Polycystic Ovary Syndrome

(Stein-Leventhal Syndrome, Chronic Hyperandrogenic Anovulation (CHA), PCOS)

The Facts

Polycystic ovary syndrome (PCOS) is not a disease in the usual sense; rather, it is a collection of symptoms that can affect a person's reproductive health and heart health, and it can have other significant effects on health and lifestyle. It affects about 6% to 15% of people assigned female at birth in their reproductive years. Its risk factors are not well known, but heredity does play a role.

The Causes

The causes of PCOS are unknown. Researchers believe that insulin resistance and an imbalance of male hormones (e.g., testosterone) and female hormones (e.g., estrogens and progestins, those important for the menstrual cycle) contribute to the development of this condition. Research suggests a family history of PCOS, may be a risk factor for its development.

Symptoms And Complications

There are many possible symptoms, and you can have PCOS without having all of them. Some of the common symptoms include:

acne
difficulty becoming pregnant (infertility)
irregular menstrual periods
obesity
skin discolourations
unwanted hair growth or loss

Symptoms most commonly associated with PCOS are unwanted hair growth and irregular menstrual periods. Affected people may have fewer menstrual periods (oligomenorrhea) or miss their periods for 6 months or more (amenorrhea). When they do have their period, they may have prolonged or heavy bleeding.

Many people do not know they have PCOS until they try to become pregnant. Infertility is an issue for about 75% of those with PCOS. If these people do become pregnant, they are at an increased risk of complications and of miscarriage. About half of those with PCOS have acanthosis nigricans (a grey-brown skin discoloration), signifying that the body has too much insulin.

At least 50% of people with PCOS have an unhealthy body weight, and in many cases the extra body weight is centered around the abdomen. Central obesity increases the risk of developing many conditions, including:

cholesterol problems
heart disease
high blood pressure
type 2 diabetes
depression and anxiety
sexual dysfunction
sleep apnea

Regardless of their body weight, people with PCOS have an increased risk for developing these conditions.

Acne is another symptom seen by some people with PCOS. About 75% of people with PCOS over the age of 20 suffer from acne. Loss of hair from the scalp is also possible. A person with PCOS may also experience male-pattern hair growth due to hormone imbalance.

Complications of PCOS can include endometrial cancer: if a person has irregular menstrual periods for an extended time, the lining of the uterus can build up and develop cancerous cells. This may take many years to develop. People assigned female at birth who do not have regular periods (or any periods at all) should consult their doctor.

Making A Diagnosis

PCOS is a diagnosis that is made once other conditions causing similar signs and symptoms have been investigated and ruled out by your doctor.

To rule out other conditions, your doctor performs a physical examination and may order a series of laboratory tests, including:

testosterone
dehydroepiandrosterone (DHEA-S), a steroid hormone made by the adrenal gland
female hormones (follicle stimulating hormone [FSH] and prolactin)
blood sugar
cholesterol
thyroid function

Your doctor may also ask you to have a pelvic ultrasound. This will allow your doctor to visualize your ovaries and the diagnosis of PCOS may be confirmed.

If you have PCOS, the ultrasound may show 12 or more cysts smaller than 10 mm in size on each ovary. These are often said to look like a string of pearls. Interestingly, these lesions are not actually cysts but the remains of ovarian follicles that did not successfully make or release an ovum (egg). However, up to 20% of all people with ovaries will have ovarian cysts, so having 1 or 2 cysts does not necessarily mean you have PCOS.

Treatment And Prevention

Given that the cause(s) of PCOS are unknown, there is no cure for the condition. The focus, instead, is on managing bothersome symptoms or those that increase the risk for other diseases.

A healthy diet and exercise are important parts of managing PCOS regardless of your weight. Weight loss is recommended for those with obesity – while it will not cure PCOS, it will lessen symptoms and may help improve fertility.

Medications used to manage PCOS often influence how the body uses insulin or restore the balance between male and female hormones in the body.

Oral contraceptives are used to manage many symptoms associated with PCOS for people who are not trying to become pregnant. They regulate menstrual periods and can reduce acne. Other options that affect hormone levels and are used by people not planning pregnancy include progestins and antiandrogens (e.g., spironolactone*). Medications that improve the body's ability to use insulin help to regulate blood sugar. Metformin, an antidiabetic medication, may be an alternative for those who cannot take oral contraceptives. Metformin can also help reduce weight.

For people who do desire to become pregnant, infertility medications which help ovulation to occur (e.g., gonadotropins) may be recommended. Although not officially approved by Health Canada for this use, the medication letrozole may also be used to induce ovulation. People with PCOS are at higher risk for pregnancy complications.

Hair loss on the scalp may be managed with medications such as minoxidil and spironolactone. Shaving, waxing, or other hair removal methods may be required to eliminate unwanted body hair. Acne may also be managed with medications available with or without a prescription that can be taken by mouth or applied directly to the skin.

Acanthosis nigricans may fade with the use of prescription medications applied directly to the skin. Examples include 15% urea, alpha-hydroxy acid, and salicylic acid. This symptom may lessen with the use of metformin as well.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.