthy weight loss.

Medications

There are a number of medications used to manage the different symptoms of PCOS, including for acne, excess hair growth, problems with your periods and fertility issues. Some medicines may help more than one symptom. PCOS affects everyone differently and your doctor will work out which medicines best meet your needs. 

Read more about treatment options for PCOS.

Sometimes excessive hair growth is best managed with both medical treatment and electrolysis or laser therapy. Your doctor can advise what’s best for you. 

Emotional health and wellbeing

PCOS can be a challenging condition to live with. You have a greater risk of mental health issues, such as low self esteem, poor self-image, anxiety and depression. This may be due to a combination of hormonal influences and dealing with the symptoms of PCOS. These feelings can affect your overall quality of life. Getting support and taking good care of yourself are important. Read more about PCOS and emotional wellbeing.

What are the complications of PCOS?

PCOS can increase your chances of developing health problems later in life, so you need to have regular medical check-ups. Even though some PCOS symptoms may lessen after menopause, this is likely to be the time many of the long-term associated conditions appear.

Type 2 diabetes (and insulin resistance) 
The difficulty most women with PCOS have in processing insulin tends to get worse with age. By the time of menopause, about 50% of women with PCOS are diagnosed with type 2 diabetes. Because of this, it is important to follow a healthy diet and maintain an exercise programme long before menopause. Read more about prediabetes and diabetes

High blood pressure 
Women with PCOS tend to have high blood pressure, which can lead to heart problems and should be treated. Ask your doctor at what age you should start having cardiovascular risk assessments and getting your blood pressure checked regularly.

Depression and mood swings
The symptoms of PCOS may affect how you see yourself and how you think others see you. It can lower your self-esteem. Read about depression.

Snoring and daytime drowsiness
PCOS can lead to fatigue or sleepiness during the day. It is also associated with snoring.

Endometrial hyperplasia
Endometrial hyperplasia occurs when the endometrium, the lining of your uterus (womb), becomes too thick. Because PCOS means you don't ovulate often, you have infrequent periods, which results in a build-up of the lining of your uterus. This may increase the risk of the uterine lining producing abnormal cells that can turn into cancer, although this is not known for certain.

Is there a cure for PCOS?

There is no cure for PCOS. Medical treatments aim to manage and reduce the symptoms or consequences of having PCOS. Medication alone has not been shown to be any better than healthy lifestyle changes (weight loss and exercise). Many women with PCOS successfully manage their symptoms and long-term health risks without medical intervention.

Learn more

Polycystic ovary syndrome – what it means for your long-term health Royal College of Obstetricians and Gynaecologists, UK, 2015
Ask PCOS Monash University, Australia, 2018

References

  1. International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018 Monash University, Melbourne, Australia, 2018
  2. Understanding polycystic ovary syndrome BPAC, NZ, 2008
  3. Long-term consequences of polycystic ovary syndrome Royal College of Obstetricians and Gynaecologists, UK, 2014  
Credits: Health Navigator Editorial Team.