What Is Polycystic Ovary Syndrome?
Polycystic (pronounced pah-lee-SIS-tik) ovary syndrome, or PCOS, is a set of symptoms related to a hormonal imbalance that can affect women and girls of reproductive age.
PCOS may cause menstrual cycle changes, skin changes such as increased facial and body hair and acne, cysts in the ovaries, and infertility. Often, women with PCOS have problems with their metabolism also.
Women with PCOS usually have at least two of the following three conditions:
- Absence of ovulation, leading to irregular menstrual periods or no periods at all
- High levels of androgens (a type of hormone) or signs of high androgens, such as having excess body or facial hair
- Cysts (fluid-filled sacs) on one or both ovaries—"polycystic" literally means "having many cysts"
- Some women diagnosed with PCOS have the first two conditions listed above as well as other symptoms of PCOS but do not have cysts on their ovaries.
PCOS is the most common cause of anovulatory (pronounced an-OV-yuh-luh-tawr-ee) infertility, meaning that the infertility results from the absence of ovulation, the process that releases a mature egg from the ovary every month. Many women don't find out that they have PCOS until they have trouble getting pregnant.
PCOS can cause other problems as well, such as unwanted hair growth, dark patches of skin, acne, weight gain, and irregular bleeding.
Women with PCOS are also at higher risk for the following:
- Obstructive sleep apnea, a disorder that causes pauses in breathing during sleep
- Insulin resistance
- Metabolic syndrome, a group of risk factors for heart disease and type 2 diabetes
- Type 2 diabetes
- Obesity
- Heart disease and high blood pressure (cardiovascular disease)
- Mood disorders
- Endometrial hyperplasia (pronounced en-doh-MEE-tree-uhl hahy-per-PLEY-zhuh), a condition in which the lining of the uterus becomes too thick, and endometrial cancer
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PCOS Symptoms Checklist
In addition to the three features used to diagnose polycystic ovary syndrome (PCOS) (absence of ovulation, high levels of androgens, and ovarian cysts), PCOS has many signs and symptoms, some of which may not seem to be related. Symptoms include the following:
- Menstrual irregularities:
- No menstrual periods—called amenorrhea (pronounced ey-men-uh-REE-uh)
- Frequently missed periods—called oligomenorrhea (pronounced ol-i-goh-men-uh-REE-uh)
- Very heavy periods
- Bleeding but no ovulation—called anovulatory periods
- Infertility
- Excess hair growth on the face, chest, belly, or upper thighs—a condition called hirsutism (pronounced HUR-soo-tiz-uhm)
- Severe, late-onset, or persistent acne that does not respond well to usual treatments
- Obesity, weight gain, or trouble losing weight, especially around the waist
- Pelvic pain
- Oily skin
- Patches of thickened, dark, velvety skin—a condition called acanthosis nigricans (pronounced ay-kan-THOE-sis NY-grih-kanz)
Because many women don't consider problems such as oily skin, extra hair growth, or acne to be symptoms of a serious health condition, they may not mention these things to their health care providers. As a result, many women aren't diagnosed with PCOS until they have trouble getting pregnant or if they have abnormal periods or missed periods.
Although PCOS is a leading cause of infertility, many women with PCOS can and do get pregnant. Pregnant women who have PCOS, however, are at higher risk for certain problems, such as miscarriage.
How Do You Diagnose Polycystic Ovary Syndrome?
Health care providers look for three characteristic features of polycystic ovary syndrome (PCOS): absence of ovulation, high levels of androgens, and cysts on the ovaries. Having one or more of these features could lead to a diagnosis of PCOS. If your medical history suggests that you might have PCOS, your health care provider will rule out other conditions that may cause similar symptoms.
Some of these conditions include the following:
- Excess hormone production by the adrenal glands, called adrenal hyperplasia (pronounced uh-DREEN-l hahy-per-PLEY-zhuh)
- Problems with the function of the thyroid gland
- Excess production of the hormone prolactin by the pituitary gland, called hyperprolactinemia (pronounced hi-per-pro-lak-tuh-NEE-mee-uh).
After ruling out other conditions and before making a diagnosis of PCOS, your health care provider will do the following:
- Take a full family history. Your health care provider will ask you about your menstrual cycle and any history of infertility. He or she also will ask you whether you have a mother or sister with PCOS or with symptoms like yours, as PCOS tends to run in families.
- Conduct a complete physical exam. Your health care provider will do a physical exam and look for extra hair growth, acne, and other signs of high levels of the hormone androgen. He or she also will take your blood pressure, measure your waist, and calculate your body mass index, a measure of your body fat based on your height and weight.
- Take blood samples. Your health care provider will check the levels of androgens, cholesterol, and sugar in your blood.
- Do a pelvic exam or ultrasound to check your ovaries. During the pelvic exam, your health care provider will insert two fingers into your vagina and press on your belly to feel for cysts on your ovaries. To help see cysts in your ovaries, he or she might recommend an ultrasound, a test that uses sound waves to take a picture of your pelvic area. Your health care provider also will check how thick the lining of your uterus is; if your periods are irregular, the lining of your uterus could be thicker than normal.
Because there is currently no universal definition of PCOS, different expert groups use different criteria to diagnose the condition. However, all the groups look for the following three features:
- Menstrual irregularities, such as light periods or skipped periods, that result from long-term absence of ovulation (the process that releases a mature egg from the ovary)
- High levels of androgens that do not result from other causes or conditions, or signs of high androgens, such as excess body or facial hair
- Multiple cysts of a specific size on one or both of the ovaries as detected by ultrasound
Your health care provider will use one of three different methods to diagnose PCOS. One method requires only features 1 and 2 above for a PCOS diagnosis; another requires any two of the three features above for a PCOS diagnosis; and the last one requires feature 1, plus one other feature listed above for a PCOS diagnosis.
Courtesy: Eunice Kennedy Shriver National Institute of Child Health and Human Development.
