Being diagnosed with PCOS can answer some questions that have been nagging at you (so that’s why my periods are irregular), while bringing up new ones (what brought this on?).

While the hormonal disorder is quite common—estimates suggest 1 in 10 women has it, and that’s likely undershooting—clear answers can be hard to come by. You might wonder how PCOS might affect your health long-term, including your fertility, and what you can do to manage symptoms and reduce complications. We got you. We asked experts to share exactly what you need to know about the condition, including its causes, how it’s diagnosed, and your treatment options.

Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age. It’s caused by a hormonal imbalance, which leads to symptoms like irregular menstrual cycles, acne, excessive hair growth, and hair loss. It’s also one of the most common causes of infertility, per the Office on Women’s Health (OWH).

People with PCOS have excess follicles on their ovaries, the tiny fluid-filled sacs where eggs grow. “Cystic” just means that an ultrasound shows there are a lot of more follicles on the ovaries than there are supposed to be, according to Jenna Turocy, M.D., a reproductive endocrinologist at Columbia University Fertility Center in New York City. “These follicles are making the hormones in excess, causing symptoms.” This overproduction of reproductive hormones is also associated with metabolic issues, including insulin resistance, weight gain, and type 2 diabetes.

PCOS symptoms can vary widely among women. While some people may experience textbook PCOS, checking all the boxes of telltale signs, others may only have one symptom. And some women may have issues that are bothersome but aren’t considered part of the diagnostic criteria. “This variability in symptoms can make diagnosis challenging,” says Bana Kashani, M.D., a reproductive endocrinologist and infertility specialist in Laguna Hills, CA.

Common PCOS symptoms, per the OWH and The American College of Gynecologists and Obstetricians (ACOG), include:

• Irregular menstrual cycle, including missed periods or no periods at all

• Hirsutism, which means excess hair on the face or parts of the body where men usually have hair

• Severe acne on the face, chest, and upper back

• Thinning hair or hair loss on the scalp, known as male-pattern baldness

• Weight gain or difficulty losing weight

• Difficulty getting pregnant

• Patches of thickened, velvety, darkened skin called acanthosis nigricans

• Skin tags in the armpits or neck area

The exact cause of PCOS is unclear. PCOS tends to run in families, indicating a genetic component, though researchers have yet to pinpoint a specific gene responsible, according to Lauren Streicher, M.D., a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine and medical director of community education at Midi Health. Ultimately, experts believe a combination of genetics and environmental factors cause PCOS, according to the National Institutes of Health (NIH).

Two related forces are at play behind PCOS symptoms:

High Levels of Androgens

Androgens are also known as male hormones, though women have a small amount of them, too. In a person without PCOS, the ovaries make both estrogen and androgens—including dehydroepiandrosterone sulphate (DHEAS), dehydroepiandrosterone (DHEA), androstenedione (A), testosterone (T), and dihydrotestosterone—in the right proportions. In women with PCOS, the delicate balance is off, causing an overabundance of these male hormones. Higher than normal androgen levels can interrupt follicle development, delay ovulation, and cause extra hair growth, acne, and male-pattern baldness, per the NIH.

Insulin resistance

Insulin is another hormone that’s implicated in PCOS. Normally, the pancreas produces insulin and releases it into the bloodstream, where it moves glucose (sugar) into the body’s cells where it’s used for energy. When the cells don’t respond normally to insulin, sugar builds up in the blood, and the body keeps producing insulin to compensate. High insulin levels increase androgen levels, and can also increase appetite and lead to weight gain, according to the NIH.

While the exact causes of PCOS are unclear, experts have identified two risk factors that tend to make you more likely to develop the condition. Those include:

• Family history of PCOS, specifically your mother or sister

While there’s not much you can do to avoid or prevent PCOS, sticking to lifestyle habits like eating a balanced diet and exercising regularly can help. “These help you maintain a healthy weight and reduce the risk of metabolic conditions like insulin resistance, which seem to play a role,” says Dr. Turocy.

PCOS is a syndrome, meaning it's a combination of symptoms. There’s no one single diagnostic test that can confirm if you have it or not. Instead, PCOS is diagnosed using criteria—the most commonly used is known as the Rotterdam Criteria—that lay out the symptoms that need to be present to confirm the condition. PCOS is also a diagnosis of exclusion, meaning that your clinician will also need to exclude other conditions that could cause similar symptoms before confirming a PCOS diagnosis.

To be diagnosed, you must have two of the three markers of PCOS:

• Clinical or biochemical hyperandrogenism. This means either elevated levels of various androgens in bloodwork (including total or free testosterone, DHEAS, and ANSD) or signs of high androgens, or male hormones, like abnormal hair growth.

