If you have oily skin, missed periods, or trouble managing your weight, you may think those issues are just a normal part of your life. But such frustrations could actually be signs that you have polycystic ovary (or ovarian) syndrome, also known as PCOS.
The condition has many symptoms, and you may not have all of them. It’s pretty common for it to take women a while — even years — to find out they have this condition.
Common Symptoms of PCOS
Common signs and symptoms of PCOS are:
Hair growth in unwanted areas. Your doctor may call this “hirsutism” (pronounced HUR-soo-tiz-uhm). You might have unwanted hair growing on your face or chin, breasts, stomach, or thumbs and toes.
Hair loss. Women with PCOS might see thinning hair on their head, which could worsen in middle age.
Acne or oily skin. Hormone changes due to PCOS can cause oily skin and pimples. (You can have these skin problems without PCOS, of course).
Darkening of skin. You may see thick, dark, velvety patches of skin under your arms or breasts, on the back of your neck, and in your groin area. This condition is called acanthosis nigricans.
Problems sleeping or feeling tired all the time. You could have trouble falling asleep. Or you might have a disorder known as sleep apnea. This means that even when you do sleep, you do not feel well-rested after you wake up.
Headaches. The surging hormones that cause PCOS can give you headaches, too.
Heavy periods. PCOS can cause big swings in the menstrual cycle, including very heavy bleeding and frequent periods.
Irregular periods. You may not have a period, or it may skip a few months.
Trouble getting pregnant. Not having regular periods can make it difficult to get pregnant. PCOS is one of the leading causes of infertility.
Weight gain. About half of women with PCOS struggle with weight gain or have a hard time losing pounds. PCOS can make you gain a lot of weight. And being overweight can make PCOS symptoms more serious. Shedding even just a few pounds may improve the timing of your periods. Losing weight can be a healthy way to keep your cholesterol and blood sugar levels in check, both of which are important if you have PCOS.
How Do I Know If I Have PCOS?
There’s no single test that, by itself, shows whether you have polycystic ovary syndrome, or PCOS. Your doctor will ask you about your symptoms and give you a physical exam and blood tests to help find out if you have this condition.
PCOS is a common hormone disorder that can cause problems with your period, fertility, weight, and skin. It can also put you at risk for other conditions, such as type 2 diabetes. If you have it, the sooner you find out, the sooner you can start treatment.
What Your Doctor Will ask
Your doctor will want to know about all the signs and symptoms you’ve noticed. This is an important step to help figure out whether you have PCOS, and to rule out other conditions that cause similar symptoms.
You’ll need to answer questions about your family’s medical history, including whether your mother or sister has PCOS or problems getting pregnant. This information is helpful — PCOS tends to run in families.
Be ready to discuss any period problems you’ve had, weight changes, and other concerns.
Your doctor may diagnose PCOS if you have at least two of these symptoms:
- Irregular periods
- Higher levels of androgen (male hormones) shown in blood tests or through symptoms like acne, male-pattern balding, or extra hair growth on your face, chin, or body
- Cysts in your ovaries as shown in an ultrasound exam
Physical Exam
Your doctor may check your blood pressure, BMI (body mass index), and waist size. They may also look at your skin to check for extra hair growth, acne, and discolored skin, which can all happen if you have PCOS.
Pelvic exam: This is just like what happens when you get a regular checkup. Your doctor will look at and feel areas of your body including the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum, checking for anything unusual.
Pelvic ultrasound (sonogram): : This produces an image of what your ovaries look like. For the ultrasound, you lie down and the doctor briefly places an ultrasound device in your vagina. The doctor will check for cysts in your ovaries and how thick the lining is in your uterus. That lining may be thicker than normal if your periods aren’t happening when they’re supposed to.
Your ovaries may be 1½ to 3 times larger than normal when you have PCOS. The ultrasound can show ovary changes in about 90% of women who have PCOS.
• Tests
Blood tests: Your doctor or other health care provider will take a small amount of blood from a vein in your arm. Lab tests will measure the levels of these hormones:
- Follicle-stimulating hormone (FSH) affects your ability to get pregnant. Your level might be lower than normal, or even normal, if you have PCOS.
- Luteinizing hormone (LH) encourages ovulation. It could be higher than normal.
- Testosteroneis a sex hormone that would be higher in women with PCOS.
- Estrogensare group of hormones that allow women to get their periods. Your level may be normal or high if you have PCOS.
- Your level of sex hormone binding globulin (SHBG) may be lower than normal.
- A sex hormone called androstenedione may be at a higher-than-normal level.
Human chorionic gonadotropin (hCG): This is a hormone test that can check to see if you’re pregnant.
Anti-Mullerian hormone (AMH): This test can check how well your ovaries are working and to help estimate how far off menopause may be. The levels would be higher with PCOS.
