Polycystic Ovary Syndrome (PCOS)

Topic Overview

What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (say 'pah-lee-SIS-tik OH-vuh-ree SIN-drohm') is a problem in which a woman's hormones are out of balance. It can cause problems with your periods and make it difficult to get pregnant. PCOS may also cause unwanted changes in the way you look. If it is not treated, over time it can lead to serious health problems, such as diabetes and heart disease.

Polycystic ovary syndrome (or PCOS) is common, affecting as many as 1 in 15 women. Often the symptoms begin in the teen years. Treatment can help control the symptoms and prevent long-term problems.

What are hormones, and what happens in PCOS?

Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone.

For reasons that are not well understood, in PCOS the hormones get out of balance. One hormone change triggers another, which changes another. This makes a vicious circle of out-of-balance hormones. For example:

• The sex hormones get out of balance. Normally, the ovaries make a tiny amount of male sex hormones (androgens). In PCOS, they start making slightly more androgens. This may cause you to stop ovulating, get acne, and grow extra facial and body hair.
• The body may have a problem using insulin, called insulin resistance. When the body doesn't use insulin well, blood sugar levels go up. Over time, this increases your chance of getting diabetes.

What are the symptoms?

Symptoms tend to be mild at first. You may have only a few symptoms or a lot of them. The most common symptoms are:

• Acne.
• Weight gain and trouble losing weight.
• Extra hair on the face and body. Often women get thicker and darker facial hair and more hair on the chest, belly, and back.
• Thinning hair on the scalp.
• Irregular periods. Often women with PCOS have fewer than nine periods a year. Some women have no periods. Others have very heavy bleeding.
• Fertility problems. Many women with PCOS have trouble getting pregnant (infertility).
• Depression.

Most women with PCOS grow many small cysts on their ovaries. That is why it is called polycystic ovary syndrome. The cysts are not harmful, but lead to hormone imbalances.

What causes PCOS?

The symptoms of PCOS are caused by changes in hormone levels. There may be one or more causes for the hormone level changes.

PCOS seems to run in families, so your chance of having it is higher if other women in your family have PCOS, irregular periods, or diabetes. PCOS can be passed down from either your mother's or father's side.

How is PCOS diagnosed?

To diagnose PCOS, the doctor will:

• Ask questions about your past health, symptoms, and menstrual cycles.
• Do a physical exam to look for signs of PCOS, such as extra body hair and high blood pressure. The doctor will also check your height and weight to see if you have a healthy body mass index (BMI).
• Do a number of lab tests to check your blood sugar, insulin, and other hormone levels. Hormone tests can help rule out thyroid or other gland problems that could cause similar symptoms.

You may also have a pelvic ultrasound to look for cysts on your ovaries. Your doctor may be able to tell you that you have PCOS without an ultrasound, but this test will help him or her rule out other problems.

How is it treated?

Regular exercise, healthy foods, and weight control are key treatments for PCOS. Medicines to balance hormones may also be used. Getting treatment can reduce unpleasant symptoms and help prevent long-term health problems.

The first step in managing PCOS is to get regular exercise and eat heart-healthy foods. This can help lower blood pressure and cholesterol and reduce the risk of diabetes and heart disease. It can also help you lose weight if you need to.

• Try to fit in moderate activity and/or vigorous activity on a regular basis. Walking is a great exercise that most people can do.
• Eat a heart-healthy diet. In general, this diet has lots of vegetables, fruits, nuts, beans, and whole grains. It also limits foods that are high in saturated fat, such as meats, cheeses, and fried foods. If you have blood sugar problems, try to eat about the same amount of carbohydrate at each meal. A registered dietitian can help you make a meal plan.
• Most women with PCOS can benefit from losing weight. Even losing 10 lb (4.5 kg) may help get your hormones in balance and regulate your menstrual cycle. PCOS can make it hard to lose weight, so work with your doctor to make a plan that can help you succeed.
• If you smoke, consider quitting. Women who smoke have higher androgen levels that may contribute to PCOS symptoms.¹ Smoking also increases the risk for heart disease.

A doctor may also prescribe medicines, such as:

• Birth control pills. They can help your periods be regular and can reduce symptoms such as excess facial hair and acne. An androgen-lowering medicine, spironolactone, may be used with birth control pills to help reduce symptoms even more. These medicines are not used if you are trying to get pregnant.
• A diabetes medicine called metformin. It can help control insulin and blood sugar levels and reduce androgen levels. This lowers your risk for diabetes and heart disease and can help restore regular menstrual cycles and fertility.
• Fertility medicines, if you are trying to get pregnant.

It is important to see your doctor for follow-up to make sure treatment is working and adjust it if needed. You may also need regular tests to check for diabetes, high blood pressure, and other possible problems.

