Polycystic ovary syndrome (PCOS) is a common endocrine system disorder among wom

en of reproductive age. Women with PCOS may have enlarged ovaries that contain s
mall collections of fluid
called follicles located in each ovary as seen during
an ultrasound exam.
Infrequent or prolonged menstrual periods, excess hair growth, acne, and obesity
can all occur in women with polycystic ovary syndrome. In adolescents, infreque
nt or absent menstruation may raise suspicion for the condition.
The exact cause of polycystic ovary syndrome is unknown. Early diagnosis and tre
atment along with weight loss may reduce the risk of long-term complications, su
ch as type 2 diabetes and heart disease.
Polycystic ovary syndrome signs and symptoms often begin soon after a woman firs
t begins having periods (menarche). In some cases, PCOS develops later during th
e reproductive years, for instance, in response to substantial weight gain.
PCOS has many signs
things you or your doctor can see or measure and symptoms
ings that you notice or feel. All of these can worsen with obesity. Every woman
with PCOS may be affected a little differently.
To be diagnosed with the condition, your doctor looks for at least two of the fo
llowing:
Irregular periods. This is the most common characteristic. Examples include mens
trual intervals longer than 35 days; fewer than eight menstrual cycles a year; f
ailure to menstruate for four months or longer; and prolonged periods that may b
e scant or heavy.
Excess androgen. Elevated levels of male hormones (androgens) may result in phys
ical signs, such as excess facial and body hair (hirsutism), adult acne or sever
e adolescent acne, and male-pattern baldness (androgenic alopecia).
Polycystic ovaries. Polycystic ovaries become enlarged and contain numerous smal
l fluid-filled sacs which surround the eggs.
When to see a doctor
See your doctor if you have concerns about your menstrual periods, if you're exp
eriencing infertility or if you have signs of androgen excess such as acne and m
ale-pattern hair growth.
Doctors don't know what causes polycystic ovary syndrome, but these factors may
play a role:
Excess insulin. Insulin is the hormone produced in the pancreas that allows cell
s to use sugar (glucose) your body's primary energy supply. If you have insulin
resistance, your ability to use insulin effectively is impaired, and your pancre
as has to secrete more insulin to make glucose available to cells. Excess insuli
n might also affect the ovaries by increasing androgen production, which may int
erfere with the ovaries' ability to ovulate.
Low-grade inflammation. Your body's white blood cells produce substances to figh
t infection in a response called inflammation. Research has shown that women wit
h PCOS have low-grade inflammation and that this type of low-grade inflammation
stimulates polycystic ovaries to produce androgens.
Heredity. If your mother or sister has PCOS, you might have a greater chance of
having it, too. Researchers also are looking into the possibility that certain g
enes are linked to PCOS.
Having polycystic ovary syndrome may make the following conditions more likely,
especially if obesity also is a factor:
Type 2 diabetes

th

High blood pressure

Cholesterol and lipid abnormalities, such as elevated triglycerides or low highdensity lipoprotein (HDL) cholesterol, the "good" cholesterol
Metabolic syndrome
a cluster of signs and symptoms that indicate a significantly
increased risk of cardiovascular disease
Nonalcoholic steatohepatitis
a severe liver inflammation caused by fat accumulat
ion in the liver
Infertility
Sleep apnea
Depression and anxiety
Abnormal uterine bleeding
Cancer of the uterine lining (endometrial cancer), caused by exposure to continu
ous high levels of estrogen
Gestational diabetes or pregnancy-induced high blood pressure
For polycystic ovary syndrome, you might first see your family doctor or primary
care provider. However, you may be referred to a doctor who specializes in cond
itions affecting the female reproductive tract (gynecologist), one who specializ
es in hormone disorders (endocrinologist) or one who specializes in treating inf
ertility (reproductive endocrinologist).
What you can do
To prepare for your appointment:
Write down any symptoms you're experiencing. Include all of your symptoms, even
if you don't think they're related.
Make a list of medications, vitamins and dietary supplements you take. Write dow
n doses and how often you take them.
Have a family member or close friend accompany you, if possible. You may be give
n a lot of information at your visit, and it can be difficult to remember everyt
hing.
Bring a notepad or electronic device with you to take notes. Use it to record im
portant information during your visit.
Think about what questions you'll ask. Write them down so that you won't forget
important points you want to discuss with your doctor.
For polycystic ovary syndrome, some basic questions to ask include:
What kinds of tests might I need?
How does this condition affect my ability to become pregnant?
Are medications available that might improve my symptoms or my ability to concei
ve?
I have other medical conditions. How can I best manage them together?
What side effects can I expect from medication use?
What treatment do you recommend for my situation?
What are the long-term health implications of PCOS?
Do you have any brochures or other printed materials that I can take with me?
What websites do you recommend visiting?
Don't hesitate to ask your doctor to repeat information or to ask follow-up ques
tions for clarification.
What to expect from your doctor
Some potential questions your doctor or health care provider might ask include:
What signs and symptoms are you experiencing?
When did each symptom begin?
Have you had symptoms since you first started having periods?
How often do you experience these symptoms?

