What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a long-term condition in women in which there is an abnormality in female sex hormones. This is associated with a range of health problems including increased facial and body hair growth, increased tendency to develop type 2 diabetes, irregular menstrual cycles and reduced fertility.

PCOS is common, affecting between 12-21% of women of reproductive age. [1] It is estimated that around 70% of women with PCOS do not know they have the condition. [1]

Hormones

A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.

Menstrual cycles

A monthly cycle of changes that a woman's body goes through to prepare for a potential pregnancy.

Ovary

Female organs located on either side of the uterus. Each ovary produces eggs that travel along the fallopian tubes to the uterus.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

Signs and symptoms

Women are often diagnosed with PCOS in late adolescence or in their 20s. The symptoms vary, but they can include:

  • Facial and body hair growth;
  • Irregular menstrual cycles (infrequent or too frequent), or no menstrual cycles at all;
  • Problems with fertility and getting pregnant;
  • Weight gain (most women with PCOS are overweight or obese);
  • Thinning or loss of hair on the scalp; 
  • Acne;
  • Acanthosis nigricans, which is dark patches of skin that tend to form on the neck and breasts and in the armpits and groin, and;
  • Body shape changes, including reduced size of breasts and, very rarely, an enlarged clitoris.

Women with PCOS can also be at greater risk of experiencing mental health problems such as:

  • Problems with body image and low self-esteem;
  • Anxiety;
  • Depression;
  • Eating disorders, and;
  • Problems with sex.

PCOS is also associated with:

Anxiety

A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.

Blood pressure

The pressure the blood places on the walls of the arteries, largely mirroring the contraction of the heart, and consisting of two readings. The higher reading is systolic blood pressure, when the heart contracts, and the lower is diastolic blood pressure, when the heart is relaxed.

Cholesterol

A type of fat produced by the body that is necessary for metabolism.

Clitoris

A small, sensitive female sexual organ located at the point where the labia meet at the front of the vagina. It is analogous to the male penis.

Menstrual cycles

A monthly cycle of changes that a woman's body goes through to prepare for a potential pregnancy.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

Causes

The exact cause of PCOS is unclear. However, it involves abnormalities in a number of hormones, including:

These hormonal changes can prevent the ovaries from releasing fully mature eggs. Usually, once each menstrual cycle during ovulation, one or more eggs are released from the ovaries into the fallopian tubes. The eggs then pass to the uterus, where, if they are fertilised, can develop into an embryo.

In PCOS, eggs are not released, but instead form tiny cyst-like structures in the ovaries. Over time, these cysts can build up and the ovaries can become 'polycystic'. Because eggs are less likely to be released from the ovaries, women with PCOS are more likely to have problems with fertility.

Female reproductive organs showing a polycystic ovary.The female reproductive organs showing a polycystic ovary. 

Androgens are known as 'male' hormones, although small amounts are naturally produced in the female body. When levels of androgens are raised in women, this can lead to the development of features more common in males. This results in some of the symptoms experienced in PCOS, such as increased body hair, loss of hair on the scalp and acne.

Most women with PCOS have insulin resistance whether they are overweight or not. Metabolic syndrome is also increased in women with PCOS. Metabolic syndrome is a term given to the consequences of insulin resistance, which is a range of health problems including type 2 diabetes, high blood pressure (hypertension) and high blood cholesterol.

Insulin works by helping glucose (sugar) pass from the bloodstream into cells in the body. In PCOS, this process can be affected. This occurs because although the pancreas can still make insulin, the cells no longer respond the way they should (called insulin resistance). When glucose can no longer enter the cells and instead stays in the bloodstream, it can result in the pancreas making more insulin to try to control blood glucose levels. Eventually, type 2 diabetes can develop, in which the pancreas can no longer produce enough insulin to control glucose levels. 

Adrenal glands

Two glands, each located on top of a kidney, that produce hormones including cortisol and sex hormones.

Androgens

The male sex hormones.

Blood pressure

The pressure the blood places on the walls of the arteries, largely mirroring the contraction of the heart, and consisting of two readings. The higher reading is systolic blood pressure, when the heart contracts, and the lower is diastolic blood pressure, when the heart is relaxed.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Cholesterol

A type of fat produced by the body that is necessary for metabolism.

Cyst

A closed sac in or under the skin that contains fluid.

Embryo

An organism in the early stages of development. An unborn human between the time of fertilisation and the eighth week of pregnancy.

Fallopian tubes

The tube-like structures connecting a woman's uterus to her ovaries. Eggs released by the ovaries travel to the uterus via the fallopian tubes.