• Irregular ovulation: Menstrual cycles are irregular (oligo-ovulation) or absent (amenorrhea). In general, this means you have menstrual cycles that are longer than 35 days or you have fewer than 9 cycles per year.

• Polycystic appearing-ovarian morphology: A transvaginal ultrasound shows more follicles than normal; the standard often used is greater than or equal to 20 follicles per ovary.

The Rotterdam Criteria leave a lot up to the interpretation of individual healthcare providers, says Michelle Roach, M.D., an assistant professor of clinical obstetrics and gynecology at Vanderbilt Health in Franklin, TN. (Some medical providers and organizations use different criteria—this is just the most popular.) A diagnosis requires putting all the puzzle pieces together, which can be challenging because no two women with PCOS present in the same way. Many women see specialists for different symptoms, like their gynecologist about their cycles but a dermatologist about their acne, so each clinician is focused on one piece of the puzzle. Taken alone, each symptom could be ascribed to other causes, leaving PCOS potentially unrecognized.

According to one survey, at least one-third of women with PCOS said it took more than two years and three or more healthcare professionals before they were diagnosed. Their main symptoms were difficulty losing weight, irregular menstrual cycles, and infertility—two of which are not even considered as diagnostic criteria despite being common symptoms of PCOS.

Two other factors that contribute to the underdiagnosis of PCOS: A lot of young women get on birth control early in their teens, to clear up acne, for instance, and it can mask irregular periods. “The misconception that everyone with PCOS is overweight or obese make diagnosis difficult,” says Dr. Roach. Anywhere from 10-20% of people with PCOS may be normal weight, and those patients may be missed.

The best treatment for PCOS will depend on what symptoms you’re experiencing, how bothersome they are, and whether or not you’re trying to get pregnant. Usually, treatment requires a holistic approach—not just treating one specific thing but working with your care team to address all aspects of the syndrome. You may need to use several measures to manage your PCOS effectively.

PCOS treatment may include:

• Diet and exercise. There’s no single best diet for PCOS, but “leading an overall healthy lifestyle—including regular physical activity and a balanced diet—is one of the best ways to treat the condition, especially if insulin resistance is a big factor for you,” says Dr. Roach.

• Hormonal birth control. The pill is a go-to treatment for PCOS because it helps regulate the menstrual cycle. Other hormonal birth control methods can work similarly, according to Dr. Roach, including the progestin shot and IUDs. The way your body metabolizes them helps reduce the amount of free male hormones, specifically testosterone, so over time, it can help with symptoms like acne and abnormal hair growth.

• Metformin. Metformin is an FDA-approved drug for type 2 diabetes. It works by improving the body’s ability to use insulin properly. It’s also commonly used off-label to treat PCOS. By helping to lower insulin levels, symptoms of PCOS may improve over time, Dr. Roach says.

• Other type 2 diabetes drugs. Several medications used to treat diabetes are used off-label to regulate insulin and promote weight loss in women with PCOS. These include: SGLT2 inhibitors, DPP-IV inhibitors, and GLP-1 receptor agonists (like semaglutide, a.k.a. Ozempic). Taking off pounds can go far in managing PCOS—even losing 5% to 10% of your body weight can help. This is why some women’s symptoms improve on these drugs. Says Dr. Roach, “As they lose weight, cycles become regular, and acne and abnormal hair growth may improve, too.”

• Anti-androgen medications. A handful of oral medications can treat symptoms associated with high androgen levels, like abnormal hair growth and acne, according to Dr. Turocy. Examples include spironolactone, finasteride, flutamide, and bicalutamide. Research has found a combination treatment of low-dose oral contraceptives and spironolactone is particularly effective at managing symptoms like excess hair growth.

• Fertility medications. If you have PCOS and want to get pregnant, you may benefit from a medication that encourages regular ovulation. Clomiphene and letrozole are the two first-line treatment options for ovulation, helping women ovulate more predictably so they can time intercourse during their fertile window. If these medications alone aren't working, your doctor may consider other fertility drugs or treatments like in-vitro fertilization (IVF), says Dr. Roach.

• Surgery: If you’ve exhausted the above treatment options and still are not ovulating, your healthcare provider may suggest surgery. Known as ovarian drilling, surgery for PCOS is rare but can help reduce the number of active follicles, reduce androgens, and restore normal ovulation for at least a few months, provided the chance to conceive.

There’s no cure for PCOS and the hormonal imbalance of PCOS does not go away, even if your cycles become more regular with treatment or with age, so you’ll need ongoing treatment to manage it.

