Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders affecting women of reproductive age. It can influence menstrual cycles, fertility, skin, hair growth, body weight, and long-term metabolic health.

Although the name suggests that ovarian cysts are the defining feature, many women with PCOS do not have ovarian cysts, and many women with ovarian cysts do not have PCOS — the condition is more complex than its name implies. The encouraging news is that PCOS is treatable: early diagnosis and appropriate management can improve symptoms while reducing the risk of future health problems.

What Is PCOS?

PCOS is a hormonal disorder characterized by problems with ovulation and increased levels or effects of androgens (often called “male hormones,” though they are naturally present in women too). The exact cause remains unknown, but genetics, insulin resistance, and hormonal regulation all appear to play important roles. PCOS affects approximately 6% to 13% of reproductive-age women, depending on the diagnostic criteria used.

Common Symptoms

Symptoms vary considerably — some women have only mild menstrual irregularities, while others develop several symptoms:

Not every woman has every symptom.

Why Do Periods Become Irregular?

Ovulation normally occurs once each menstrual cycle. In PCOS, ovulation often becomes infrequent or stops altogether. Without regular ovulation, periods may become unpredictable, cycles may run longer than 35 days, and some women skip several months between periods. Irregular cycles are often one of the earliest signs of PCOS.

Insulin Resistance and PCOS

Many women with PCOS have insulin resistance, meaning the body’s cells do not respond normally to insulin. As insulin levels increase, the ovaries may produce more androgens, which can worsen acne, unwanted hair growth, and irregular ovulation. Insulin resistance also increases the long-term risk of prediabetes, type 2 diabetes, high blood pressure, high cholesterol, and fatty liver disease.

How Is PCOS Diagnosed?

There is no single blood test that confirms PCOS. Physicians diagnose it using a combination of medical and menstrual history, physical examination, laboratory testing, and pelvic ultrasound when appropriate. Many specialists use the Rotterdam criteria, which require at least two of the following after excluding other causes: irregular or absent ovulation; clinical or laboratory evidence of elevated androgens; and polycystic ovarian appearance on ultrasound.

Conditions That Can Mimic PCOS

Several disorders can produce similar symptoms and should be considered during evaluation: thyroid disorders, elevated prolactin levels, congenital adrenal hyperplasia, Cushing syndrome, and (rarely) androgen-producing tumors. Appropriate laboratory testing helps distinguish these conditions.

Can PCOS Affect Fertility?

Yes. Irregular ovulation is one of the most common causes of infertility. However, many women with PCOS become pregnant naturally or with medical treatment. Treatment depends on whether pregnancy is desired.

Treatment Depends on Your Goals

Lifestyle changes — regular physical activity, balanced nutrition, weight management, and adequate sleep — improve many aspects of PCOS; even modest weight loss can improve ovulation and insulin sensitivity in women with overweight or obesity.

Combined hormonal contraceptives (birth control pills) are commonly prescribed for women not trying to conceive; they help regulate cycles, reduce acne, lower androgen levels, and improve unwanted hair growth over time.

Metformin improves insulin sensitivity and may be recommended for selected women, particularly those with insulin resistance, prediabetes, or type 2 diabetes; some women also experience more regular cycles.

Acne associated with PCOS may improve with topical prescription medications, hormonal contraceptives, or other prescription therapies. Unwanted hair growth can be managed with laser hair removal, electrolysis, prescription medications in selected patients, and cosmetic methods — improvement usually takes several months.

Long-term health matters Women with PCOS have an increased risk of prediabetes, type 2 diabetes, high blood pressure, high cholesterol, obstructive sleep apnea, endometrial hyperplasia, and depression or anxiety. Routine preventive care is an important part of long-term management. (See our guide to blood pressure management.)

Frequently Asked Questions

Does every woman with PCOS have ovarian cysts?

No. Many women with PCOS have normal-appearing ovaries on ultrasound.

Can I still become pregnant?

Yes. Many women with PCOS conceive, although some require fertility treatment.

Does losing weight cure PCOS?

Weight loss does not cure PCOS, but it can improve insulin resistance, menstrual regularity, and ovulation in many women.

Is PCOS lifelong?

PCOS is considered a chronic condition, but symptoms often improve with appropriate treatment and healthy lifestyle changes.

How YourMD Telehealth Can Help

If you’ve noticed irregular periods, persistent acne, unwanted hair growth, or difficulty losing weight, PCOS may be one possible explanation. Many aspects can be evaluated through telehealth — your physician can review your menstrual history, symptoms, weight history, previous lab results, pregnancy plans, and current medications, and explain which tests are recommended if laboratory testing or imaging is needed. With YourMD Telehealth, Nevada residents can consult with a board-certified physician from home: secure messaging ($20), live chat ($20), phone ($40), or video ($50). We’ll create a personalized management plan based on your goals — whether symptom relief, fertility, or long-term metabolic health.

References

This article is for general educational purposes and is not a substitute for individualized medical advice. Prescriptions are provided only when a physician determines treatment is clinically appropriate. Services currently available to Nevada residents 18 and older.