Glucose

A simple sugar found in many foods (such as fruit) that functions as a major energy source for the body.

Hormones

A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.

Insulin

A hormone secreted by the pancreas in order to regulate glucose levels in the body's cells, which is used for energy.

Menstrual cycle

A monthly cycle of changes that a woman's body goes through to prepare for a potential pregnancy.

Oestrogen

One of a group of steroid hormones involved in the development and maintenance of female sex characteristics. These are the primary female sex hormones.

Ovaries

Female organs located on either side of the uterus. Each ovary produces eggs that travel along the fallopian tubes to the uterus.

Ovulation

The phase of the female menstrual cycle during which an ovum (egg) is released from one of the woman's two ovaries.

Pancreas

An organ located behind the stomach that secretes insulin and glucagon into the bloodstream and digestive enzymes into the intestines.

Pituitary gland

A small gland located at the base of the brain which produces many hormones important for the healthy function of the body.

Progesterone

A female sex hormone produced by the ovaries and the placenta during pregnancy. It also plays an important role in the menstrual cycle.

Uterus

The hollow organ of the female reproductive system that is responsible for the development of the embryo and fetus during pregnancy. Also known as the womb.

Luteinising hormone

A type of hormone produced by the pituitary gland. In females, this hormone triggers the cyclical release of an egg, roughly each month. In males, it stimulates testosterone production.

Metabolic syndrome

The combination of abdominal obesity, high blood-sugar level, abnormal cholesterol level and high blood pressure that is associated with an increased risk of developing type 2 diabetes, heart disease and stroke.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

Risk factors

You may be at greater risk of developing PCOS if:

  • You have a family history of PCOS (for example, your sister or mother has it), and;
  • You are also overweight or obese.

Women from some cultural backgrounds are at increased risk, including indigenous Australians and women from the Indian subcontinent.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

Methods for diagnosis

There is no one test to diagnose PCOS. So to help make the diagnosis of PCOS, your doctor will usually assess for two out of the following three criteria:

A transvaginal pelvic ultrasound is generally only performed on women over 18 years of age. It is important to recognise that not every woman who has polycystic ovaries on ultrasound will have PCOS.

When diagnosing PCOS, your doctor will need to make sure that other health conditions are not causing your symptoms. They may also want to do tests to investigate how PCOS is affecting your general health.

Tests can include:

Androgen

The male sex hormones.

Blood pressure

The pressure the blood places on the walls of the arteries, largely mirroring the contraction of the heart, and consisting of two readings. The higher reading is systolic blood pressure, when the heart contracts, and the lower is diastolic blood pressure, when the heart is relaxed.

Blood test

During a blood test, blood can be drawn using a needle or by a finger prick. Your blood can then be analysed to help diagnose and monitor a wide range of health conditions.

Cholesterol

A type of fat produced by the body that is necessary for metabolism.

Glucose

A simple sugar found in many foods (such as fruit) that functions as a major energy source for the body.

Insulin

A hormone secreted by the pancreas in order to regulate glucose levels in the body's cells, which is used for energy.

Ovaries

Female organs located on either side of the uterus. Each ovary produces eggs that travel along the fallopian tubes to the uterus.

Ultrasound

A scan that uses high-frequency soundwaves to produce images of the body’s internal structures.

Oral glucose tolerance

A test used to assist in the diagnosis of type 2 diabetes through periodic evaluation of glucose levels in urine and/or blood samples, before and after consuming a set amount of glucose.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

Types of treatment

If you have PCOS, there are a range of treatments available. You may need to work with a range of healthcare professionals such as an endocrinologist, fertility specialist, dietitian and exercise physiologist to manage the condition.

Lifestyle

Managing your lifestyle is a very important part of controlling PCOS and reducing the risk of health problems that can arise.

Weight loss

If you are overweight or obese, aiming at achieving a healthy weight can help to improve PCOS symptoms, improve blood glucose control and help with other health conditions such as high blood pressure (hypertension). Weight loss can be challenging, but even losing a small amount, for example 5% of your body weight, can help.

Healthy diet

A healthy, well-balanced diet can help to manage PCOS symptoms. A low-fat diet with plenty of fruits, vegetables and whole grains is recommended. If you need help planning your meals, a dietitian can provide guidance.

Physical activity

Regular physical activity can help to manage PCOS. However, particularly if you have type 2 diabetes as well as PCOS, it's important to talk to your doctor about what activities are suitable and any precautions you may need to take in order to be active safely. 

