Polycystic ovary syndrome (PCOS): Symptoms, diagnosis, and treatment

• Polycystic ovary syndrome (PCOS) is a highly impactful and under-recognized hormonal and metabolic condition.
• We don’t know exactly what causes PCOS, but people with the condition often experience insulin resistance and excess androgens (or male hormones). 
• There’s no cure for PCOS, but lifestyle modifications and medicine can help you manage your symptoms. 

PCOS (polycystic ovary syndrome) can impact almost every aspect of your life, from your fertility to your appearance to your overall health. 

It increases your risk for heart disease, type 2 diabetes, fatty liver, sleep apnea, and depression.

It’s a stressful condition to manage, to say the least. 

For people with PCOS, their ovaries produce an excess amount of androgens (male sex hormones). 

The condition affects 5% to 10% of women (or about 5 million) between the ages of 15 and 44 and is often misdiagnosed.

We spoke to Noy Phimphasone-Brady, Ph.D., a clinical health psychologist who treats people with PCOS, for answers about this highly impactful and under-recognized condition. 

What causes PCOS

The exact cause of PCOS is not yet known, but according to the Mayo Clinic, it may be related to several factors, including:

• Excess insulin
• Low-grade inflammation
• Excess androgens (male hormones or testosterone)
• Heredity

People with PCOS are more likely to have a mother or sister with the condition. 

PCOS signs and symptoms

“PCOS is a complex metabolic, reproductive, and psychiatric condition,” said Dr. Phimphasone-Brady. “It’s going to be person-specific.”

While people experience different signs and symptoms, they generally include some combination of the following:

• Increased weight gain 
• Hirsutism (excessive hair growth, especially on the face and chin)
• Hyperandrogenism (higher than normal levels of male hormones)
• Male-pattern baldness
• Menstrual irregularities
• Infertility
• Acne
• Insulin resistance
• Small, fluid-filled sacs in the ovaries
• Darkening of skin (particularly along neck creases, in the groin, and under the breasts)
• Skin tags (small excess flaps of skin in the armpits or around the neck)

Experts are unsure whether insulin resistance is a symptom or a contributing factor (or both), but it’s common in people with PCOS (about 70%). Unfortunately, insulin resistance makes it difficult to lose weight.  

“For someone who has PCOS, their bodies are essentially resistant to insulin, so they have higher blood glucose levels, which increases their risk for weight gain,” said Dr. Phimphasone-Brady. 

“If you have too much glucose in your body, and there’s not enough insulin, that glucose starts to get stored as fat.”

You’re also more likely to experience insulin resistance if you are obese.

Racial and ethnic differences can make the condition even more challenging to diagnose. 

For example, Dr. Phimphasone-Brady said, Black women tend to have higher BMIs, and in them, PCOS is more likely to look like metabolic syndrome. 

In some Asian and Middle-Eastern women, central adiposity (fat stored around the abdomen) and excessive facial hair are more common. 

How is PCOS detected?

PCOS is a “syndrome” (a group of symptoms), so at least two of the hallmark symptoms have to be present for a PCOS diagnosis. But there’s no one test that provides a definitive answer. 

“PCOS is a diagnosis of exclusion,” said Dr. Phimphasone-Brady. That means other conditions are ruled out first—so it’s a process of elimination.

It’s not uncommon for it to take up to 10 years to be diagnosed, she said, and that doesn’t usually happen until the person has been struggling with infertility for some time. (The hormonal imbalance in people with PCOS can prevent ovulation and, therefore, pregnancy.)

Some of the tests your doctor might recommend include: 

• A blood test to measure hormone levels, glucose tolerance, C-reactive protein, and white blood cells (which can indicate inflammation). They might also check your thyroid levels since thyroid disease can cause symptoms similar to PCOS. 
• A pelvic exam to check for growths and other abnormalities that could signal high levels of androgens.
• An ultrasound to check for ovarian cysts.

PCOS treatment

Managing PCOS can be stressful, to say the least. But lifestyle modifications can help lessen some of the bothersome symptoms. 

Note: Always talk to your health care provider before making dietary changes.

Weight loss and diet

As many people who are living with PCOS know all too well, weight gain can make your symptoms worse. So the first line of defense against the condition is maintaining a healthy weight.  

Weight loss can help mitigate the symptoms of PCOS like hyperandrogenism, fertility issues, and insulin resistance. 

Diet is a key factor in weight management. Choose nutritious, whole foods to avoid blood-sugar spikes that increase insulin resistance and contribute to weight gain.

“There’s not a specific diet for PCOS,” said Dr. Phimphasone-Brady, but she recommends that her patients with PCOS loosely follow the Mediterranean diet by eating more high-fiber and anti-inflammatory foods, like:

• Whole grains
• Lean proteins
• Fruit
• Vegetables
• Healthy fats

“There’s also good research to support supplements like vitamin D, vitamin B, omega 3 fatty acids, and pre- and probiotics,” she said. 

Movement

Exercise has many benefits, from maintaining cardiovascular health, muscle mass, and bone strength, to managing stress. Movement can also help alleviate symptoms of PCOS. 

“Exercise helps keep the glucose levels down, so it doesn’t make the insulin resistance worse,” said Dr. Phimphasone-Brady. 

Not only can movement play a role in reducing insulin resistance and weight loss, it can also help reduce the stress and fatigue that many people with PCOS experience. 

If you’re not physically active now, that’s okay. Dr. Phimphasone-Brady recommends her patients with PCOS start by just focusing on being less sedentary. 

Your health care provider can give you suggestions for safe ways to build more movement into your routine.

You may start with a hundred steps a day and, over time, find yourself walking several miles—but take it at a pace that works for you. 

Medication

Along with recommending lifestyle modifications, your health care provider might prescribe medication to help you manage your PCOS symptoms, such as:

• Hormonal birth control to regulate your menstrual cycle, reduce excess hair growth, and improve acne.
• Metformin to reduce insulin and androgen levels. It may also promote ovulation.
• Ovary-stimulating medicines like Clomiphene, Letrozole, and Gonadotropins to encourage ovulation.
• Anti-androgen medicines like Spironolactone to reduce facial and body hair growth, acne, and hair loss on the scalp. 

Treatment like this can help make PCOS symptoms more manageable and prevent future health problems. 

Can PCOS be cured?

The short answer? No. “PCOS doesn’t go away and there’s no cure,” said Dr. Phimphasone-Brady. 

“It just goes away in the sense that it’s not bothersome. Treatments are very effective and PCOS can be easily managed.”

The good news? A management plan that includes weight loss, movement, and medicine can help lessen the severity of your symptoms and reduce health risks.

Losing weight with PCOS

We know that for people with PCOS, weight loss can be challenging. But it’s not impossible—and the experts agree it’s an effective way to manage your symptoms.
Learn practical tips for losing weight with PCOS here.