Polycystic Ovary Syndrome: Symptoms, Diagnosis and Treatment

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Polycystic ovary syndrome (PCOS) affects up to 1in 10 women of reproductive age, yet many women struggle for years to getan accurate diagnosis. That’s because PCOS is not one disease. It’s a syndrome:a constellation of hormonal and metabolic symptoms.

Maybe you’ve skipped periods, battled acne well beyond your teen years or tried diet after diet only to gain weight. Or maybe you’ve triedto get pregnant for more than a year during your prime child-bearing years without success.

“What I want women to understand is that PCOS is not a simple, clear-cut diagnosis,” said JessicaChan, MD, a reproductive endocrinologist at Cedars-Sinai. “It’s a highlyvariable hormonal and metabolic condition that requires thoughtful evaluationand individualized care.”

What Is PCOS?

PCOS is a lifelong metabolic syndrome characterized by a group of features that occur together. Researchers believe genetics,environmental factors and metabolic issues all play a role in the condition.But despite its name, PCOS doesn’t mean your ovaries are bursting with cysts.

“Those ‘cysts’ are actually immature follicles—tiny, fluid-filled sacs that hold eggs,” said Chan. “In PCOS, disrupted hormonalsignals cause those follicles to stall instead of maturing and releasing anegg.”

PCOS is closely linked to insulin resistance.High insulin levels can stimulate the ovaries to produce more testosterone, which disrupts ovulation and fuels many PCOS symptoms.

What I want women to understand is that PCOS is not asimple, clear-cut diagnosis. It’s a highly variable hormonal and metabolic condition that requires thoughtful evaluation and individualized care.

What Are the Symptoms of PCOS?

PCOS shows up differently in each person. Some peopleexperience only mild hormonal changes. Others struggle with multipleoverlapping issues.

Common symptoms include:

• Irregular or missed periods (menstrual cycleshorter than 22 days or longer than 34-35 days)
• Infertility (because infrequent ovulation canmake conception more challenging)
• Acne on the face, chest or back
• Excess facial or body hair
• Thinning scalp hair
• Weight gain, especially around the abdomen
• Darkened, velvety skin in body folds (acanthosisnigricans), a sign of insulin resistance

“Not everyone with PCOS struggles with their weight orinfertility. And not every woman with PCOS has irregular periods,” said Chan.“That’s why a thorough medical history, physical exam and lab work are soimportant.”

How Do Doctors Diagnose PCOS?

There is no single blood test for diagnosing PCOS. Instead,clinicians rely on a detailed medical and menstrual history, a physical exam,blood tests and a complete metabolic screening to make a diagnosis. Doctors mayalso order a pelvic ultrasound to look for multiple follicles on the ovaries.

PCOS-like symptoms happen in other conditions, too,including thyroiddisease, Cushing syndrome and adrenal disorders. That’s why women with PCOSsee an average of threeproviders before learning they have PCOS.

“PCOS is really a diagnosis of exclusion,” said Chan. “If apatient is experiencing irregular periods and high androgen levels and theyhave multiple follicles on their ovaries—and other conditions have been ruledout—then we can make the diagnosis.”

What Are the Health Risks of PCOS?

PCOS is associated with several long-term health risks,including:

• Type 2 diabetes
• Obesity
• Increased cardiovascular risks, including highblood pressure and high cholesterol
• Endometrial hyperplasia, when the endometrium(the lining of the uterus) becomes too thick, increasing the risk ofendometrial cancer

“Women with PCOS also have significantly higher rates of depression andanxiety compared to the general population,” said Chan.

Treatments for PCOS

There is no cure for PCOS, and there currently are noFDA-approved treatments for the condition. However, depending on your lifestage and goals, doctors have many effective strategies to help manage PCOSsymptoms.

• ‍For infertility: Medications such asletrozole or clomiphene can help stimulate egg release and increase the chancesof pregnancy. ‍
• For insulin resistance and weight gain:Metformin, a medication used to treat Type 2 diabetes, can help improve insulinsensitivity. Weight loss medications, including GLP-1 drugs, that targetinsulin pathways may also help alleviate symptoms.  ‍
• For irregular menstrual cycles, acne andfacial hair: Combined hormonal birth control pills can help regulatemenstrual cycles and improve symptoms such as acne and unwanted hair growth.

Lifestyle strategies can also make a meaningful difference. Patientscan support their metabolic health with:

• A whole-foods diet rich in vegetables,high-fiber carbohydrates and lean protein
• Regular physical activity
• Adequate sleep
• Proper stress management

When to Get Help for PCOS

PCOS can happen to anyone who has a uterus at any time after puberty. It affects all races and ethnicities, though women who have a motheror sister with PCOS may be at higher risk.

“Adolescents naturally have irregular cycles,” said Chan.“But if you’re more than two to three years out from your first period and yourcycles are still irregular, it’s time to talk to your doctor.”

If symptoms persist, it’s important to advocate for yourself. Many people with PCOS report feeling dismissed or being told to “loseweight.” That advice can be harmful, especially for women who face insulin resistance, which makes weight loss a tremendous challenge.

“PCOS is a chronic condition,” Chan said. “But with the right tests and an individualized plan, most people with PCOS can manage their symptoms,protect their long-term health and—when they choose to—pursue pregnancysuccessfully.”