Patient with Doctor

Polycystic Ovary Syndrome (PCOS)


Meredith Provost, MD, PhD Indiana Fertility Institute

“You’ve got PCOS.”

It’s a commonly heard phrase in fertility offices. But what exactly does it mean?

Polycystic Ovary Syndrome (or PCOS) is the most common endocrine disorder in females, diagnosed in approximately 1 out of every 10 women.

But it’s also one of the most complicated and confusing disorders, as its symptoms and presentation vary significantly between patients, a fact which only serves to muddy the waters when it comes to diagnosis. The disease looks different, for example, in adolescents vs. adults, in thin women vs. obese women, and in women with very irregular periods vs. those with almost normal periods.

For that reason, PCOS is called a “syndrome” which in medical terms is just a group of symptoms that consistently occur together, rather than a “disease” where a single cause of these symptoms is known.

If you’ve been confused about PCOS, you’re not alone – even medical professionals debate what symptoms should be included in order to diagnose a patient with PCOS. Over the past 2 decades and handful of different (but very similar) diagnostic criteria have been offered by well-respected medical organizations.

In order to try and simplify PCOS, let’s take a brief look at some of the main aspects of the disease that nearly everyone DOES agree on! Most physicians agree that to be diagnosed with PCOS, a patient has to have at least 2 of the following:

  • High Testosterone Levels: PCOS patients have higher than average female range testosterone production in their ovaries. This isn’t male range levels, but can result in things like excess hair growth or acne. These testosterone levels affect the bodies normal ovulation process which leads us to our next symptom.
  • Irregular Menstrual Periods: At least 80% of women with PCOS experience irregular or absent periods. Many patients are not ovulating regularly which makes it very difficult to get pregnant! Fortunately, a number of fertility medications can help patients with PCOS to ovulate, but it can be frustrating finding the right dose/medication combination that works. A side note, not regularly having full periods can put you at risk for endometrial cancer down the road, so it is important that patients never go more than 3 months without a full menses.
  • Polycystic Ovaries on Ultrasound: Polycystic ovaries have a very specific appearance on ultrasound. Often they are slightly larger than their non PCO counterparts and tend to have a lot of little follicles.

Underlying the above symptoms is a close relationship between PCOS and insulin resistance, which puts all PCOS patients at a higher risk of developing Type II Diabetes, so it is important that all patients diagnosed with PCOS be screened for diabetes as well as make lifestyle changes to decrease their overall risk.

When not trying to get pregnant, birth control pills can help to regulate the side effects of higher testosterone levels and protect the uterine lining.

If you haven’t seen a physician and have any of the above symptoms, you should contact your Ob/Gyn or see a Reproductive Endocrinologist (REI).