Polycystic Ovary Syndrome (PCOS): Causes, Symptoms and Treatments

As the most common endocrine disorder affecting women of reproductive age, polycystic ovary syndrome (PCOS) touches the lives of 5% to 15% of women globally.¹

Yet, despite its prevalence, women can spend years searching for answers, lost in a maze of seemingly unrelated symptoms. PCOS presents a range of challenges, from the frustration of irregular periods and the emotional strain of unexplained weight gain to the heartbreak of fertility struggles. Fortunately, both PCOS and related infertility concerns are highly treatable.¹

This guide offers an overview of PCOS, including its causes, symptoms, potential long-term effects and available treatment options.

What Is PCOS?

PCOS is a complex hormonal disorder that affects millions of women each year. As the name suggests, it typically (but not always) involves the formation of multiple ovarian cysts (fluid-filled sacs). Arising from an imbalance in hormones, this syndrome disrupts normal ovulation and can lead to weight gain, metabolic disorders and infertility.¹

Diagnosis

To be diagnosed with PCOS, you should meet at least two of the following criteria:¹

1. Signs or symptoms of elevated androgens, such as excessive facial or body hair, hair thinning or loss on the scalp, acne or high testosterone levels in the blood — after ruling out other potential causes
2. Irregular or absent menstrual cycles — once other underlying causes have been excluded
3. The presence of polycystic ovaries on ultrasound

Understanding Potential Causes of PCOS

The exact cause of PCOS remains a mystery, but research points to a combination of genetic, hormonal and environmental factors like these:²

Genetic predisposition

Studies suggest that PCOS runs in families. So, if your mother or sister has PCOS, your chances of developing it may be higher. While no gene or trait has been definitively identified, researchers are looking into several genes linked to insulin regulation, androgen production and ovarian function that may contribute to the condition across generations.²

Insulin resistance (prediabetes)

Insulin resistance (IR) may contribute to having PCOS as it co-occurs in between 35% and 80% of cases. With IR, your body’s cells become less responsive to insulin, which forces the pancreas to produce higher levels of insulin.³

High insulin levels can stimulate the ovaries to produce excess androgens.¹ This can disrupt normal ovulation and worsen symptoms like weight gain, acne and abnormal hair growth.² Insulin resistance also increases the likelihood of developing type 2 diabetes and metabolic syndrome in women with PCOS.³

Hormonal imbalances

Scientists are still unsure about the exact causes of hormone imbalances leading to PCOS and its symptoms. However, they have determined that variations in certain hormones influence each other in the following ways:³

Metabolic dysfunction (diabetes, insulin resistance)

• Elevated insulin levels
• Increased hunger hormone (ghrelin)
• Leptin resistance
• Reduced growth hormone¹

Infertility

• Decreased growth hormone¹
• Elevated luteinizing hormone (LH)¹
• Higher levels of male hormones (androgens)²
• Reduced estrogen²
• Unbalanced LH and follicle-stimulating hormone (FSH)¹

Lifestyle and environmental factors

While PCOS is not caused by lifestyle choices alone, some habits and exposures may exacerbate its symptoms, worsen insulin resistance and increase hormonal imbalances. This can include:⁴

• Altered gut microbiome. Imbalances in gut microbiota may contribute to metabolic and inflammatory features of PCOS.
• Diet. Poor-quality diets, including those high in processed foods and sugars, are linked to metabolic dysfunction in PCOS.
• Endocrine-disrupting chemicals (EDCs). Exposure to chemicals that interfere with hormonal balance (e.g., PFAS, phthalates) is linked to the development and worsening of PCOS.
• Genetic and growth patterns. Environmental exposures during fetal development, including maternal diet and stress, may predispose individuals to PCOS through epigenetic changes.
• Obesity. While not all individuals with PCOS are obese, excess weight exacerbates symptoms and metabolic dysfunction in many cases.
• Physical inactivity. Sedentary lifestyles contribute to insulin resistance, obesity and other metabolic features associated with PCOS.
• Stress. Chronic stress may influence hormonal imbalances and exacerbate symptoms of PCOS.

Recognizing Early Signs of PCOS

A missed period can be an exciting milestone when you're trying to conceive. But what if that missed period points to something other than pregnancy? For individuals with PCOS, this hope is often clouded by uncertainty. PCOS disrupts ovulation, commonly causing irregular or absent menstrual cycles, which can make conception challenging.¹

Normal menstrual cycle vs. PCOS menstrual cycle

Understanding the differences between a typical reproductive cycle and one affected by PCOS can help you recognize changes earlier and take proactive steps toward your goals.