It may take a while for treatments to help with symptoms such as facial hair or acne. In the meantime:

• Over-the-counter or prescription acne medicines may help with skin problems.
• Waxing, tweezing, and shaving are easy ways to get rid of unwanted hair. Electrolysis or laser treatments can permanently remove the hair but are more expensive. Your doctor can also prescribe a skin cream that slows hair growth for as long as you use it regularly.

It can be hard to deal with having PCOS. If you are feeling sad or depressed, it may help to talk to a counselor or to other women who have PCOS. Ask your doctor about local support groups, or look for an online group. It can make a big difference to know that you are not alone.

Frequently Asked Questions

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Cause

The cause of polycystic ovary syndrome (PCOS) is not fully understood, but genetics may be a factor. If you have PCOS, your sisters and daughters have a 50% chance of developing PCOS.¹

The first signs of PCOS are usually after a girl's menstrual cycle begins (menarche). A teen with menstrual periods over 45 days apart may need to be seen by a doctor to make sure she doesn't have PCOS. (Normally, the first periods and ovulation are hard to predict. They become regular within the first 2 years after menarche. For more information, see the topic Normal Menstrual Cycle.) In some women, PCOS starts after a big weight gain.^{2, 3}

PCOS problems are caused by hormone changes. One hormone change triggers another, which changes another. This makes a "vicious circle" of out-of-balance hormones in your endocrine system, including:

• Ovary hormones. When the hormones that trigger ovulation are not at the right levels, the ovary does not release an egg every month. In some women, cysts form on the ovaries. These cysts make androgen.
• High androgen levels. High androgen in a woman causes male-type hair and acne problems and can stop ovulation.
• High insulin and blood sugar levels. About half of women with PCOS have a problem with how the body uses insulin, called insulin resistance. When the body doesn't use insulin well, blood sugar builds to high levels. If not treated, this can lead to diabetes.

Symptoms

Polycystic ovary syndrome (PCOS) symptoms tend to start gradually. Often, hormone changes that lead to PCOS start in the early teens, after the first menstrual period. Symptoms may be especially noticeable after a weight gain.

With PCOS, you may have only a few symptoms or many symptoms. It is common for PCOS symptoms to be mistaken for other medical problems.

Early symptoms

Early symptoms of PCOS include:

• Few or no menstrual periods . This can range from less than nine menstrual cycles in a year (more than 35 days between cycles) to no menstrual periods.³ Some women with PCOS have regular periods but are not ovulating every month. This means that their ovaries are not releasing an egg each month.
• Heavy, irregular vaginal bleeding. About 30% of women with PCOS have this symptom.⁴
• Hair loss from the scalp and hair growth (hirsutism) on the face, chest, back, stomach, thumbs, or toes. About 70% of women in the United States with PCOS complain of these hair problems caused by high androgen levels.⁵
• Acne and oily skin, caused by high androgen levels.
• Depression or mood swings. Hormonal changes are a known cause of emotional symptoms.

Living with PCOS symptoms can affect your sense of well-being, sexual satisfaction, and overall quality of life. This too can lead to depression.⁶ For more information, see the topic Depression or Depression in Children and Teens.

Gradual symptoms

PCOS symptoms that may develop gradually include:

• Weight gain or upper body obesity (more around the abdomen than the hips). This is linked to high androgen levels.⁵
• Male-pattern baldness or thinning hair (alopecia). This is linked to high androgen levels.
• Repeat miscarriages. The cause for this is not known. These miscarriages may be linked to high insulin levels, delayed ovulation, or other problems such as the quality of the egg or how the egg attaches to the uterus.
• Inability to become pregnant (infertility). This is because the ovaries are not releasing an egg (not ovulating).
• Symptoms of too much insulin (hyperinsulinemia) and insulin resistance, which can include upper body weight gain and skin changes, such as skin tags or dark, velvety skin patches under the arm, on the neck, or in the groin and genital area.
• Breathing problems while sleeping (obstructive sleep apnea). This is linked to both obesity and insulin resistance.³
• Pain in the lower abdomen and pelvis (chronic pelvic pain).

High blood pressure may be more common in women with PCOS, especially if they are very overweight. Your doctor will check your blood pressure.

The most common reasons that first bring women with PCOS to a doctor include:

• Menstrual problems.
• Male-type hair growth (hirsutism) on the face and body.
• Infertility.
• Weight gain or upper body obesity.

What Happens

Polycystic ovary syndrome (PCOS) is a group of health problems linked to a woman's out-of-balance hormones. Common symptoms of PCOS include irregular periods, infertility, repeat miscarriages, male-pattern hair loss, male-type facial and body hair, acne, and obesity. PCOS raises your risks for serious health problems, including high blood pressure (hypertension), heart disease, diabetes, and uterine (endometrial) cancer.