Your doctor may recommend a few more tests to rule out other conditions such as thyroid problems, tumors, and hyperplasia (organ-swelling due to too many cells) that have similar symptoms to PCOS.
• After Your Diagnosis
If you have PCOS, you then may get a blood glucose and cholesterol test. Doctors often do these tests to check on your overall health and chance of having other conditions:
Lipid profiles checks your cholesterol and triglycerides. PCOS can make you more likely to develop heart disease.
Glucose test helps to see if you have diabetes. More than half of women who have PCOS get this disease.
Insulin: Your doctor will want to find out how well your body responds to insulin, which helps control your blood sugar level. If your body doesn’t respond to the insulin it’s making, you may have insulin resistance. It’s common among women with PCOS and can lead to diabetes.
Your doctor will work with you to manage your PCOS symptoms and become as healthy as you can be.
• PCOS Treatment
Treatments can help you manage the symptoms of polycystic ovary syndrome (PCOS) and lower your odds for long-term health problems such as diabetes and heart disease.
You and your doctor should talk about what your goals are so you can come up with a treatment plan. For example, if you want to get pregnant and are having trouble, then your treatment would focus on helping you conceive. If you want to tame PCOS-related acne, your treatment would be geared toward skin problems.
• Lifestyle Changes for PCOS
One of the best ways to deal with PCOS is to eat well and exercise regularly.
Many women with PCOS are overweight or obese. Losing just 5% to 10% of your body weight may ease some symptoms and help make your periods more regular. It may also help manage problems with blood sugar levels and ovulation.
Since PCOS could lead to high blood sugar, your doctor may want you to limit starchy or sugary foods. Instead, eat foods and meals that have plenty of fiber, which raise your blood sugar level slowly.
Staying active helps you control your blood sugar and insulin, too. And exercising every day will help you with your weight.
Treatments for PCOS
Many women need a combination of lifestyle changes and medications to treat PCOS. Your doctor will create a treatment plan for you tailored to treat your individual symptoms.
Menstrual problems
Birth control is the most common PCOS treatment for women who don’t want to get pregnant. Hormonal birth control — pills, a skin patch, vaginal ring, shots, or a hormonal IUD (intrauterine device) — can help restore regular periods.
These birth control methods may also lower your chance of having endometrial cancer, in the inner lining of the uterus.
Taking just a hormone called progestin could help get your periods back on track. It doesn’t prevent pregnancies or treat unwanted hair growth and acne. But it can lower the chance of uterine cancer.
• Extra weight
When a healthy diet and regular exercise aren’t enough, medications can make losing weight easier. Different drugs work in different ways. Your doctor will prescribe the medication they think will be the most successful for you. Options include:
Orlistat (Alli, Xenical): This drug stops your body from digesting some of the fat in your food, so it may also improve your cholesterol levels.
Metformin (Fortamet, Glucophage): This drug lowers insulin levels. It can help with weight loss and may prevent you from getting type 2 diabetes.
If you’re severely obese and other methods haven’t helped you reach a healthy weight, your doctor may suggest weight loss surgery. The change in your weight afterward can regulate your menstrual cycle and hormones and cut your odds of having diabetes.
• Excessive hair growth
Sometimes PCOS causes unwanted hair growth, which your doctor can treat with medications and hair removal methods, such as:
Depilatories: These are creams, gels, and lotions that break down the protein structure of hair so it falls out of the skin. Follow the directions on the package.
Electrolysis or laser therapy: Electrolysis removes individual hairs with an electric current that destroys the root. Laser therapy destroys hair follicles. You’ll need several sessions, and though some hair may come back, it should be finer and less noticeable.
Hormonal birth control: Birth control pills and other contraceptives that use hormones can also treat unwanted hair growth and acne.
Spironolactone (Aldactone): If birth control doesn’t stop hair growth after 6 months, your doctor may prescribe this drug. It lowers the level of a type of sex hormone called androgens. But you shouldn’t take it if you’re pregnant or plan to become pregnant, because it can cause birth defects.
• Fertility problems
Your doctor may prescribe medication to help you get pregnant. Medications that help with fertility include:
- Clomiphene and letrozole (Femara), which encourage steps in the process that trigger ovulation
- Shots of hormones called gonadotropins
- Metformin
Other options to improve your fertility are:
Surgery: A procedure called ovarian drilling might make your ovaries work better when ovulation medications don’t, but it’s being done less often than it used to. The doctor makes a small cut in your belly and uses a tool called a laparoscope with a needle to poke your ovary and wreck a small part of it. The procedure changes your hormone levels and may make it easier for you to ovulate.
In vitro fertilization, or IVF: With this procedure your egg is fertilized outside of your body and then placed back inside your uterus. This may be the best way to get pregnant when you have PCOS, but it can be expensive.
