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PCOS: Causes, Diagnosis and Treatment

Polycystic ovarian syndrome, or PCOS, is a very common disorder. It affects 5-10% of women of reproductive age, making it one of the most common hormonal disorders in this age group.

PCOS is a condition that involves irregular periods which also means that ovulation does not happen every month. This happens due to a mix of metabolic and hormonal imbalances which do not let follicles (where eggs are located) from growing and developing normally. This leads to a whole bunch of follicles staying in a smaller, under-developed state which causes a “string-of-pearls” appearance on an ultrasound.

What causes PCOS?

The exact cause of PCOS is not known. It is likely that a combination of factors lead to the development of it. It is thought to arise from both genetic factors that may run in families and environmental factors. The diet that one consumes, are also thought to play a role in its development. 

Characteristics of PCOS

Women with polycystic ovarian syndrome often have three characteristic symptoms. They are diagnosed when they have at least two of these three symptoms:

  • irregular periods
  • excess androgens (either measured in the blood or seen through symptoms such as acne or excess hair growth)
  • and polycystic ovaries, seen on ultrasound.

Irregular Periods

Women with polycystic ovarian syndrome may have irregular periods, often having only 6-8 periods per year. They may get their period every month for a few months and then skip a month or two. Or they may go many months without having a period.

Many women with polycystic ovarian syndrome will have infertility associated with their irregular menses. Also, when women with PCOS do become pregnant, they have an increased rate of miscarriage.

PCOSExcess Androgens

Another common feature of polycystic ovarian syndrome is acne or oily skin. Acne may occur over the face but may also be found over the back or chest. This is due to relatively higher levels of a hormone called testosterone circulating in the bloodstream of women with PCOS. Testosterone is a hormone that is found in much higher levels in men.

Women with PCOS do not have male levels of testosterone but the levels of testosterone may be higher than expected for females. These higher levels of circulating testosterone can also cause excess facial hair on the chin or upper lip or excess hair growth on the chest and abdomen.

The hormone imbalances seen in polycystic ovarian syndrome can also cause a type of hair thinning which occurs at the front of the scalp. Sometimes blood tests can show excess levels of testosterone in women with PCOS but other times they do not.

Polycystic Ovaries

The third common feature of polycystic ovarian syndrome is what is called polycystic ovaries. This can be seen on transvaginal ultrasound. This is actually a misnomer as the ovaries of women are not really full of cysts but rather ovarian follicles that each contains an egg. All women have these follicles in their ovaries and each month a group of follicles start to develop, with one going on to be the dominant follicle that ovulates the egg.

The ovaries of women with PCOS may contain many small follicles that do not go on to ovulate an egg each month. These follicles fail to develop normally because of the hormonal imbalances in PCOS. Since the ovaries do not grow and ovulate an egg each month, women with PCOS may also experience difficulty getting pregnant.


Obesity is also common in women with polycystic ovarian syndrome. According to, up to 50-60% of women with PCOS are obese. Symptoms such as those described above can be worsened by obesity. The hormonal imbalances found in women with PCOS may cause them to be more likely to gain weight and become obese.

Women with PCOS are also prone to developing something called insulin resistance in which the body produces excess amounts of insulin. This is thought to be a precursor to Type II diabetes. Women with PCOS are at greater risk of developing diabetes and therefore should be screened for insulin resistance.

Treatment options

There are treatments available for women with polycystic ovarian syndrome. These treatments do not cure the disease but rather help improve the symptoms of PCOS.

  • For women who are obese, diet and exercise to maintain a normal body weight may alleviate many of the symptoms of PCOS. In fact, for obese women, losing even 5-10% of body weight may help.
  • Oral contraceptive pills are often given to correct some of the hormonal imbalances found in PCOS and can help decrease acne and excess hair growth as well as regulate menstrual cycles.
  • Acne can also be treated with topical ointments or antibiotic creams.
  • Women with excess hair growth often find laser electrolysis helpful.
  • Metformin is an oral medication that may be prescribed to women with PCOS who are insulin resistant.
  • Women who are having difficulty conceiving may take a medication called clomiphene citrate or clomid to help them ovulate regularly.

In women with PCOS who take clomid, about 80% will ovulate in response to the medication and 30-40% will become pregnant. About half of women will ovulate when taking one pill a day (50 mg) on cycle days five through nine. The other 50% of women do not ovulate on this dose of clomid and may need a higher dose or another medication.

Using clomid increases your chances of having a multiple pregnancy to 8-13%, with twins being the most common. If pregnancy does not occur after six cycles of clomid use, further evaluation or a change in therapy is recommended.

Polycystic ovarian syndrome is very common. If you think you may be experiencing any or all of the symptoms, it is important to see a doctor for diagnosis and treatment.

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Original post March 30, 2015
Updated September 1, 2021, and August 31, 2023

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