Reproductive problems

Hormone imbalances linked to PCOS cause several types of pregnancy problems and related problems, including:

• Infertility. This happens when the ovaries are not releasing an egg every month.
• Repeat miscarriages. The cause for this is not known. These miscarriages may be linked to high insulin levels, delayed ovulation, or other problems such as the quality of the egg or how the egg attaches to the uterus.
• Gestational diabetes during pregnancy. This risk is greater in women with PCOS than in women who ovulate regularly.
• Increased blood pressure during pregnancy or delivery, having a larger than normal or smaller than normal baby, or having a premature baby.
• Precancer of the uterine lining (endometrial hyperplasia). This can happen when you don't have regular menstrual cycles, which normally build up and "clear off" the uterine lining every month. You can take birth control pills or other hormone medicines to reduce the risk of endometrial hyperplasia.
• Uterine (endometrial) cancer. Risk during the reproductive years is 3 times greater in women with PCOS than in women who ovulate monthly.⁷

You may have more regular menstrual cycles as you near menopause. The reason for this is not known. But your history of PCOS may still increase your long-term risk of high blood pressure (hypertension), heart disease, diabetes, or endometrial cancer.

Problems with insulin and sugar metabolism

Insulin is a hormone that helps your body's cells get the sugar they need for energy. Sometimes these cells do not fully respond to the action of insulin. This is called insulin resistance. Insulin resistance can lead to an increase in blood sugar and diabetes.

Up to 40% of women with PCOS have insulin resistance, and up to 10% get type 2 diabetes by the time they reach age 40.³ Insulin levels also rise in people with insulin resistance. High insulin levels can increase the production of male hormones and make your PCOS worse.

Serious health problems linked to insulin resistance include:

• High blood pressure.
• High triglycerides.
• Low HDL ("good") cholesterol.
• High blood sugar.
• Excess body fat (particularly abdominal obesity).

Heart and blood circulation problems

It is possible that high insulin from PCOS makes heart and blood vessel problems worse.³ These problems include:

• Hardening of the arteries (atherosclerosis).
• Coronary artery disease and heart attack. Some studies have shown that heart attack risk may be increased by as much as 7 times in women with PCOS compared with women who don't have PCOS.⁸
• High blood pressure.
• High cholesterol.
• Stroke.

Breathing/sleep problems

Women with PCOS have a higher risk of breathing problems while sleeping (obstructive sleep apnea). This is linked to both obesity and insulin resistance.³

What Increases Your Risk

The main risk factor for polycystic ovary syndrome (PCOS) is a family history of PCOS. Experts think that a combination of genes plays a part in PCOS.³ If you have the syndrome, your sisters and daughters have a 50% chance of developing PCOS.¹

A family history of diabetes may increase your risk for PCOS because of the strong relationship between diabetes and PCOS. Research on this risk factor is ongoing.

The use of the seizure medicine valproate (such as Depakote) has been linked to an increased risk of PCOS.¹

When To Call a Doctor

Polycystic ovary syndrome (PCOS) is a long-term (chronic) condition. Symptoms tend to start gradually. It is common for PCOS symptoms to be mistaken for some other medical problem.

PCOS causes a wide range of symptoms, so it may be difficult to know when to see your doctor. But early diagnosis and treatment of PCOS will help prevent serious health problems, such as diabetes and heart disease. See your doctor if you have symptoms that suggest PCOS.

If you are a teenage girl, see your doctor if you have:

• Not started menstruating by age 14 and have hair growing on your chest, back, belly, or face (hirsutism).
• Not started menstruating by age 15 or within 2 years of breast and genital hair development.
• Fewer than eight menstrual cycles a year, and this has lasted for 2 years after you started menstruation.
• Severe acne.
• Hair loss from your scalp.
• Excessive hair growth or hair growing in places such as the chest, back, belly, or face.
• Menstrual cycles that are consistently less than 21 days apart or more than 45 days apart.
• Any symptoms of diabetes, such as increased thirst and frequent urination (especially at night), unexplained increase in appetite, unexplained weight loss, fatigue, blurred vision, or tingling or numbness in your hands or feet.
• Skin problems such as acne, oily skin, dandruff, skin tags (acrochordons) in the armpits or neck area, or dark skin patches (acanthosis nigricans) in skin folds or on the neck, groin, or underarms.
• Excess weight gain or upper body obesity (more abdominal fat than hip fat). This is linked to high androgen levels.
• Decided to quit smoking, if you have been smoking. For more information, see the topic Quitting Smoking.