 

A young woman exercising.Physical activity can help to manage symptoms associated with polycystic ovary syndrome. 

Quitting smoking

Smoking can make the health problems that occur with PCOS significantly worse. If you smoke, your doctor can advise you on treatments and approaches that can make quitting smoking easier.

Treatments for menstrual problems

The lifestyle measures described above can help make your menstrual cycle more regular. Medications can also be prescribed. Your doctor will advise you on what medications are most suitable for your situation.

These include:

  • The combined oral contraceptive pill;
  • Cyclic progesterones, and;
  • Metformin, a drug for type 2 diabetes that can help to stimulate ovulation and the regularity of the menstrual cycle.

Fertility treatments

The lifestyle measures described above can help improve fertility. Medications that help to stimulate follicle development and ovulation include clomiphene citrate, metformin and gonadotrophins.

In vitro fertilisation (IVF) may help to achieve pregnancy if other fertility treatments are not successful.

Surgery

Laparoscopic surgery can be used to either remove an ovary or treat it. It can help to remove tissue that is producing androgens (male hormones) and improve the hormone imbalances in PCOS.

In laparoscopic ovarian drilling (LOD) a laparoscope is inserted into the pelvis and used to destroy tissue in the ovaries. This is done either with heat or a laser. The effect of these procedures is not permanent.

Prevention of long-term health complications

The lifestyle measures described above can help reduce insulin resistance and improve your blood pressure and blood glucose levels. This can reduce the risk of serious health problems such as type 2 diabetes and heart disease.

Metformin may also be prescribed to help reduce insulin resistance.

Mental health

Dealing with some of the symptoms caused by PCOS can be challenging. Women with PCOS can be at greater risk of a range of mental health problems, including depression, anxiety and eating disorders. Seeking support or advice from your doctor or a mental health practitioner can help.

Treatments for hair growth

There are a range of options available to reduce body hair. Cosmetic hair-removal treatments, particularly laser hair removal, are recommended.

Eflornithine hydrochloride is available in a cream. It disrupts an enzyme in hair follicles that is necessary for the hair to grow. It can help to prevent or delay facial hair regrowth and may improve the effect of cosmetic hair-removal treatments.

If these treatments are ineffective, or not an option, some medications may help.

These include:

  • The combined oral contraceptive pill, and;
  • Anti-androgen medications (aldactone or cyproterone acetate).

Your doctor can advise on what therapies may be suitable for you. 

Non-medication options can also be used to control hair growth, such as plucking, waxing and laser hair removal.

Acne

The combined oral contraceptive pill can help to improve acne. Topical and oral medications can also be prescribed to treat acne specifically. 

Your doctor can advise you on suitable therapies. 

Blood pressure

The pressure the blood places on the walls of the arteries, largely mirroring the contraction of the heart, and consisting of two readings. The higher reading is systolic blood pressure, when the heart contracts, and the lower is diastolic blood pressure, when the heart is relaxed.

Dietitian

A health professional who specialises in diet and nutrition.

Endocrinologist

A doctor specialising in the endocrine (hormone) system of the body.

Exercise physiologist

A health professional specialising in exercise to prevent and manage chronic diseases and injuries.

Glucose

A simple sugar found in many foods (such as fruit) that functions as a major energy source for the body.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

Potential complications

Because of the hormone imbalances that occur in PCOS, it can increase your risk of a range of serious health problems, including type 2 diabetes, high blood pressure (hypertension), heart attack and stroke.

When you have PCOS, you may need to see your doctor more regularly to check for these conditions.

Cancer

Women with PCOS can have an increased risk of endometrial cancer.

Blood pressure

The pressure the blood places on the walls of the arteries, largely mirroring the contraction of the heart, and consisting of two readings. The higher reading is systolic blood pressure, when the heart contracts, and the lower is diastolic blood pressure, when the heart is relaxed.

Endometrial

Relating to the internal lining of the uterus.

Hormone

A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

Prognosis

PCOS is a long-term condition that may need to be managed for the rest of your life. With healthy lifestyle measures and appropriate treatment, most women with PCOS can achieve pregnancy and limit the symptoms and health problems the condition can cause.

In some women, PCOS may resolve without treatment around the age of 30-40 years. 

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

Prevention

PCOS cannot always be prevented, but lifestyle measures such as eating a healthy diet, exercising regularly and keeping your weight within a healthy range can reduce your risk of developing the condition, as well as helping to prevent or reduce many of its associated health problems. 

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.

1. March W.A. Moore V.M. Willson K.J. et al. (2010) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25:544–551.