Polycystic Ovary Syndrome (PCOS): What is It and What are the Signs?

Carla Bozzolo and Sasha Milbeck, National Center for Health Research

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Monthly changes in hormones affect nearly all women. Some of the symptoms are more bothersome or noticeable than others, and sometimes they signal health problems. Studies show that 8% to 13% of women of reproductive age have a condition called polycystic ovary syndrome (PCOS). ^[1] It can be difficult to diagnose because it is similar to so many other conditions. What is PCOS, and what are the signs?

PCOS is also known as “Stein-Levanthal Syndrome.” It is caused by sex hormone imbalances, usually by an increase in androgens such as testosterone.^[2] Androgens are considered male sex hormones but are also found in all women. While PCOS is not a disease, early diagnosis is important to manage symptoms and reduce the risk of future health problems.

PCOS can be hard to identify, particularly for adolescents. The symptoms vary widely and are not unique to PCOS. There is no cure, but there are ways to reduce symptoms and promote long-term overall health.

If you have PCOS, you may experience any combination of the following symptoms: ^[1-5]

• Obesity
• Weight gain/Difficulty losing weight
• Male pattern hair growth (e.g. stomach, nipples, and face) called Hirsutism
• Irregular periods
• No period after puberty
• Acne
• Chronic high blood sugar
• High bad cholesterol (LDL)
• High testosterone and male hormone levels (called hyperandrogenism)
• High Anti-Mullerian hormone (AMH) levels (hormone produced by ovarian follicles)
• Increased number of ovarian follicles
• Infrequent ovulation/difficulty getting pregnant

What are the risks of PCOS?

It is important to diagnose PCOS early, because untreated symptoms increase one’s chances of developing the following health problems: ^[1-7]

• Type 2 diabetes
• Gestational diabetes
• Endometrial cancer
• Infertility
• High cholesterol
• Hypertension
• Heart disease
• Psychiatric diseases

Women with PCOS who are pregnant, women who need hormone treatments to help them get pregnant, and pregnant women with PCOS who are obese (Body Mass Index over 30) are also at higher risk for gestational diabetes, a kind of diabetes that occurs only during pregnancy, but can have lasting effects on the mother and the baby. ^{[5, 7]}

Studies have recently shown that women with PCOS are more likely to develop obstructive sleep apnea (OSA) than other adults. OSA is a condition where breathing will stop during sleep and disrupt a person’s sleep cycle. PCOS symptoms such as obesity, high blood sugar, and high testosterone levels, are thought to play a role in the onset of OSA.^[8]

A common misconception about PCOS is that it increases the risk of breast cancer and ovarian cancer. However, this is not supported by recent studies. ^[6,9] More research is needed before any definite conclusions can be made.

What Tests Are Needed to Diagnose PCOS?

Unfortunately, there is no one reliable test to diagnose PCOS. ^[1-3] Instead, there are a variety of tests that can be used to rule out other conditions that cause similar symptoms.

Hormone Levels

High levels of testosterone and AMH in the blood are the major signs of PCOS. A blood test can determine if testosterone and AMH levels are higher than normal, and whether there are imbalances with other sex hormones. Abnormal levels of female sex hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol can indicate other health problems. ^[3,4]

Fasting Glucose

The fasting glucose (blood sugar) test can help determine if a woman has the warning signs for developing type 2 diabetes. Many women with PCOS have high fasting blood sugar, and are more likely to develop type 2 diabetes, or gestational diabetes when pregnant. ^[1,5,7]

Cholesterol Test

A high level of bad cholesterol (LDL) in the blood is a common sign of PCOS, especially in younger women. People with PCOS and higher levels of LDL are more likely to develop cardiovascular disease and type 2 diabetes. ^[1,5] Physicians measure LDL levels through an analysis of the blood called a lipid panel.

Thyroid Function Test

Many symptoms related to thyroid disorders are similar to PCOS symptoms, such as insulin resistance, cystic ovaries, and menstrual irregularities. ^[10] A thyroid function test can eliminate a thyroid condition as a reason for the symptoms.