If you are between 20 and 40 years old, see your doctor if you have:

• Menstrual cycles that are consistently less than 21 days apart or more than 35 days apart.
• Regular menstrual cycles but you have been trying unsuccessfully to become pregnant for more than 12 months.
• Vaginal bleeding that lasts more than 8 days; large clots; or excessive spotting.
• Pelvic pain that lasts for more than 4 weeks.
• Excessive hair growth or hair growing on the chest, back, belly, or face (hirsutism).
• Any symptoms of diabetes, such as increased thirst and frequent urination (especially at night), unexplained increase in appetite, unexplained weight loss, fatigue, blurred vision, or tingling or numbness in your hands or feet.
• Skin problems such as acne, oily skin, dandruff, skin tags (acrochordons) in the armpits or neck area, or dark skin patches (acanthosis nigricans) in skin folds or on the neck, groin, or underarms.
• Depression or mood swings. Many women may have emotional problems related to the many physical symptoms of PCOS, such as excess hair, obesity, or infertility.
• Excess weight gain or upper body obesity (more abdominal fat than hip fat). This is also known as android obesity and is related to increased male hormone (testosterone) levels.
• Decided to quit smoking, if you have been smoking. For more information, see the topic Quitting Smoking.

If you are older than 40, call your doctor if you have:

• Vaginal bleeding that lasts more than 8 days; large clots; or excessive spotting.
• Pelvic pain that lasts for more than 4 weeks.
• Any symptoms of diabetes, such as increased thirst and frequent urination (especially at night), unexplained increase in appetite, unexplained weight loss, fatigue, blurred vision, or tingling or numbness in your hands or feet.
• Any symptoms of heart disease, such as chest pain or pressure, shortness of breath, unusual fatigue, or high blood pressure (hypertension).
• Depression or mood swings. Hormonal changes are a known cause of emotional symptoms. But depression and mood swings can also be linked to living with physical PCOS symptoms, such as skin and hair problems, obesity, or infertility.
• Decided to quit smoking, if you have been smoking. For more information, see the topic Quitting Smoking.

Watchful Waiting

Taking a wait-and-see approach (called watchful waiting) is not appropriate when PCOS is suspected. Early diagnosis and treatment may help prevent future complications such as reproductive, metabolic, or heart problems.

Who To See

Health professionals who can diagnose and treat PCOS include:

• Gynecologists.
• Obstetricians.
• Family medicine doctors.
• Nurse practitioners.
• Physician assistants.
• Internists.
• Endocrinologists (pediatric or medical).
• Reproductive endocrinologists.
• Registered dietitians.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

If you have possible symptoms of polycystic ovary syndrome (PCOS), such as menstrual cycle problems or trouble getting pregnant, see your doctor for an exam. PCOS increases your risks of infertility, uterine cancer, diabetes, and heart disease. If you are diagnosed with PCOS, be sure to have regular checkups. This helps you and your doctor lower your risk of these serious health problems.

No single test can show that you have PCOS. Your doctor will talk to you about your medical history, do a physical exam, and run some lab tests. You may also have an ultrasound scan of your pelvis.

• The medical history includes questions about your symptoms. Your doctor may ask you about changes in your weight, skin, hair, and menstrual cycle. He or she may also ask you about problems with getting pregnant, medicines you are taking, and your eating and exercise habits. Be sure to mention whether you have lost hair from your scalp or have male-pattern facial or body hair. You will also talk about any family history of hormone (endocrine) problems, including diabetes.
• The physical exam checks your thyroid, skin, hair, breasts, and belly. You will have a blood pressure check and a pelvic exam to check for enlarged or abnormal ovaries. Your doctor can also tell you what your body mass index (BMI) is, which is based on your height and weight.

Lab tests are also used to look for signs of PCOS. These signs may include high androgen levels, high blood sugar, or high lipid levels. Other tests may include checking your blood for:

• Human chorionic gonadotropin (hCG), to find out if you are pregnant.
• Testosterone, an androgen. Androgens at high levels can block ovulation and cause acne, male-type hair growth on the face and body, and hair loss from the scalp.
• Prolactin, which can play a part in a lack of menstrual cycles or infertility.
• Cholesterol and triglycerides, which can be at unhealthy levels with PCOS.
• A chemistry screen to check kidney and liver function and glucose levels.
• Thyroid-stimulating hormone (TSH) to check for an overactive or underactive thyroid.
• Adrenal gland hormones, such as DHEA-S or 17-hydroxyprogesterone. An adrenal problem can cause symptoms much like PCOS.
• Glucose tolerance and insulin levels, which can show insulin resistance.

