For women of childbearing age, a good relationship with your obstetrician-gynecologist (OB/GYN) is key to understanding the conditions and illnesses you may experience during these years.

Polycystic ovarian syndrome (PCOS) affects 5-10% of women of childbearing age and involves the reproduction system, hormone levels, and metabolic dysfunctions.

With so many questions about PCOS, we asked Sonata Cooper, M.D., an OB-GYN with Hackensack Meridian Health Pascack Valley Medical Center, to answer some of the most common questions about this condition.

What is Polycystic Ovarian Syndrome (PCOS)?

The name is a misnomer, as women commonly think that the only symptom of PCOS is having multiple cysts on their ovaries. In fact, a woman with PCOS may experience irregular cycles that may or may not cause ovulation every month and perhaps elevated male hormones known as androgens. Multiple cysts may appear on the ovaries, but it is the combination of all these symptoms that would give you the diagnosis of PCOS.

What are the causes of PCOS?

We don’t know the exact cause of PCOS, but we do know that it’s a metabolic disorder. Women with this condition tend to have other types of metabolic dysfunction, such as obesity, diabetes, and an increased risk of coronary artery disease. Therefore, if a woman has symptoms of PCOS, it’s essential to be thoroughly evaluated to rule out these other risk factors.  

What is the difference between PCOS and endometriosis?

PCOS is found in women with irregular periods, such as monthly cycles only nine times or less in a year or going 3-4 months at a time without getting a cycle. Women with PCOS will have evidence of these irregular cycles and some evidence of increased male hormones. Evidence of increased male hormones may appear as more hair growth on their upper lip or lower chin or finding multiple cysts or follicles on their ovaries. 

Endometriosis is a condition that causes very painful cycles. These individuals have excruciating cramping (dysmenorrhea), which can last throughout their cycles. It is very common for women with endometriosis to have their cycle every month, unlike PCOS women, who tend to skip months between their cycles.  

Is PCOS hereditary?

We have not yet identified a gene associated with PCOS. However, in clinical practice, we do find that multiple women in the same family tend to have evidence of the syndrome. These mothers and sisters along the same gene line tend to have irregular cycles and evidence of elevated male hormones.

What are the symptoms of PCOS in females?

There are 3 main characteristics of a PCOS diagnosis:

1. A woman has some version of irregular menstrual cycles – either skipping multiple months at a time (amenorrhea), or she has less than 9 menstrual cycles in a calendar year (oligomenorrhea).

2. In addition to their irregular cycles, most women notice that they have excess male hormones. Clinically, the way we define this is seeing that she has excess hair along her upper lip, chin area, increased acne, or even in some cases, male patterned baldness.

3. The last characteristic is detecting multiple follicles along her ovaries, typically seen on transvaginal ultrasound.

Is PCOS a serious problem?

Yes, PCOS is a serious condition that requires evaluation. Women who can go multiple months at a time without a menstrual cycle can cause an increase in the lining of their uterine cavity. Over the years, this can increase the risk of uterine cancer. 

Additionally, women with PCOS have an increased risk of cardiovascular diseases, such as diabetes, coronary artery disease, or hyperlipidemia. This is why they must be evaluated upon diagnosis. Lastly, PCOS can increase the risk of fertility. So, women who want to get pregnant may require medications to assist them in ovulating and increase their chances of pregnancy.  

Can PCOS go away?

Most women notice from the start of their menstrual cycles that they have some evidence of irregular bleeding. Most women, roughly 40 years old, see that their menstrual cycles have become irregular.

In many cases of PCOS, women who are overweight or obese and who lose roughly 5-10 pounds will see improvement in their menstrual cycles. However, there is still an increased risk of cardiovascular disease, so these women must be tested routinely for diabetes and coronary artery disease.   

How is PCOS treated?

The treatment options for PCOS vary and are based on whether or not the woman is actively trying to get pregnant.

For those seeking to get pregnant: These women, as well as those who are not ovulating, may need assistance with medications to help them ovulate and get pregnant. We recommend cyclic progesterone – a medication that improves the protective layer lining inside of the uterus.

For those who are not seeking to be pregnant: For these women, the main treatment is the combination of oral contraceptive pills. The benefit of OCPs is that they help protect the uterine lining and help women experience monthly cycles. In addition, OCPs could have added benefits by decreasing the androgen levels, which cause increased acne or hair growth. Lastly, oral contraceptive pills act as a contraceptive. They protect the woman from unwanted pregnancy.

Does PCOS affect fertility?

Not all women diagnosed with PCOS are infertile. However, there are a large number of women who may need assistance with ovulation. Therefore, it is essential that if you have been trying to get pregnant or may have irregular cycles, you should seek guidance from your gynecologist to talk about your options and ways to increase your chances of pregnancy.