Polycystic ovary syndrome (PCOS) is a hormonal imbalance that can have an impact on periods, fertility and aspects of your appearance. It is a common condition that affects 2 to 6 in every 100 women. In the longer-term it can also increase your risk of certain medical conditions including heart disease and diabetes.
The word “syndrome” just refers to a group of symptoms, although the symptoms experienced will vary from woman to woman. Some women have only mild symptoms while others can be affected severely by a wide range of symptoms.
Potential symptoms include:
The symptoms of PCOS are mainly related to abnormal hormone levels. Why some women get this condition is not yet fully known. It’s likely due to a combination of genetic and environmental factors. It often runs in families and the risk of developing PCOS may be increased if one of your relatives (mother, aunt, sister) is affected by the syndrome.
Hormones that are affected include:
Some of the diagnosis is based purely on your symptoms, e.g. infrequent periods. In addition, the following tests are carried out:
PCOS is diagnosed according to the Rotterdam consensus criteria. To be diagnosed with PCOS you need to have any two of the following:
All of the symptoms of PCOS can also be caused by other less common conditions. These also need to be ruled out before you can be diagnosed with PCOS. See The menstrual cycle and hormones for examples of these tests.
PCOS is associated with long-term health problems, including:
Around 70% of women with PCOS may experience a delay or difficulty in becoming pregnant. This is because the infrequent or absent periods mean that ovulation (i.e. the release of an egg) is absent or infrequent. With fewer eggs, there are fewer chances in a year to get pregnant. The good news is with simple advice or treatment, most women with PCOS can get pregnant.
For most women ofchildbearing age, tiny fluid-filled cysts called follicles develop on the surface of the ovary every month. One of them will mature and produce an egg which is then released from the ovary. Female hormones play a vital role in this process. In PCOS a hormonal imbalance means that mature eggs are often prevented from developing and being released. Ovulation fails to occur and this may result in an irregular or absent menstrual cycle. The follicles continue to be present without releasing eggs, which results in multiple follicles around the surface of the ovaries. This causes the ovaries to appear larger than normal on an ultrasound scan.
It’s also important to consider that women with PCOS may also have other non-related issues that can cause reduced fertility, e.g. blocked fallopian tubes.
If you have PCOS and are interested in or actively trying to have a baby, have a look at this article on getting pregnant with PCOS.
Women with PCOS have a higher risk of complications in their pregnancy. A recent study looking at 9 million pregnancies in the USA found that women with PCOS are two times more likely to develop gestational diabetes, 50% more likely to have raised blood pressure during pregnancy and at 30% increased risk of pre-eclampsia compared to women without PCOS. This was the case even when age, obesity, smoking and other risk factors were considered, though clearly having these additional risk factors further increases risk.
There is no specific “cure” for PCOS. Medical approaches aim to manage and reduce the symptoms or consequences of having PCOS.
Weight loss: this is really the first line treatment. Several studies show that even a modest weight loss of 5-10% of body weight can result in hormone levels normalising, the menstrual cycle regulating, better rates of ovulation and increased chances of getting pregnant.
Healthy lifestyle: To achieve weight loss and stick to it in the long-term requires a change in lifestyle. Exercise and a healthy diet are key. A healthy balanced diet includes fruit, vegetables, lean meat, fish, chicken and whole food (wholemeal bread, wholegrain cereals, brown rice and whole-wheat pasta) and cutting down the amount of sugar, salt, caffeine and alcohol. Experts advise regular exercise for 30 minutes at least three times a week.
Medication for menstrual irregularity: There are a variety of oral contraceptives (contraceptive pills) that can regulate the monthly cycle and protect the lining of the womb from overgrowth and hyperplasia. Some even have the added benefit of counteracting the negative symptoms that increased testosterone brings, e.g. acne. Alternatively, the intrauterine system (IUS or Mirena coil) can act to protect the lining of the womb and act as a contraceptive without needing to have a monthly period.
Management of hirsutism: Medications to control excessive hair growth include particular types of combined oral contraceptive tablets and other anti-androgen medications that block the effects of ‘male hormones’ (testosterone). You may also want to remove the unwanted hair by other methods of cosmetic therapy such as waxing, plucking, shaving, threading, creams or laser removal.
Management of acne: There is a variety of prescription medication for moderate or severe acne such as topical retinoids; antibiotics in the form of gels, lotions or tablets; azelaic acid; and hormonal therapies (combined contraceptive pill, co-cyprindiol).
Bariatric Surgery: For women with a BMI of 40 or above or of 30 and above with a high-risk obesity-related condition, weight loss surgery is an option.
Information Leaflet: Polycystic Ovary Syndrome what it means for your long-term health, June 2015, RCOG
Fertility problems: assessment and treatment, NICE Clinical Guideline CG156, updated September 2017
NHS treatment for PCOS: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/
Long term consequences of Polycystic Ovary Syndrome, Green-top Guideline No33, November 2014, RCOG
Clinical practice guidelines for Polycystic Ovary Syndrome, Australian NHMRC, ESHRE, ASRM July 2018
ASK PCOS Evidence based information for women with polycystic ovary syndrome, Monash University on behalf of NHMRC, Centre for Research Excellence in PCOS and the Australian PCOS Alliance 2018