Polycystic Ovary Syndrome and Hormonal Disorders
Polycystic ovary syndrome (PCOS) is one of the most common causes of irregular periods and excess hair. This page explains what the symptoms are, what the doctor checks, what treatment generally looks like, and which other hormonal disorders look similar.
What is PCOS?
The NHS writes that PCOS is a hormonal condition that can affect hair growth, periods, fertility and mood. On its current page the NHS uses the name PMOS (polyendocrine metabolic ovarian syndrome) for this condition and writes that it was previously called PCOS. Because everyone in Iran knows it as PCOS, we use that name here too.
The Endocrine Society writes that about 7 to 10 percent of women of childbearing age have it and that it is the most common cause of infertility. Its exact cause is not known and differs from person to person. Insulin and testosterone may not work well. The risk is higher in some families. The NHS writes that the risk is also higher in people of Asian background.
Symptoms
The NHS and the Endocrine Society list these:
- Irregular periods or long gaps between them
- Excess hair on the face and body, or scalp hair loss
- Acne and oily skin
- Being overweight or having difficulty losing weight (but not everyone becomes obese)
- Difficulty getting pregnant
- Depression or anxiety, tiredness
- Thick dark patches on the neck or under the arms (a sign of insulin resistance)
Symptoms range from mild to severe and sometimes are not noticeable at all. Many of these symptoms also have other causes.
Who should be seen?
The NHS says to make an appointment if you think you have PCOS or if the symptoms disrupt your life, work and relationships. A few other situations also need checking:
- Milk from the breast without pregnancy. The Endocrine Society writes that raised prolactin, which may be caused by a benign pituitary tumor, produces this sign and irregular periods.
- Concern about fertility or a pregnancy plan.
How is it assessed?
The Endocrine Society lists these: a review of symptoms and history, an examination, blood tests for hormones including testosterone, and an ovarian ultrasound. Sometimes a glucose tolerance test and mental health screening are also needed. The NHS says an ovarian ultrasound is only for people over 18 and that a referral to a gynecologist or endocrinologist may be made.
Before PCOS is diagnosed, other things must be ruled out: thyroid disease, high prolactin and non-classic congenital adrenal hyperplasia. That means thyroid and prolactin tests are sometimes part of this same assessment.
What does treatment generally look like?
None of the sources promises a permanent cure. The NHS and the Endocrine Society write this: lifestyle change is the core of management, meaning balanced eating, regular activity and, if overweight, weight loss. Alongside that, a medicine is chosen for each symptom:
- Irregular periods: a combined pill, a progestogen pill, or a hormonal intrauterine device.
- Excess hair: spironolactone or eflornithine, and non-drug methods such as shaving, waxing, laser and electrolysis.
- Acne: a cream or pills.
- Tiredness and weight: metformin, and weight-loss medicines if overweight.
- Fertility: clomiphene and, if that does not work, ovarian drilling surgery by laparoscopy.
- Mood: the NHS suggests talking therapy for depression and anxiety.
We list medicine names only so you can recognize them. The choice and the schedule are up to the doctor.
Long-term effects
The NHS writes that PCOS raises the risk of type 2 diabetes, high blood pressure, heart disease, fatty liver and cancer of the uterine lining. The Endocrine Society adds sleep apnea. Regular monitoring of these lowers the risk. The NHS writes that periodic checkups help. Ask the doctor how often to check your diabetes, blood pressure and blood lipids.
Pregnancy
The Endocrine Society writes that women with PCOS, especially those who are overweight, more often have gestational diabetes, preterm birth and preeclampsia. If you plan to get pregnant, talk to the doctor before trying.
When to get urgent help
PCOS is not an emergency by itself. But if you also have diabetes and high blood sugar comes with severe thirst, vomiting, fast breathing or confusion, call 115 (Iran’s emergency number; not valid abroad). See the full list in the guide “When should I call right away?”
Frequently asked questions
Does a cyst on the ovary mean cancer?
No. The Endocrine Society writes that on a PCOS ultrasound the ovaries look enlarged and full of small follicles, and these follicles are benign. "Polycystic" is a harmless name for how the ovary looks, not a sign of a tumor.
Does PCOS go away?
The NHS and the Endocrine Society both write that there is no way to make it go away permanently, but the symptoms can be controlled with treatment and lifestyle changes. The NHS says symptoms usually start at puberty and last until menopause, but in some people they change or stop after menopause. We do not promise that it will disappear completely.
Can I get pregnant with PCOS?
The NHS writes that PCOS usually makes fertility harder because the ovaries do not release an egg every month, but treatments improve the chances. The Endocrine Society says that if lifestyle changes are not enough, ovulation-stimulating medicines help. In pregnancy the risk of gestational diabetes, preterm birth and preeclampsia is higher, so discuss pregnancy with the doctor early.
Do I have to lose weight?
The Endocrine Society writes that not everyone with PCOS becomes obese, and people of normal weight can have it too. The NHS writes that if you are overweight, losing weight, balanced eating and activity help. The goal is health. There is no place for blame.
Do irregular periods or excess hair always mean PCOS?
No. The Endocrine Society says that before PCOS is diagnosed, conditions that look similar must be ruled out: thyroid disease, high prolactin, and a type of adrenal condition called non-classic congenital adrenal hyperplasia. The NHS also writes that an underactive thyroid can make periods irregular or heavy.
Is an ovarian ultrasound always needed?
The NHS writes that blood tests for hormones and insulin resistance are done, and an ovarian ultrasound is only for people over 18. The decision about which tests are needed is up to the doctor.