A pelvic ultrasound can show enlarged ovaries or more eggs than normal on the ovaries, which are signs of PCOS. But many women with PCOS do not have these signs.

Regular testing for diabetes, heart disease, and uterine cancer for women who have PCOS

Diabetes. If you have PCOS, experts recommend that you have blood glucose testing for diabetes by age 30.⁹ You may have this done at a younger age if you have PCOS and other risk factors for diabetes (such as obesity, lack of exercise, a family history of diabetes, or gestational diabetes during a past pregnancy). After this, your doctor will tell you how often to have testing for diabetes.

Heart disease. Your doctor will regularly check your cholesterol and triglycerides, blood pressure, and weight. This is because PCOS is linked to higher risks of high blood pressure, weight gain, high cholesterol, heart disease, hardening of the arteries (atherosclerosis), heart attack, and stroke.

Uterine (endometrial) cancer. Regular menstrual cycles normally build up and "clear off" the uterine lining every month. When the uterine lining builds up for a long time, precancer of the uterine lining (endometrial hyperplasia) can grow. If you have had infrequent menstrual periods for at least 1 year, your doctor may use a transvaginal ultrasound and/or endometrial biopsy to look for signs of precancer or cancer.³

Treatment Overview

Polycystic ovary syndrome (PCOS) is a group of health problems caused by out-of-balance hormones. It often involves irregular menstrual periods beginning in puberty, or difficulty getting pregnant.

Regular exercise, a healthy diet, not smoking, and weight control are the cornerstone of treatment for PCOS. Sometimes, also using a medicine to balance hormones is helpful.

There is no cure for PCOS, but controlling it lowers your PCOS risks of infertility, miscarriages, diabetes, heart disease, and uterine cancer.

Initial treatment

The first step in managing polycystic ovary syndrome (PCOS) is getting regular exercise, eating a healthy diet, and not smoking. This is a medical treatment for PCOS, not just a lifestyle choice. Additional treatments depend on your symptoms and whether you are planning a pregnancy.

• If you are overweight, a small amount of weight loss is likely to help balance your hormones and start up your menstrual cycle and ovulation. Use regular exercise and a healthy weight-loss diet as your first big treatment step. This is especially important if you're planning a pregnancy.
• If you smoke, consider quitting. Women who smoke have higher levels of androgens than women who don't smoke.¹ Smoking also increases your risk of heart disease.
• If you are planning a pregnancy and weight loss doesn't improve your fertility, your doctor may suggest a medicine that helps lower insulin. With weight loss, this can improve your chances of ovulation and pregnancy. Fertility drug treatment may also help start ovulation.²
• If you are not planning a pregnancy, you can also use hormone therapy to help control your ovary hormones. To correct menstrual cycle problems, birth control hormones keep your endometrial lining from building up for too long. This is what prevents uterine cancer. Hormone therapy can also help with male-type hair growth and acne.³ Birth control pills, patches, or vaginal rings are prescribed for hormone therapy. Androgen-lowering spironolactone (Aldactone) is often used with estrogen-progestin birth control pills. This helps with hair loss, acne, and male-pattern hair growth on the face and body (hirsutism).³

Taking hormones does not help with heart, blood pressure, cholesterol, and diabetes risks. This is why exercise and a healthy diet are a key part of your treatment.

For helpful information, see:

• A registered dietitian who has special knowledge about diabetes.
• The topic Healthy Eating.
• The topic Fitness.
• Physical activity for weight loss.
• The topic Quitting Smoking.

Fitness: Walking for wellness

Additional treatments for menstrual cycle and hair and skin problems

Other treatments for PCOS problems include:

• Hair removal with laser, electrolysis, waxing, tweezing, or chemicals.
• Skin treatments. Acne medicines can be nonprescription or prescription. Some are taken by mouth and some are applied to the skin. (For more information, see the topic Acne Vulgaris.) Skin tag removal is not needed unless the tags are irritating, such as a tag on an eyelid. Generally they can be removed easily by your doctor.

Teenage girls. Early diagnosis and treatment of PCOS may help prevent long-term complications, such as obesity, diabetes, and infertility.

Ongoing treatment

To control polycystic ovary syndrome (PCOS) for the long term, keep up with regular exercise and eat a healthy diet to control body weight and your metabolism. This approach helps you fight the risks of diabetes and heart disease, as well as hair and skin problems caused by the hormones.

To correct menstrual cycle problems, hormone therapy keeps your endometrial lining from building up for too long. This is what prevents uterine cancer. Birth control pills, patches, or vaginal rings are prescribed for hormone therapy.

For help with male-type hair growth, male-pattern hair loss, and acne, hormone therapy and spironolactone (Aldactone) are often used together to lower androgen levels.

