Polycystic Ovarian Syndrome (PCOS)
Polycystic Ovarian Syndrome (PCOS) is an
endocrine (hormonal) disorder that affects 5-
10% of all women. PCOS can affect women
of all races and ethnic backgrounds.
Symptoms most often appear in the teen
years, but some women do not have
symptoms until they are in their early to
mid-20’s. Some of the most frequent
symptoms that bring a teen to our clinic may
1) Excessive facial or body hai
3) Irregular periods
4) Insulin resistance and/or Obesity
Women with PCOS may have symptoms of
acne, hair growth and menstrual problems.
At this time there is no cure for PCOS, but
there are ways to treat the symptoms and
their causes. Every woman with PCOS is
unique. Some women may have only a
couple of symptoms while others may have
more. Many women with PCOS have
metabolic syndrome that must be treated.
Symptoms of metabolic syndrome include
high blood pressure, high cholesterol,
glucose intolerance or diabetes.
No menstrual period (amenorrhea) or
infrequent periods (oligomenorrhea) - The
time between menstrual bleeding can be
greater than six weeks, with eight or fewer
periods per year. Irregular bleeding may
occur. Periods may be lengthy, light, or
heavy. Frequent spotting may also occur.
Cystic Ovaries- The parts of the ovary that
normally contain an egg that is released with
each menstrual cycle can turn into cysts and
no egg is released. Although the condition
is called PCOS, only some girls and women
with PCOS have cystic ovaries. Most girls
and women with PCOS have normal
ovaries. The cysts in PCOS look like a
string of pearls on ultrasound----many, many
small cysts, not just one big single cyst. A
single cyst can commonly occur in women
and is not PCOS.
Infertility- Infertility is not being able to get
pregnant within six to twelve months of
unprotected sex (depending on your age). In
the case of PCOS, this is often due to no
eggs or few eggs being released from the
ovary. Teenagers with PCOS may still get
pregnant, so they should not have
Increased blood levels of androgens
(hyperandrogenism) - The hormones
testosterone, androstenedione, and DHEAS
are androgens. Making too much of these
hormones can cause excess body and facial
hair, as well as oily skin. The ovaries and
adrenal glands produce these hormones.
Excessive hair growth (hirsutism)- The
hair growth mostly occurs on the face, chest,
abdomen, back, or toes. This can be a
response to the body making too many
Flaking skin on the scalp (Acne/Oily
Skin/Seborrhea)- All of these are a result of
the skin making too much oil. This can be
in response to the body making too many
Obesity or Weight Gain- Weight gain
tends to occur around the middle, causing an
“apple” shaped figure. Weight gain can
worsen insulin resistance and heart disease
risk factors, such as high cholesterol and
high blood pressure.
Insulin Resistance and Hyperinsulinemia
- Insulin resistance occurs when the body
does not use insulin very well to change
sugar from food into energy. The body then
has to produce higher than normal levels of
insulin (hyperinsulinemia) to try to keep the
blood sugars under control.
Abnormal lipids (dyslipidemia)- Lipids are
fats in the blood. In PCOS, the bad lipids or
cholesterols (LDL & triglycerides) become
high and the good one (HDL) becomes low.
High blood pressure (hypertension)-
Blood pressure for a young woman should
be around 120/80 or less. High blood
pressure is a reading of 130/80 or greater.
High blood pressure is a risk factor for heart
Dark patches on the skin (Acanthosis
Nigricans)- This most often occurs around
the neck, but can also occur in the skin
creases under the arms, breasts, knuckles,
and between the thighs. The patch can feel
smooth and ranges in color from tan to dark
brown. These skin changes reflect high
The exact cause of PCOS is not known. It is
diagnosed based on the symptoms that you
have, an exam, and blood tests to rule out
other diseases. In most cases, a pelvic exam
is not done at the first exam and is only
rarely done at return visits in certain cases.
An ovary ultrasound may also be done.
Birth control pills (Oral Contraceptives)-
Birth control pills contain hormones to make
periods regular. They will also decrease the
androgens produced by the ovaries and help
control symptoms such as increased hair
growth and acne. Girls and women with a
history of blood clots should not use birth
Anti-androgen Drugs- These drugs block
the effect of the hormones that cause
unwanted hair growth (on the body and
face) and acne. Spironolactone
(Aldactone®) is one of the drugs we often
prescribe to decrease acne and facial and
body hair growth. This drug may take up to
24 weeks for full results to be seen. This
drug cannot be taken during pregnancy.
Insulin Sensitizers- These drugs make the
body more sensitive to insulin. These drugs
lower the amount of insulin produced by the
pancreas. Metformin (Glucophage ) is the
most commonly used drug for this situation.
This drug can also help you to lose a small
amount of weight, regulate menstrual cycles,
and help improve cholesterol levels.
Weight Loss- Losing weight can be hard at
first for women with PCOS because of the
insulin resistance. A healthy diet and
exercise will be crucial for weight loss. Our
dietician can help you create a food plan and
set goals. Weight loss can also decrease the
risks of heart disease and type 2 diabetes.
Excessive Hair Growth- Vaniqa is a skin
cream that can be used along with anti-
androgen drugs to help reduce new growth
of facial hair. The cream must be used twice
a day for 6-8 weeks to see results. Old hair
must be removed by plucking, shaving, or
waxing. If the cream is not used as
prescribed, the hair growth will return.
Other methods of hair removal such as
electrolysis or laser treatments can work
well to achieve more permanent hair
removal. These techniques are performed by
a licensed dermatologist or plastic surgeon
and can be costly.
Long Term Health Risks
Endometrial (lining of the uterus)
Cancer- Each month, a lining builds up in
the uterus. If a woman does not become
pregnant, the lining is shed through
menstruation. Women with PCOS do have a
build up of the lining, but the lining is not
fully shed due to rare or absent periods.
This build up of the lining over time can
increase the chance of endometrial cancer if
it is not treated.
Type 2 Diabetes- Insulin resistance and
obesity both increase a woman’s risk of
having type 2 diabetes. Women with PCOS
who have family members with diabetes
appear to be at the highest risk for also
getting diabetes. Forty percent of women
with PCOS have either diabetes or are not
able to process glucose the right way
(glucose intolerance or pre-diabetes) by the
age of 40.
Heart Disease- Women with PCOS have an
increased risk of heart disease. Symptoms
such as high blood pressure, high
cholesterol, obesity, and hyperinsulinemia
increase a woman’s risk of heart disease.
Polycystic Ovarian Syndrome Association,
ξ Polycystic Ovarian Syndrome Association,
ξ University of Chicago Center for Polycystic
Ovarian Syndrome, website:
ξ Center for Young Women’s Health, website:
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is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
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this information. If you have an emergency, please call 911. Copyright 3/2017. University of Wisconsin Hospitals
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