What Is the Main Cause of PCOS?

Symptoms of PCOS (polycystic ovarian syndrome) may include:

• Irregular menstrual cycle
  • Missed menstrual periods 
  • No menstrual periods
  • Less frequent periods (fewer than eight periods in a year)
  • Unpredictable periods
  • Heavy or prolonged periods
• Weight gain, obesity, or difficulty losing weight
  • Up to 80% of women with PCOS are obese
• Multiple small fluid-filled sacs in the ovaries
• Excess hair growth (hirsutism)
  • Occurs on the face, chin, sideburn area, neck, chest, abdomen, upper arm, inner thighs, or other parts of the body where men tend to grow hair
• Oily skin 
• Severe acne or acne that does not respond to usual treatments
• Infertility/difficulty conceiving 
• Thinning hair or hair loss on the scalp; male-pattern baldness
• Darkening of skin (acanthosis nigricans), especially in neck creases, the groin, and underneath the breasts
• Skin tags
• Increased risk of heart disease and heart attack
• Sleep apnea
  • Breathing stops (apnea) during sleep
  • May occur in up to 50% of women with PCOS
  • Can cause fatigue and daytime sleepiness
  • Untreated sleep apnea increases the risk of insulin resistance, diabetes, obesity, and cardiovascular problems, such as high blood pressure, heart attack, abnormal heart rhythms, or stroke
• Anxiety 
• Depression 
• Problems with sexual function 
• Eating disorders, such as bulimia and binge eating

PCOS is diagnosed when other conditions have been ruled out and at least two of the following symptoms occur: 

• Irregular periods
• High blood levels of androgens
• Signs of high levels of androgens such as:
  • Excess male-pattern hair growth (hirsutism)
  • Thinning of scalp hair
  • Acne
• Multiple cysts on one or both ovaries

In order to rule out other conditions that may cause symptoms similar to PCOS, tests may include:

• Pelvic exam
• Pelvic ultrasound (sonogram)
• Blood tests
  • Androgen hormone levels
  • Blood glucose 
  • Cholesterol levels 
  • Thyroid-stimulating hormone (TSH)
  • Follicle-stimulating hormone (FSH) 
  • Prolactin level
  • Pregnancy test
• Sleep studies for sleep apnea screening
• Body mass index (BMI) measurement and waist size

The goal of treatment for PCOS (polycystic ovarian syndrome) is to manage symptoms; there is no cure for PCOS. Women who have PCOS usually require a combination of treatments, such as:

• Hormonal birth control, including the pill, patch, shot, vaginal ring, and hormonal intrauterine device (IUD) to regulate the menstrual cycle, reduce acne and excess male-pattern hair growth, and lower the risk of endometrial cancer
• Anti-androgen medications such as spironolactone to help with acne, excess unwanted hair growth, and scalp hair loss
  • Not approved by the Food and Drug Administration (FDA) to treat PCOS, but may be used off-label
  • May cause problems during pregnancy
• Metformin (Glucophage) to help lower insulin and androgen levels
  • Not approved by the Food and Drug Administration (FDA) to treat PCOS, but may be used off-label
• Prescription skin treatments or oral antibiotics to treat acne
• Eflornithine HCl cream to slow hair growth in unwanted places
• Infertility medications
  • Clomiphene (Clomid)
  • Letrozole (Femara)
    • Primarily used to treat breast cancer but may be effective for women with PCOS who want to conceive
  • Gonadotropin therapy (follicle-stimulating hormone [FSH] injections)

Home treatments to help relieve PCOS symptoms include: 

• Weight loss
  • This is one of the most effective approaches to help manage a number of symptoms of PCOS
• Regular exercise
• Hair removal treatments
• Hair replacement or wigs for scalp hair loss