Regular checkups are important for catching any PCOS complications, such as high blood pressure, high cholesterol, uterine cancer, heart disease, and diabetes. All women with PCOS are advised to be checked for diabetes by age 30.⁹

Treatment for infertility from PCOS focuses on starting ovulation:

• If you have PCOS and are overweight, weight loss may be all the treatment you need. Even a small weight loss can trigger ovulation. Weight loss of as little as 5% to 7% over 6 months can lower your insulin and androgen levels. This restores ovulation and fertility in more than 75% of women with PCOS.⁵
• If weight loss alone does not start ovulation (or if you don't need to lose weight), your doctor may have you try a medicine such as metformin or clomiphene to help you start to ovulate. Several months of treatment may be needed. Sometimes combining these two treatments can trigger ovulation in women with PCOS.^{10, 11}
• If metformin and clomiphene do not work, gonadotropins are sometimes used. These are similar to the hormones the body makes to start ovulation. But they also increase the chances of having a high-risk pregnancy with two or more embryos. During gonadotropin treatment, you must have daily checks of egg follicle development, using blood tests and ultrasound, to prevent ovarian hyperstimulation syndrome.

If weight loss and medicine do not work, treatment options include:

• In vitro fertilization. Eggs are fertilized with sperm in a lab, grown for a few days, then put in the uterus to start a pregnancy. This treatment is complex, difficult, and expensive, but it may improve your chances of pregnancy.
• Ovarian drilling, or partial destruction of an ovary. This is a surgical treatment that can trigger ovulation. It is sometimes used for women with PCOS who have tried weight loss and fertility medicine but still are not ovulating.¹¹

For more information, see the topic Fertility Problems.

Women with PCOS who become pregnant have increased risks during pregnancy. Using metformin when trying to get pregnant may lower your risks of miscarriage and gestational diabetes.³ But the risks of using metformin throughout pregnancy are not known. For more information, see the topic Gestational Diabetes.

Prevention

Polycystic ovary syndrome (PCOS) cannot be prevented. But early diagnosis and treatment of PCOS helps prevent long-term complications, such as infertility, metabolic syndrome, obesity, diabetes, and heart disease.

Home Treatment

Home treatment measures can help you manage the symptoms of polycystic ovary syndrome (PCOS) and live a healthy life.

Weight control or weight loss lowers your risks for diabetes, high blood pressure (hypertension), and high cholesterol.⁴ A modest weight loss can improve high androgen and high insulin levels and infertility. Weight loss of as little as 5% to 7% over 6 months can reduce androgen levels enough to restore ovulation and fertility in more than 75% of women with PCOS.⁵

• Lose weight. Reaching a healthy weight improves your health and prevents long-term health problems. Being more active and eating healthy foods are key parts of weight control. Your age, metabolism, and genetics also play an important role in how you gain and lose weight.
• Exercise. Make physical activity a regular and essential part of your life. Choose fitness activities that are right for you to help boost your motivation. Walking is one of the best activities. Having a walking or exercise partner that you can count on can also be a great way to stay active.
• Eat a balanced diet. A balanced, healthy diet that includes lots of fruits, vegetables, whole grains, and low-fat dairy products supplies your body's nutritional needs, satisfies your hunger, and decreases your cravings. And a healthy diet makes you feel better and have more energy.
• Stay at a healthy body weight. A healthy weight is one at which you feel good about yourself, have energy for work and play, and can manage your PCOS symptoms.
• If you smoke, consider quitting. Women who smoke have higher levels of androgens than women who don't smoke.¹ Smoking also increases the risk for heart disease.

For helpful information, see:

• A registered dietitian who has special knowledge about diabetes.
• The topic Healthy Eating.
• The topic Fitness.
• Physical activity for weight loss.
• The topic Quitting Smoking.

Fitness: Walking for wellness

Acne treatment may include nonprescription or prescription medicines that you put on your skin (topical) or take by mouth (oral). Some women notice an improvement in their acne after using estrogen-progestin hormone pills. For more information, see the topic Acne Vulgaris.

Excess hair growth (hirsutism) slows when high androgen levels decrease. In the meantime, you can remove or treat unwanted hair with:

• Laser hair removal, in which the hair follicle is destroyed by a laser beam.
• Electrolysis, in which your hair is permanently removed by electric current applied to the hair root.
• Depilatories, which are chemical hair removal products applied to the skin.
• Waxing, which pulls the hair out by the root.
• Shaving.
• Tweezing.
• Bleaching.

Hair removal methods differ in cost and long-term effectiveness. Before trying one, ask your doctor about risks of infection and scarring.

Medications

As part of polycystic ovary syndrome (PCOS) treatment, medicines can be used to help control reproductive hormone or insulin levels.

