Polycystic ovary syndrome: Symptoms and treatment

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in females of childbearing age, and it can sometimes make it hard to get pregnant, according to the online medical resource StatPearls.

The condition affects up to 5 million U.S. women of reproductive age, according to the Centers for Disease Control and Prevention (CDC), and it is named for the multiple cysts lining the outer edges of the ovaries. These aren't truly ovarian cysts, however. Instead, they're small, undeveloped egg follicles that may prevent regular ovulation. .

PCOS is characterized by high levels of androgens, or male reproductive hormones, and can come with a range of symptoms, including irregular periods, excessive weight gain and hair growth, and acne.

What causes PCOS?

No one knows the root cause of PCOS, and there is probably more than one, Dr. Marie Menke, a reproductive endocrinologist at University of Michigan Health, told Live Science.

One possible cause is that the ovaries make excess levels of certain sex hormones, including testosterone and anti-Müllerian hormone, Live Science previously reported. This, in turn, may drive many of the other symptoms. Why some ovaries produce excess sex hormones, however, is unclear.

Obesity and insulin resistance — the body's inability to effectively use insulin, a hormone that regulates blood sugar — also may play a role in triggering the disease. Others have proposed that children exposed to high levels of androgens in the womb may go on to have the disease.

Genes play a role, too: PCOS tends to run in families, and a woman whose mother or sister has PCOS is more likely to develop it. Women with a family History of type 2 diabetes are also more likely to develop PCOS, according to the World Health Organization.

PCOS and pregnancy

PCOS symptoms can show up as early as puberty and even after menopause. Many women find out they have the condition in their 20s and 30s, if they have trouble becoming pregnant. PCOS makes it hard to become pregnant because androgens prevent immature follicles from developing into mature eggs that can be released and develop into an embryo, according to the U.S. Department of Health & Human Services (HHS).

People who are hoping to get pregnant have a number of treatment options, including fertility medications, like clomiphene (also known by the brand names Clomid and Serophene), which are taken orally; or gonadotropins, such as follicle-stimulating hormone (FSH) or luteinizing hormone (LH), which are injected, according to the HHS.

PCOS symptoms

According to the HHS PCOS may include these signs and symptoms:

• Infertility: Women with PCOS do not ovulate regularly or frequently, so they have fewer chances per year to become pregnant
• Infrequent, irregular or absent menstrual periods
• Hirsutism, which is increased hair growth on the face, chest, stomach, thumbs or toes, likely caused by excess androgens
• Ovaries that are enlarged or have many cysts
• Acne or oily skin, also likely caused by excess androgens
• Weight gain or obesity
• Male-pattern baldness or thinning hair, another symptom of excess testosterone
• Acanthosis nigricans — thick, dark patches of skin on the neck, arms, breasts or thighs
• Skin tags, which are excess flaps of skin in the armpits or neck area
• Pelvic pain

Diagnosis & tests

Diagnosing PCOS can be challenging because symptoms vary a lot, Menke said. To be diagnosed with PCOS, a patient must experience at least two of the three main symptoms described below, Menke said.

1. Irregular menstrual cycles: Irregular, infrequent or no periods are caused by a lack of ovulation. For example, a woman may have fewer than nine periods a year or have unpredictable periods.
2. Higher than normal levels of male hormones (androgens).
3. Polycystic ovaries. However, some patients with PCOS have normal-appearing ovaries, and other women with cysts (fluid-filled sacs) on their ovaries may not have PCOS.

Complications

PCOS has been linked with a number of other health conditions. Whether PCOS actually causes these conditions isn't yet clear. These conditions include:

• Type 2 diabetes: More than half of women with PCOS develop diabetes by the age of 40, according to the CDC.
• Cholesterol abnormalities, such as high LDL ("bad") cholesterol and low HDL ("good") cholesterol, which can increase the risk for heart disease
• High blood pressure, which can affect the heart, brain and kidneys
• Metabolic syndrome, a group of risk factors for heart disease, stroke and diabetes, is twice as common in people with PCOS than the general population, according to information from the American Academy of Family Physicians.
• Sleep apnea: This condition, which can cause pauses in breathing during sleep, is more common in women with PCOS
• Anxiety or depression
• Diabetes or high blood pressure during pregnancy

Treatment & medications

It is difficult to treat all of the symptoms of PCOS at once, Menke said. So, she typically asks her patients, "What is your primary concern with PCOS?" and then focuses treatment on managing those symptoms first.

For example, if someone's main concern is excess hair growth, Menke said she would typically prescribe birth control pills, which can help reduce levels of androgens.

The treatment options available for PCOS can help manage symptoms, but they don't immediately go away, Menke said. According to the the Mayo Clinic, these treatment options may include:

• Birth control pills, which can control menstrual cycles, reduce androgen production and help clear acne.
• Fertility medications, which can stimulate ovulation in PCOS patients who wish to become pregnant. These drugs include clomiphene (also known as the brand name Clomid or Serophene), which are taken orally; or gonadotropins such as follicle-stimulating hormone (FSH) or luteinizing hormone (LH), which are injected.
• Anti-obesity drugs .
• Anti-androgens such as spironolactone or flutamide .
• Diabetes medications such as metformin that make the body more sensitive to insulin.

Additional reporting by Cari Nierenberg, Live Science contributor.