PCOS: Symptoms, Diagnosis, and Management Basics

Polycystic ovary syndrome, or PCOS, is one of the most common hormone disorders in women of reproductive age. According to the CDC, it affects an estimated 6% to 12% of U.S. women of reproductive age, yet many women go years without a diagnosis.

Understanding PCOS can help you recognize the signs, get the right care, and manage your long-term health.

What is PCOS?

PCOS is a condition in which the ovaries produce higher-than-normal amounts of androgens, hormones that are usually present in women in small amounts. This hormonal imbalance can interfere with ovulation (the release of an egg each month).

Despite the name, not everyone with PCOS has cysts on their ovaries. The "cysts" are actually many small, immature follicles that didn't release an egg.

The exact cause of PCOS isn't fully understood, but insulin resistance and genetics both play important roles. Many women with PCOS have a family member with the condition or with type 2 diabetes.

Common symptoms

Symptoms vary widely and often begin around the time of the first period, though some women develop them later.

• Irregular, infrequent, or absent periods
• Excess hair growth (hirsutism) on the face, chest, back, or abdomen
• Acne on the face, chest, or upper back
• Thinning hair or hair loss on the scalp
• Weight gain or difficulty losing weight
• Darkened, velvety skin patches (acanthosis nigricans), often on the neck, armpits, or groin, a sign of insulin resistance
• Difficulty getting pregnant

How PCOS is diagnosed

There's no single test for PCOS. Most doctors use criteria that require at least two of these three features, after ruling out other conditions:

1. Irregular or absent ovulation (often seen as irregular periods)
2. Signs of high androgens, either from symptoms (like excess hair growth or acne) or blood tests
3. Polycystic-appearing ovaries on an ultrasound (or, in some cases, a blood test called AMH)

Your provider will typically take a medical history, do a physical exam, and order blood tests to check hormone levels, blood sugar, and cholesterol. They may also test for other conditions that can cause similar symptoms, such as thyroid disorders or high prolactin levels.

Long-term health risks

PCOS affects more than reproductive health. It's associated with a higher risk of:

• Type 2 diabetes and prediabetes
• High cholesterol and high blood pressure
• Heart disease
• Sleep apnea
• Endometrial hyperplasia and endometrial cancer, due to infrequent periods
• Depression and anxiety
• Pregnancy complications, such as gestational diabetes and high blood pressure in pregnancy

That's why ongoing monitoring, including regular blood sugar and cholesterol checks, is important.

Managing PCOS

Treatment depends on your symptoms and goals, such as regulating periods, managing skin and hair symptoms, or getting pregnant.

Lifestyle changes

• Balanced eating: focus on vegetables, fruits, whole grains, lean proteins, healthy fats, and high-fiber foods. Limiting added sugars and refined carbohydrates may help with insulin resistance.
• Regular physical activity: aim for at least 150 minutes a week plus strength training.
• Weight management: for those with excess weight, losing even 5% to 10% of body weight can improve periods, ovulation, and insulin sensitivity.
• Sleep and stress management

Medications

• Hormonal birth control (pill, patch, ring, or hormonal IUD) can regulate periods, reduce acne and hair growth, and protect the uterine lining.
• Metformin, a diabetes medication, may improve insulin resistance and help regulate cycles for some women.
• Anti-androgen medications, such as spironolactone, can reduce excess hair growth and acne (these should not be used during pregnancy).
• Fertility treatments, such as letrozole, can help trigger ovulation for women trying to conceive.
• Weight-management medications may be an option for some women; ask your provider.

Emotional well-being

Living with PCOS can be frustrating, especially when symptoms affect appearance, weight, or fertility. Depression and anxiety are more common in women with PCOS. Don't hesitate to talk with your provider or a mental health professional. Support groups, such as those offered by PCOS advocacy organizations, can also help.

When to see a doctor

Talk with your health care provider if you have:

• Irregular or missed periods (fewer than 8 periods a year, or cycles longer than 35 days)
• Excess hair growth, severe acne, or scalp hair thinning
• Difficulty getting pregnant
• Signs of insulin resistance, like dark skin patches

The bottom line

PCOS is common and manageable. With an accurate diagnosis, healthy lifestyle habits, and the right treatment, most women can control symptoms and lower their long-term health risks.