PCOS increases your risk of certain health complications, which is why it’s essential to get a proper diagnosis and treat the condition. Those complications include:

Infertility

“The hormonal imbalance in PCOS affects ovulation, which can make it difficult to get pregnant,” says Dr. Kashani. Some women with PCOS are not able to ovulate and release an egg, while others ovulate unpredictably, making it difficult to conceive.

“Overall, the outlook for PCOS and pregnancy is quite positive,” says Dr. Turocy. For some women, losing weight can even be enough to regulate their cycle and get pregnant with lifestyle changes alone. For others, medications can promote ovulation. So, as long there’s nothing else negatively impacting your fertility, a lot of women with PCOS will conceive once they get help ovulating. Per Dr. Roach, “While it’s not guaranteed, many women with PCOS go on to conceive without using IVF.”

Metabolic Syndrome

Metabolic syndrome refers to a grouping of conditions that raise your risk of heart disease, stroke, and type 2 diabetes. The hormonal and metabolic problems in PCOS can increase a woman’s risk of metabolic syndrome and subsequently, these other conditions, says Dr. Roach. Some research suggests that 43% of adult women and nearly one-third of adolescents with PCOS have metabolic syndrome. People with PCOS are more likely to be overweight or have obesity and are at an increased lifetime risk of developing type 2 diabetes, hypertension, sleep apnea, high cholesterol, and more.

Uterine (Endometrial) Cancer

When you go long stretches without ovulating, the lining in the uterus (endometrium) doesn’t shed like it’s supposed to. This buildup of tissue can put you at a higher risk of uterine (endometrial) cancer. PCOS aside, women who are overweight also tend to have an increased risk of uterine cancer. Being overweight or having obesity makes you two to four times more likely to get uterine cancer, according to the National Cancer Institute.

Hormonal birth control—whether pills, shots, or an IUD—can help mitigate this cancer risk, because it contains progesterone. This hormone works to keep the uterus lining thin and helps prevent precancerous and cancerous changes, says Dr. Roach.

Managing PCOS properly will benefit your long-term health and help you keep symptoms under control so you can live more comfortably day-to-day. In addition to taking medication if your doctor deems it necessary, you can minimize the condition's impact on your life by adopting a few key habits—moves anyone with or without PCOS can benefit from, TBH. They include:

• Exercising regularly

• Eating a balanced Mediterranean-style diet full of fruits, vegetables, lean protein, and whole grains

• Managing stress using techniques like yoga, meditation, and mindfulness

• Getting adequate sleep

• Avoiding smoking and excessive alcohol consumption

• Scheduling regular medical follow-ups to monitor and manage symptoms

PCOS can be diagnosed at any point in a woman’s reproductive lifetime. That means anytime after puberty is fair game. However, women are typically diagnosed in their 20s and 30s, most commonly when they try to get pregnant and are having trouble, per the OWH.

It’s tricky to get diagnosed as a teenager, when symptoms like irregular periods and acne are super common. The reality is that puberty is a time of huge hormonal changes that can manifest similarly to PCOS. “While irregular periods when you begin menstruating are normal, they should become regular after the first couple of years,” says Dr. Turocy. “If they’re not, it could point to PCOS.”

“PCOS is the most common hormonal disorder in women of reproductive age,” says Dr. Turocy, affecting at least 10% of all women. It’s likely, though, that the condition is under-diagnosed. In fact, according to the World Health Organization, it is estimated that up to 70% of affected women worldwide remain undiagnosed.

PCOS has been linked to an increased risk of pregnancy complications. Per the OWH, pregnant women with PCOS have higher rates of:

• Miscarriage

• Gestational diabetes

• Preeclampsia

• C-section births

However, research suggests that these complications are primarily related to body mass index (BMI) before pregnancy, which is an independent risk factor for most maternal complications., and that most women with PCS have uneventful pregnancies.

If your periods are more than 35 days apart, you skip periods, or you have other symptoms of PCOS like abnormal hair growth, hair loss, acne, or difficulty maintaining a healthy weight, talk with your doctor. You can start with either your primary care provider or your gynecologist, who can order blood work to diagnose you with PCOS. They can also refer you to a specialist in reproductive endocrinology for treatment, especially if you’re hoping to get pregnant. If your periods are irregular, you don’t have to wait a certain time before asking about medical intervention—go ahead and make an appointment with your provider.

Regardless of whether you want to get pregnant, it’s important to treat PCOS to reduce your risk of complications like type 2 diabetes, cardiovascular disease, and uterine cancer. Managing this syndrome will have long-term benefits that future you will be grateful for.

This article was originally published March 7, 2018 and most recently updated July 2, 2024.