PCOS: Key Q&A

Reviewed By:
Joanne Poje Tomasulo, M.D., ACOG

What is PCOS?

PCOS stands for polycystic ovarian syndrome. It is a syndrome — a group of symptoms that occur together in a predictable pattern — that affects the endocrine system. This means that normal hormone cycles are disrupted, interfering with a woman's ovulation cycle. Hormones are responsible for various functions throughout the body, including regulating a woman's reproductive functions by ensuring normal development of eggs in the ovaries. It is not completely understood why or how the hormone cycles are disrupted by PCOS.

How common is PCOS?

PCOS is one of the most common hormonal disorders among women of childbearing age, the years from the onset of puberty or menstruation until menopause. According to the American Society for Reproductive Medicine, about 5 percent of women in the United States have PCOS.

What complications are associated with it?

If left untreated, PCOS can put a woman at increased risk for many conditions, including heart disease, high blood pressure and pregnancy-induced hypertension. It can also raise her odds of developing high cholesterol, type 2 diabetes and gestational diabetes. PCOS also increases the risk of obesity, infertility,  endometrial cancer and sleep apnea (a condition in which your breathing stops and restarts several times during sleep).

What causes PCOS?

Even though the hormonal imbalance that produces the symptoms of PCOS is becoming better understood, the disorder's actual cause is unknown.

What are the symptoms?

Symptoms of PCOS may first appear around the time of puberty. But usually they do not become noticeable until the early 20s. The most common symptoms are excessive hair growth (hirsutism), especially in areas where such growth is common to men, such as the chin and chest; irregular periods; PMS symptoms; excessive weight gain; acne; polycystic ovaries (enlarged ovaries with follicular cysts); male pattern hair thinning; acanthosis nigricans (a darkening of the skin around the areas of the neck, arms, breasts or thighs) and skin tags (small pieces of excess skin).

Symptoms of PCOS vary. Some women have just mild acne, whereas others have severe acne, facial hair growth and hair loss from the scalp. Many women do not show any visible signs of the syndrome.

How is PCOS diagnosed?

There is no single test to diagnose PCOS, which makes diagnosis difficult. However, the American Society for Reproductive Medicine and European Society of Human Reproduction and Embryology have agreed on guidelines for PCOS diagnosis. To be diagnosed with PCOS, a woman must exhibit two of the following: irregular or absent ovulation, elevated levels of androgens (male hormones), or polycystic ovaries diagnosed by ultrasound.

What conditions must be ruled out before PCOS is diagnosed?

Because PCOS encompasses a broad spectrum of symptoms, the diagnosis is one of exclusion. This means that doctors will first rule out other conditions with similar symptoms. These include hyperprolactinemia (an elevation of prolactin hormone levels), excess adrenal hormones, Cushing's syndrome (a rare disorder in which the adrenal glands produce too much of the hormone cortisol), androgen-secreting tumors in the ovaries, thyroid problems and eating disorders.

How is PCOS treated?

Although there is no cure for PCOS at this time, treatments are available to manage the condition, relieve its symptoms and reduce the risk of related complications. If any of the more serious complications associated with PCOS are present, such as diabetes, heart disease or uterine cancer, doctors will immediately begin aggressive treatment of these conditions. In some cases, treatment for these conditions can be long term. Treatment of PCOS itself involves lifestyle changes, such as weight management, and either fertility or birth control medications.

Can PCOS be prevented?

Because the primary cause of PCOS is unknown, there are no known prevention methods. However, early detection of the condition is critical. Therefore, it is important for a young woman to visit a gynecologist after her first menstruation. Treatment that begins at an early age has a better chance of preventing the more serious risks associated with the disorder.