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Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a common hormonal disorder causing irregular periods, excess androgen, and insulin resistance in women of reproductive age. Treatment eases symptoms and protects long-term health.

EndocrineGenito Urinary
Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders in women of reproductive age, affecting roughly one in ten. It involves a combination of irregular ovulation, higher-than-normal levels of androgens ("male" hormones that all women make in small amounts), and, in many women, insulin resistance. PCOS matters beyond its immediate symptoms: it is a leading cause of infertility and carries long-term metabolic risks that deserve attention early. Causes and Risk Factors: The exact cause is not known, but several interconnected factors drive the syndrome:
  • Insulin resistance: Present in a majority of women with PCOS regardless of weight; high insulin levels stimulate the ovaries to make more androgen.
  • Excess androgen: Responsible for many visible symptoms and for interfering with ovulation.
  • Genetics: PCOS clusters in families, and having an affected mother or sister raises the risk.
  • Weight: Excess weight worsens insulin resistance and symptoms, though PCOS also affects lean women.
  • Low-grade inflammation: Women with PCOS often show mild chronic inflammation, which is thought to contribute to both androgen excess and metabolic risk.
Symptoms: Symptoms usually begin around the time of the first menstrual periods, though they may emerge later:
  • Irregular or absent periods: Infrequent ovulation leads to cycles that are unpredictable, far apart, or missing.
  • Excess hair growth (hirsutism): Coarse hair on the face, chest, or back.
  • Acne and oily skin: Androgen-driven acne that often persists past adolescence.
  • Thinning scalp hair: A male-pattern distribution of hair loss.
  • Weight gain and difficulty losing weight: Reflecting the underlying insulin resistance.
  • Difficulty becoming pregnant: A frequent reason PCOS first comes to medical attention.
  • Darkened skin patches: Velvety darkening at the neck and skin folds (acanthosis nigricans), a marker of insulin resistance.
Diagnosis: There is no single test. PCOS is diagnosed when at least two of three features are present — irregular ovulation, clinical or laboratory evidence of excess androgen, and polycystic-appearing ovaries on ultrasound — after other causes are excluded. Blood tests typically include androgen levels, thyroid function, and prolactin, plus screening for the metabolic problems that travel with PCOS: fasting glucose or A1C for prediabetes (impaired fasting glucose) and a lipid panel. Conditions that can imitate PCOS — thyroid disease, elevated prolactin from a pituitary source, and rarer disorders of adrenal hormone production — are ruled out first, because their treatment is entirely different. Ultrasound is not required when the other two features are clearly present, and "polycystic" ovaries alone, without irregular cycles or androgen excess, do not establish the diagnosis. Treatment: Treatment is tailored to each woman's main concerns — cycle regulation, skin and hair symptoms, fertility, or metabolic health:
  • Lifestyle change: Even a 5 to 10 percent weight loss can restore ovulation and improve insulin resistance.
  • Combined hormonal contraceptives: Pills containing an estrogen and a progestin such as levonorgestrel-ethinyl estradiol regulate cycles, lower androgens, and improve acne and hair growth.
  • Metformin: Improves insulin sensitivity, supports weight efforts, and can help restore regular cycles.
  • Spironolactone: Blocks androgen effects on skin and hair; used with reliable contraception.
  • Fertility treatment: Medications that induce ovulation are effective for many women with PCOS who wish to conceive.
Complications: PCOS is a lifelong metabolic condition as much as a reproductive one, and several of its risks accumulate quietly over decades:
  • Prediabetes and type 2 diabetes: Insulin resistance makes diabetes substantially more likely, and it often appears at a younger age than usual.
  • Cardiovascular and metabolic risk: High triglycerides (hypertriglyceridemia), high blood pressure, and fatty liver disease all occur more frequently.
  • Overgrowth of the uterine lining: Cycles without ovulation leave the lining exposed to estrogen unopposed by progesterone, which over years increases the risk of endometrial hyperplasia and uterine cancer — a key reason to regulate cycles even when pregnancy is not the goal.
  • Obstructive sleep apnea: More common in PCOS than in other women of the same weight, and it worsens both insulin resistance and daytime fatigue.
  • Anxiety and depression: Mood symptoms occur more often with PCOS and deserve to be asked about directly rather than waited for.
Because these risks build over a lifetime, PCOS care continues well past the reproductive years, with periodic checks of weight, blood pressure, blood sugar, and lipids. The primary-care team at Zimmer Medical Group manages PCOS comprehensively and coordinates gynecology or endocrinology referral when needed.

Related Medications

Commonly prescribed medications for this condition

MetforminSpironolactoneLevonorgestrel-Ethinyl EstradiolClomiphene

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