Medication Choices

Medicines to treat reproductive or metabolic problems of PCOS include:

• Combination estrogen and progestin hormones in birth control pills, vaginal rings, or skin patches. These hormones correct irregular menstrual bleeding or absent menstrual cycles. They may also improve your androgen-related acne problems, male-type hair growth, and male-pattern hair loss. The progestin makes your endometrial lining build up and shed, similar to a menstrual period. This monthly shedding is what prevents uterine precancer and uterine cancer. The Yasmin birth control pill is considered "potentially ideal" for PCOS hormone treatment.¹² This is because it contains the progestin called drospirenone, which is an antiandrogen.³
• Synthetic progestin. If you are not able to use the hormone estrogen, talk to your doctor about using progestin shots or pills for part of your cycle. The progestin makes your endometrial lining build up and shed, similar to a menstrual period. This monthly shedding is what prevents uterine cancer. There are three prescription progestins that do not increase androgen levels and are best for PCOS treatment: norgestimate, desogestrel, and drospirenone.³ Possible side effects include headaches, fluid retention, and mood changes.
• Androgen-lowering spironolactone (Aldactone), which is a diuretic. It is often used with estrogen-progestin therapy. This improves hair loss, acne, and abnormal hair growth on the face and body (hirsutism).
• Metformin (Glucophage). This diabetes medicine is a newer PCOS treatment for controlling insulin, blood sugar levels, and androgen levels. This lowers your diabetes and heart disease risks and helps restore regular menstrual cycles and fertility.³
• Clomiphene citrate (Clomid, Serophene) (fertility medicines) and gonadotropin injections (LH and FSH). Clomiphene can be combined with metformin if metformin has not triggered ovulation. Combining the two treatments can make it more likely that clomiphene will work.¹¹

Eflornithine (such as Vaniqa) is a prescription skin cream that slows hair growth for as long as you use it regularly. Talk to your doctor about whether it is right for you.

Treatment for acne includes nonprescription and prescription medicines that are applied to the skin (topical) or taken by mouth (oral). For more information, see the topic Acne Vulgaris.

Combination hormone pills can improve acne that is related to high androgen levels.³

What To Think About

Metformin has been shown to be a useful treatment for many of the problems in PCOS. Taking metformin may improve fertility, reduce miscarriages and gestational diabetes, and reduce long-term health problems.³ The use of metformin in pregnancy remains controversial although the risk appears to be small. Metformin is only FDA-approved for the treatment of diabetes, so the use of this medicine for treating PCOS symptoms should be discussed with your doctor.

Some prescription progestins raise androgen levels. There are three prescription progestins that do not increase androgen levels and are best for PCOS treatment. The combination birth control pills that contain these progestins are drospirenone (Yasmin, or "Yaz"); norgestimate (Ortho-Cyclen and Ortho Tri-Cyclen Lo); and desogestrel (Mircette, Desogen, Ortho-Cept, and Cyclessa).³

Some medicines to treat abnormal hair growth may increase your risk for insulin-related metabolic problems, so it is important to discuss medicine side effects with your doctor.

Surgery

Surgical treatment is occasionally used for women with infertility caused by polycystic ovary syndrome (PCOS) who do not start ovulating after taking medicine. During surgery, ovarian function is improved by reducing the number of small cysts.

Surgery Choices

• Ovarian wedge resection is the surgical removal of part of an ovary. This is done to help regulate menstrual cycles and start normal ovulation. It is rarely used now because of the possibility of damaging the ovary and creating scar tissue.
• Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women with PCOS who have not responded to weight loss and fertility medicine. Electrocautery or a laser is used to destroy portions of the ovaries. Studies of women with PCOS have reported that ovarian drilling results in an 80% ovulation rate and a 50% pregnancy rate,¹¹ but other studies have shown less success. Younger women and those with a body mass index in the normal range are most likely to benefit from laparoscopic ovarian drilling.¹³

What To Think About

There is no known cure for PCOS. Surgery for PCOS may be recommended only if you have not responded to any other treatment for PCOS. Each woman will want to discuss the risks and benefits of this surgery with her doctor. Surgery is less likely to lead to multiple pregnancies than taking fertility medicines. It is not known how long the benefits from surgery will last. There is some concern that ovarian surgery can cause scar tissue, which can lead to pain or more fertility problems.

Other Treatment

All treatment for polycystic ovary syndrome (PCOS) is done to control symptoms, such as infertility, irregular menstrual cycles, or unwanted hair growth, or to prevent long-term disease. There is no cure for PCOS, but effective treatments for each symptom are available. For women who are overweight, the most effective therapy is to control weight and eat a healthy diet. A healthy lifestyle is very important for women with PCOS.