How long have you been experiencing symptoms?

How severe are your symptoms?
When was your last period?
Have you gained weight since you first started having periods? How much weight h
ave you gained? When did you gain the weight?
Does anything improve your symptoms?
Does anything make your symptoms worse?
Are you trying to become pregnant, or do you wish to become pregnant?
Has your mother or sister ever been diagnosed with PCOS?
Lifestyle changes
As a first step, your doctor may recommend weight loss through a low-calorie die
t combined with moderate exercise activities. Even a modest reduction in your we
ight
for instance, losing 5 percent of your body weight
might improve your condi
tion.
Medications
Your doctor may prescribe a medication to:
Regulate your menstrual cycle. To regulate your menstrual cycle, your doctor may
recommend combination birth control pills pills that contain both estrogen and
progestin. These birth control pills decrease androgen production and give your
body a break from the effects of continuous estrogen, lowering your risk of endo
metrial cancer and correcting abnormal bleeding. As an alternative to birth cont
rol pills, you might use a skin patch or vaginal ring that contains a combinatio
n of estrogen and progestin. During the time that you take this medication to re
lieve your symptoms, you won't be able to conceive.
If you're not a good candidate for combination birth control pills, an alternati
ve approach is to take progesterone for 10 to 14 days every one to two months. T
his type of progesterone therapy regulates your periods and offers protection ag
ainst endometrial cancer, but it doesn't improve androgen levels and it won't pr
event pregnancy. The progestin-only minipill or progestin-containing intrauterin
e device are better choices if you also wish to avoid pregnancy.
Your doctor also may prescribe metformin (Glucophage, Fortamet, others), an oral
medication for type 2 diabetes that improves insulin resistance and lowers insu
lin levels. This drug may help with ovulation and lead to regular menstrual cycl
es. Metformin also slows the progression to type 2 diabetes if you already have
prediabetes and aids in weight loss if you also follow a diet and an exercise pr
ogram.
Help you ovulate. If you're trying to become pregnant, you may need a medication
to help you ovulate. Clomiphene (Clomid, Serophene) is an oral anti-estrogen me
dication that you take in the first part of your menstrual cycle. If clomiphene
alone isn't effective, your doctor may add metformin to help induce ovulation.
If you don't become pregnant using clomiphene and metformin, your doctor may rec
ommend using gonadotropins follicle-stimulating hormone (FSH) and luteinizing ho
rmone (LH) medications that are administered by injection. Another medication th
at your doctor may have you try is letrozole (Femara). Doctors don't know exactl
y how letrozole works to stimulate the ovaries, but it may help with ovulation w
hen other medications fail.
When taking any type of medication to help you ovulate, it's important that you
work with a reproductive specialist and have regular ultrasounds to monitor your
progress and avoid problems.

Reduce excessive hair growth. Your doctor may recommend birth control pills to d
ecrease androgen production, or another medication called spironolactone (Aldact
one) that blocks the effects of androgens on the skin. Because spironolactone ca
n cause birth defects, effective contraception is required when using the drug,
and it's not recommended if you're pregnant or planning to become pregnant. Eflo
rnithine (Vaniqa) is another medication possibility; the cream slows facial hair
growth in women.

To help offset the effects of PCOS:

Keep your weight in check. Obesity makes insulin resistance worse. Weight loss c
an reduce both insulin and androgen levels and may restore ovulation. No single
specific dietary approach is best, but losing weight by reducing how many calori
es you consume each day may help with polycystic ovary syndrome, especially if y
ou're overweight or obese. Use smaller plates, reduce portion sizes and resist t
he urge for seconds to help with weight loss. Ask your doctor to recommend a wei
ght-control program, and meet regularly with a dietitian for help in reaching we
ight-loss goals.
Consider dietary changes. Low-fat, high-carbohydrate diets may increase insulin
levels, so you may want to consider a low-carbohydrate diet if you have PCOS
and
if your doctor recommends it. Don't severely restrict carbohydrates; instead, c
hoose complex carbohydrates, which are high in fiber. The more fiber in a food,
the more slowly it's digested and the more slowly your blood sugar levels rise.
High-fiber carbohydrates include whole-grain breads and cereals, whole-wheat pas
ta, bulgur wheat, barley, brown rice, and beans. Limit less healthy, simple carb
ohydrates such as soda, excess fruit juice, cake, candy, ice cream, pies, cookie
s and doughnuts.
Be active. Exercise helps lower blood sugar levels. If you have PCOS, increasing
your daily activity and participating in a regular exercise program may treat o
r even prevent insulin resistance and help you keep your weight under control