Could You Have PCOS? Symptoms, Diagnosis and Treatment

PMOS is a lifelong condition that affects your hormones, periods and how your body uses energy.

Women naturally produce hormones called androgens. With PMOS, androgen levels may be higher than usual, or the body may be more sensitive to them. This can affect periods, ovulation, skin and hair growth.

PMOS can disrupt ovulation, which means an egg may not be released regularly. This can cause irregular periods and make it more difficult to become pregnant.

Some women with PMOS have many small follicles on their ovaries. Follicles are fluid-filled sacs that hold immature eggs; they are not the same as ovarian cysts. Not everyone with PMOS has this ovarian appearance.

PMOS does not look the same in everyone. Common symptoms include:

• Irregular, infrequent or missed periods
• Heavy or prolonged menstrual bleeding
• Trouble getting pregnant
• Unwanted hair growth on the face, chest, abdomen or back
• Acne or oily skin
• Thinning hair on the scalp
• Weight gain or difficulty managing weight
• Dark, thickened patches of skin around the neck, groin or underarms
• Skin tags, especially around the neck or underarms

Having one or more of these symptoms does not necessarily mean you have PMOS. Other conditions can cause similar changes, so talk with your doctor if symptoms persist or concern you.

“If you notice changes in your periods, weight gain, changes in skin or hair growth, talk with your doctor,” Dr. Ofir says. “Finding the cause is the first step toward managing your symptoms and protecting your long-term health.”

The exact cause is not known. Genetics, hormonal changes and metabolic factors likely play a role. Your risk may be higher if your mother or sister has the condition.

Insulin resistance is also common. When the body does not respond well to insulin, it produces more insulin to keep blood sugar under control. Higher insulin levels can increase androgen production and disrupt ovulation.

Excess weight can worsen insulin resistance and some symptoms, but PMOS can affect women of any body size.

PMOS may increase the risk of:

• Prediabetes and type 2 diabetes
• High blood pressure and unhealthy cholesterol levels
• Heart disease
• Sleep apnea
• Depression and anxiety
• Thickening of the uterine lining, called endometrial hyperplasia
• Endometrial cancer, although the overall risk remains low

Going long stretches without a period can allow the uterine lining to become too thick. Your doctor may recommend treatment to protect the lining.

Regular health checks are also important. Your doctor may recommend blood sugar and cholesterol checks. How often you need them will depend on your age, health history and previous results.

There is no single test for PMOS. Your doctor will review your symptoms, menstrual history and medical history. You may also have a physical exam and blood tests to rule out other conditions that can cause similar symptoms, including thyroid, pituitary and adrenal disorders.

Blood tests may measure androgen levels, blood sugar, cholesterol and other markers of metabolic health.

In adults, PMOS is generally diagnosed after other possible causes have been ruled out and at least two of the following are present:

• Irregular or absent ovulation, often indicated by irregular or missed periods
• Signs of higher androgen activity, such as unwanted hair growth, or elevated androgen levels on a blood test
• A polycystic ovarian appearance on ultrasound or an elevated anti-Mullerian hormone level

If you have both irregular periods and signs of higher androgen activity, an ultrasound or an anti-Müllerian hormone test may not be needed. Anti-Müllerian hormone testing should not be used by itself to diagnose PMOS.

Diagnosing PMOS in adolescents can be more difficult because irregular periods and acne are common during puberty. After other causes have been ruled out, diagnosis generally requires both persistent menstrual irregularity and signs of higher androgen activity. Ultrasound and anti-Müllerian hormone testing are not recommended for diagnosing PMOS in adolescents.

There is no cure for PMOS, but treatment can help manage symptoms and reduce long-term health risks. Your treatment plan will depend on your symptoms, health and pregnancy goals.

“Some women are looking to conceive and others to improve their general hormonal health,” Dr. Ofir says. “We develop an individualized treatment plan based on each patient’s symptoms, health needs and pregnancy goals.”

Treatment options may include:

• Hormonal birth control to regulate periods and reduce unwanted hair growth or acne
• Periodic progestin to protect the uterine lining when periods are infrequent
• Metformin to help the body respond to insulin and manage blood sugar
• Medications or cosmetic treatments for unwanted hair growth, acne or thinning scalp hair
• Fertility medications to help stimulate ovulation

Healthy habits can help manage some PMOS symptoms and support your long-term health at any body size, even if you do not lose weight.

“Healthy habits can improve how your body responds to insulin even when the number on the scale does not change,” Dr. Ofir says. “Focus on realistic changes that fit your life and that you can maintain over time.”

Helpful steps include:

• Eating balanced meals with vegetables, fruits, whole grains, lean protein and healthy fats
• Getting regular physical activity
• Making consistent, restful sleep a priority
• Tracking your periods and symptoms
• Keeping appointments for blood pressure, blood sugar and cholesterol checks