Vaginal Ultrasound

The name “polycystic ovary syndrome” is misleading because it implies that women with the condition have ovarian cysts. Actually, ovulatory polycystic ovaries (PCO) is a medical condition that is different from PCOS. Ovarian cysts are sacs filled with fluid in the ovaries. They are very common and occur naturally as a result of the menstrual cycle. PCO has very similar symptoms to PCOS but does not involve long-term hormonal or metabolic abnormalities. ^[11] Women with PCOS usually have an increased number of ovarian follicles. Ovarian follicles are part of the ovary that contain egg cells and release them during ovulation. In PCOS, abnormal hormone levels prevent the follicles from growing and releasing eggs. Instead, the immature follicles stay in the ovaries and can look like cysts on ultrasounds. A vaginal ultrasound can help determine whether a woman has PCO or PCOS and allow a physician to treat the correct condition accordingly.

What are the Treatments for PCOS?

While there is no cure, different treatments exist to reduce the impact of PCOS symptoms on everyday life. Studies have found that being overweight or obese worsens the symptoms, increases the risks of future health problems, and usually increases the chances of a poor response to infertility treatments. ^[12] Eating a healthy diet, regularly exercising, and achieving and maintaining a healthy weight are the most effective ways of eliminating or at least reducing symptoms.

Other ways of coping with PCOS symptoms include:

• Excess body hair: Methods to reduce excess body hair include electrolysis (removes individual hairs from face), or the prescription drugs Eflornithine and Spironolactone. Eflornithine is a cream used to treat excessive hair growth on the face of women. Spironolactone is a pill that works to remove the levels of androgens in the body (hormone responsible for acne and excess body hair). However, Spironolactone can cause serious side effects, although they are relatively rare.  Common side effects include frequent urination, dehydration, and fatigue, among others.
• High blood sugar: Healthy eating habits and exercise are the most promising ways to naturally reduce blood sugar. For some patients, physicians may suggest Metformin, a medication for diabetes that can help with weight and hormones. However, the drug can cause serious side effects and increase one’s chance of heart failure.
• High cholesterol: High cholesterol can be reduced by eating a healthier diet, physical activity and exercise, or cholesterol-reducing drugs.
• Ovarian cysts: Small ovarian cysts are common in women and typically won’t affect their health. ^[11] Cysts can be identified on an ultrasound, and large painful cysts can be removed with laparoscopy surgery. ^[1] The procedure involves small cuts in the abdomen or pelvis and a camera to guide the surgeon.
• Hormonal Birth Control: Birth control pills and some intrauterine devices (IUDs) contain female hormones that may reduce abnormal hair growth, improve acne, and reduce androgen. However, all birth control pills increase the risk of blood clots, so they should be taken only if contraception is also needed. Different types of birth control pills have different risks and benefits for women with PCOS. Some women find that birth control pills help them control symptoms, while others say that the pills make their symptoms worse!
• Infertility: Infertility can be treated through pills that induce ovulation, gonadotropins that stimulate production of female hormones needed for ovulation and pregnancy, and in-vitro fertilization. ^[1]

What is Still Unknown About PCOS?

PCOS seems to run in families, but an exact gene has not been found. However, recent studies have shown that variations in genes that code for receptors of male sex hormones, female sex hormones, and insulin, could be responsible for PCOS. ^[13]

PCOS is difficult to diagnose in adolescents because many symptoms, like irregular periods, are common for adolescent girls. Treatment is determined on a case-by-case basis, because  symptoms will vary based on overall health, diet, and other health problems. The way a woman experiences PCOS varies even within a family— a mother’s PCOS could have very different symptoms from her daughter’s.

Bottom Line

If it is not diagnosed and no efforts are made to treat it, PCOS can be emotionally challenging and increase the risk of other health problems. Some women with PCOS may feel uncomfortable with their looks if they have a lot of body or facial hair. Being unable to get pregnant can result in depression in some women. Getting a diagnosis and getting help for symptoms reassures women that these are symptoms of a health condition that can be controlled. As with other health problems, eating nutritious food, exercising, and maintaining a healthy weight can go a long way to combat the most serious health risks and noticeable symptoms.

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.

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