Other Places To Get Help

Organizations

Related Information

• Acne Vulgaris
• Birth Control
• Coronary Artery Disease
• Endometrial (Uterine) Cancer
• Fertility Problems
• Fitness
• Gestational Diabetes
• High Cholesterol
• Obesity
• Type 2 Diabetes
• Weight Management

References

Citations

1. Barbieri RL (2007). Polycystic ovary syndrome. In DC Dale, DD Federman, eds., ACP Medicine, section 16, chap. 5. New York: WebMD.

2. Speroff L, Fritz MA (2005). Recurrent early pregnancy loss. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 1069-1101. Philadelphia: Lippincott Williams and Wilkins.

3. Ehrmann DA (2005). Polycystic ovary syndrome. New England Journal of Medicine, 352(12): 1223-1236.

4. Speroff L, Fritz MA (2005). Anovulation and the polycystic ovary. Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 465-498. Lippincott Williams and Wilkins.

5. Huang I, et al. (2007). Endocrine disorders. In JS Berek, ed., Berek and Novak's Gynecology, 14th ed., pp. 1069-1135. Philadelphia: Lippincott Williams and Wilkins.

6. Elsenbruch S, et al. (2003). Quality of life, psychological well-being, and sexual satisfaction in women with polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism, 88(12): 5801-5807.

7. Hunter MH, Sterrett JJ (2000). Polycystic ovary syndrome: It's not just infertility. American Family Physician, 62(5): 1079-1088.

8. Lobo RA, Carmina E (2000). The importance of diagnosing the polycystic ovary syndrome. Annals of Internal Medicine, 132(12): 989-993.

9. American Association of Clinical Endocrinologists (2005). Position statement on metabolic and cardiovascular consequences of polycystic ovary syndrome. Endocrine Practice: 11(2): 126-134.

10. Haas DA, et al. (2003). Effects of metformin on body mass index, menstrual cyclicity, and ovulation induction in women with polycystic ovary syndrome. Fertility and Sterility, 79(3): 469-481.

11. American College of Obstetricians and Gynecologists (2002, reaffirmed 2006). Management of infertility caused by ovulatory dysfunction. ACOG Practice Bulletin No. 34. Obstetrics and Gynecology, 99(2): 347-358.

12. Hatcher RA, et al. (2004). Combined (estrogen and progestin) contraceptives. In A Pocket Guide to Managing Contraception, pp. 97-119. Tiger, GA: Bridging the Gap Foundation.

13. Stegmann BJ, et al. (2003). Characteristics predictive of response to ovarian diathermy in women with polycystic ovarian syndrome. American Journal of Obstetrics and Gynecology, 188(5): 1171-1173.

Other Works Consulted

• Al-Inany H (2006). Polycystic ovary syndrome, search date October 2005. Online version of BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.

• American College of Obstetricians and Gynecologists (2002, reaffirmed 2006). Polycystic ovary syndrome. ACOG Practice Bulletin No. 41. Obstetrics and Gynecology, 100(6): 1389-1402.

• Dronavalli S, Ehrmann DA (2007). Pharmacologic therapy of polycystic ovary syndrome. Clinical Obstetrics and Gynecology, 50(1): 244-254.

• Hall J (2007). Neuroendocrine changes with reproductive aging in women. Seminars in Reproductive Medicine, 25(5): 344-351.

• Hatcher RA, et al. (2005). Combined (estrogen and progestin) contraceptives. In A Pocket Guide to Managing Contraception. 2005-2007 ed., pp. 101-123. Tiger, GA: Bridging the Gap Foundation.

• Legro RS, et al. (2007). Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. New England Journal of Medicine, 356(6): 551-566.

• Polycystic Ovary Syndrome Writing Committee (2005). American Association of Clinical Endocrinologists position statement on metabolic and cardiovascular consequences of polycystic ovary syndrome. Endocrine Practice, 11(2): 125-134.

• Practice Committee of the American Society for Reproductive Medicine (2006). The evaluation and treatment of androgen excess. Fertility and Sterility, 86(4, Suppl): S241-S247.

• Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2003). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility, 81(1): 19-25.

• Setji T, Brown AJ (2007). Polycystic ovary syndrome: Diagnosis and treatment. American Journal of Medicine, 120(2): 128-132.

• Thatcher SS (2000). Polycystic Ovary Syndrome: The Hidden Epidemic. Indianapolis: Perspectives Press.

• Thatcher SS, Jackson EM (2006). Pregnancy outcome in infertile patients with polycystic ovary syndrome who were treated with metformin. Fertility and Sterility, 85(4): 1002-1009.

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