What You Need to Know About PCOS

There are many things to be said about polycystic ovarian syndrome (PCOS), but perhaps the biggest takeaway is this: it’s complicated.

A hormonal condition that affects the reproductive organs of 12 million American women, PCOS occurs when the ovaries make more androgens (a male sex hormone) than needed. As the name suggests, cysts on the ovaries are a hallmark of the disease. However, some individuals with PCOS do not have polycystic ovaries, and most individuals who develop cysts on their ovaries do not have PCOS. Like we said, it’s complicated.

While the exact cause of PCOS isn’t clear, researchers believe a combination of a family history of PCOS and other health factors lead to an imbalance in the endocrine system, resulting in high levels of androgens. Those high levels can lead to a myriad of health challenges—including having trouble getting pregnant and increased cardiovascular risks—and symptoms.
Common symptoms include:

- Missed periods, irregular periods, very light periods, or very heavy periods

- Ovaries that are large or have many cysts 

- Excess hair growth, most notably on the face, chest, stomach, or thighs

- Weight gain, especially around the belly, and/or obesity

- Cramping, with or without menstruation

- Acne or oily skin

- Thick patches of skin that appear dark and velvety, most often where your skin folds (think armpits and groin)

In some cases, symptoms can be so mild they may go unnoticed until an individual cannot become pregnant. In others, symptoms are pronounced enough—even in the teen years—to drive someone to a doctor for a diagnosis.

Diagnosing PCOS involves an evaluation of your health history and symptoms. Very often, a pelvic exam is performed. Other common tests may include an ultrasound of your ovaries to check for cysts visually and blood tests to check your androgen levels and other hormones.

While there is no cure for PCOS, there are a range of treatment options that can work to reduce symptoms. The type of treatment plan depends on the severity of your symptoms, whether or not you wish to become pregnant, and overall health.

Common treatment options include:

Lifestyle changes: Maintaining a healthy weight through diet and exercise can reduce symptoms and actually help with ovulation and decrease cardiovascular risks.

Medication: Depending upon the underlying cause of your condition, your doctor may recommend one of the following medications:

- Birth control pills: These help to control menstrual cycles, lower androgen levels, and reduce acne. 

- Diabetes medicine: Used to lower insulin resistance in PCOS, this particular medication may also help reduce androgen levels, slow hair growth, and lead to more regular ovulation.

- Anti-androgens: These medicines work to stop your ovaries from producing androgens, and can help with acne and excess hair growth.

- Fertility medication: Used to help the ovaries to release eggs normally and increase the chance of conception if desired.

Even if you have no plans to become pregnant, getting a diagnosis of PCOS is important if you have symptoms, as PCOS is linked to certain serious health problems including type 2 diabetes, high blood pressure, problems with the heart and blood vessels, and uterine cancer. A diagnosis will enable your healthcare provider to stay on top of your PCOS as well as these other potential risks.

Themarge Small, MD, FACOG, is an obstetrics & gynecology specialist at SVMC.