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Polycystic ovary syndrome (PCOS) is a chronic condition that affects the ovaries. Among women and girls of reproductive age, it’s the most common hormonal condition — reported to impact 5 million women in the U.S. Since doctors aren’t sure exactly what causes PCOS, they’re not sure how to cure it. It’s sometimes referred to as polycystic ovarian syndrome.
To diagnose PCOS, your healthcare provider must rule out other potential causes of your symptoms, and you must meet certain medical criteria. An accurate diagnosis can help your doctor effectively treat PCOS and reduce your risk of complications. Most people with PCOS are able to lead normal lives, despite the chronic condition.
PCOS is a hormonal disorder that can develop anytime after the menstrual cycle begins. Several hormones are linked to the condition — androgens, insulin, estrogen, and progesterone. While some hormone levels may be too high, others may be too low.
This hormonal imbalance is the cause of PCOS symptoms. Since levels of these hormones vary among people, different levels of each may result in different types of PCOS.
Though androgens, like testosterone, tend to be referred to as “male hormones,” everyone has them. Levels of androgens are just normally much higher in men than in women. The ovaries normally produce small amounts of androgens, which play a role in regulating the reproductive system. If the ovaries produce too much androgen, however, PCOS can develop.
High levels of androgens are referred to as hyperandrogenism. This can alter the balance of hormones, preventing ovulation (when an ovary releases an egg) and affecting the menstrual cycle. Excess androgen can also lead to other PCOS symptoms, such as acne, hirsutism (excess hair growth on the body and face), and cysts in the ovaries.
Insulin is the hormone that allows our cells to take in and use glucose (blood sugar). Insulin resistance occurs when cells become less sensitive to insulin than they should be. This leads to insulin becoming less effective at managing blood sugar levels.
When blood sugar levels get too high, the body creates more insulin in response. This can then lead to levels of insulin that are too high. Around 70 percent of PCOS cases involve high insulin levels due to being insulin resistant. High insulin levels can also signal the body to produce more androgens. Because insulin resistance is so common in PCOS, women with PCOS have a higher risk of developing type 2 diabetes.
Estrogen — known as a “female hormone” — is important for regulating many processes within the body, including ovulation. Progesterone is a hormone produced in the ovaries after ovulation to prepare the uterus to support a fertilized egg during pregnancy.
If you have PCOS, high androgen levels can prevent ovulation, sometimes leading to an imbalance of estrogen and progesterone. You may also have irregular levels of other hormones involved in menstruation — luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
Too little progesterone or estrogen can lead to irregular menstrual cycles and miscarriages, if pregnancy occurs.
Reports of PCOS-like symptoms have been described for thousands of years. The first known reports date back to ancient Greece. But much of what we know about PCOS has been discovered since the middle of the 20th century.
In 1935, American gynecologists Irving Stein Sr. and Michael Leventhal observed the presence of ovarian cysts in women with anovulation — absent or infrequent ovulation. They named this condition Stein-Leventhal syndrome. For many years, the syndrome was diagnosed by the presence of ovarian cysts with anovulation. Over time, the disorder came to be known as polycystic ovarian syndrome.
It wasn’t until the early 1990s at a National Institutes of Health (NIH) conference that formal diagnostic criteria for PCOS were proposed. In 2003, standardized criteria were established at a conference of PCOS experts in Rotterdam. These Rotterdam criteria are commonly used by doctors for diagnosing PCOS.
According to the current guidelines, a PCOS diagnosis requires only two of three main criteria to be met — irregular periods, high androgen levels, and polycystic ovaries. Recent research has also led to the understanding that PCOS “cysts” aren’t actually cysts, but follicles filled with fluid.
Reports of how many people have PCOS (prevalence) vary widely. One review noted global PCOS prevalence was between 5 percent and 26 percent.
Meanwhile, other studies have found that global prevalence varies depending on which diagnostic criteria are used. For example, one review noted that the prevalence of PCOS according to the Rotterdam criteria was between 8 percent and 13 percent. In contrast, the prevalence of PCOS using the older NIH criteria was between 5 percent and 8 percent. A 2024 review found that PCOS impacts 9.2 percent of women globally.
Symptoms of PCOS can differ among people. Often, the hormonal imbalance of PCOS presents as irregular menstrual periods, unwanted facial and body hair, and acne. Other signs of PCOS may include:
PCOS is also the leading cause of female infertility.
PCOS often runs in families. People who have a family history of PCOS may be more likely to develop it than those without an affected family member.
Some studies have shown PCOS to be more common among certain races and ethnic groups. For example, South Asian, Indian, Middle Eastern, and Mediterranean women were found to have higher rates of PCOS linked to severe hirsutism. However, the data is inconsistent.
Other risk factors that may play a role in developing PCOS include obesity, smoking, and cholesterol levels.
Having PCOS raises your risk of developing other health problems, including:
PCOS also increases the risk of obesity, cardiovascular disease, nonalcoholic fatty liver disease, sleep apnea, mood disorders like anxiety and depression, and high blood pressure.
PCOS is diagnosed through a combination of medical history, physical exam, imaging, and blood tests. If your doctor rules out other causes of your symptoms and you meet two of the three Rotterdam criteria, you’ll be diagnosed with PCOS.
Management of polycystic ovary syndrome involves treating its symptoms. Your treatment will vary depending on your symptoms and whether you’re trying to become pregnant. Your doctor may also recommend lifestyle changes, such as a healthy diet, and/or medications.
For those not trying to get pregnant, treatment options include:
For those who do plan to become pregnant, treatment options include:
On myPCOSteam, people share their experiences with PCOS, get advice, and find support from others who understand.
What has your experience been like with PCOS? Let others know in the comments below.
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