Common PCOS Symptoms

Subtle symptoms can go unnoticed, leading to delays in diagnosis and treatment. To catch PCOS early, look for clusters of co-occurring symptoms. PCOS can develop as early as a woman's first period but may also appear later in life.⁴

Symptoms can vary widely from person to person. Some individuals experience mild or no symptoms and may only discover they have PCOS when facing difficulties with pregnancy. Others may experience more pronounced and severe symptoms:⁶

• Acne can occur from hormonal imbalances and may become persistent or severe.¹
• Darkened skin patches (acanthosis nigricans) often appear on the neck, armpits or under the breasts.
• Excess hair (hirsutism) can grow on the face, chest or back due to higher levels of androgens.
• Infertility is a hallmark symptom of PCOS due to irregular ovulation.
• Insulin resistance is a common feature of PCOS and can lead to an increased chance of type 2 diabetes.¹
• Irregular or missed periods are caused by a lack of ovulation.
• Skin tags may develop or increase in number due to insulin resistance or diabetes.
• Thinning hair or hair loss may resemble male-pattern baldness due to increased male hormones.
• Weight gain, especially around the abdomen, is common in many women with PCOS. It may lead to difficulty managing weight.

Managing the Long-Term Effects of PCOS

PCOS is more than just a reproductive health condition. There can also be long-term health consequences like these:

Long-term metabolic disorders

Women with PCOS are more likely to develop diabetes compared to those without the condition. Additionally, PCOS can lead to metabolic syndrome, a cluster of conditions that includes high blood pressure, high cholesterol and abdominal obesity. These factors significantly increase the likelihood of heart disease and stroke.⁷

Endometrial cancer

Irregular or missed periods caused by PCOS can lead to a buildup of the uterine lining (endometrium). Over time, this increases the chance of developing endometrial hyperplasia and, in some cases, endometrial cancer. Women with PCOS are more likely to develop endometrial cancer compared to those without the condition.⁸

Mental health impacts

Polycystic ovary syndrome is not only a physical health condition but can also significantly impact mental health. If you have PCOS, you have a higher chance of developing depression, anxiety and eating disorders, which can negatively impact your quality of life. The hormonal imbalances associated with PCOS may also contribute to mood changes. If you’re struggling with the emotional effects of PCOS, seeking support from a mental health professional or joining a support group can be a vital step toward healing.⁹

Diagnostic Challenges of PCOS

Diagnosing PCOS can be challenging due to its overlap with symptoms of other common conditions and the absence of a single definitive test. For instance, thyroid disorders may cause irregular periods, weight gain and fatigue.¹⁰ Meanwhile, elevated cortisol levels can result in excess hair growth and acne — symptoms that closely resemble those of PCOS.¹¹

To establish a diagnosis, healthcare providers rely on a comprehensive approach that includes a detailed medical history, physical examinations, blood tests and imaging studies. Blood tests often assess hormone levels, such as luteinizing hormone and follicle-stimulating hormone, which can offer valuable insights into the condition.⁶

Treating Polycystic Ovaries

Managing PCOS requires a personalized approach designed to address your specific symptoms and align with your health goals, such as achieving pregnancy or losing weight. Here’s an overview of how treatment usually works:

If you want to become pregnant

If you’re trying to get pregnant, the focus of treatment for PCOS will be on improving ovulation. Lifestyle changes, such as losing weight through a healthy diet and regular exercise, can make a big difference.⁶

Your doctor may also prescribe medications like clomiphene or letrozole to stimulate ovulation. In more complex cases, assisted reproductive technologies like in vitro fertilization (IVF) may be an option.¹

If you don't want to become pregnant

If pregnancy isn’t a goal, PCOS treatment focuses on managing symptoms and preventing complications. Birth control pills are often the first line of treatment because they regulate periods, reduce androgen levels and improve acne.⁶

Anti-androgen medications can help with excess hair growth, while metformin, a medication for diabetes, can improve insulin sensitivity and regulate menstrual cycles.¹

Living With PCOS

Living with PCOS can feel isolating at times, but it’s important to remember that you are not alone — millions of women share your experiences.¹ If you’re feeling overwhelmed by your diagnosis or struggling with symptoms that affect your daily life, don’t hesitate to reach out for support from a healthcare professional who understands the physical and emotional challenges of this condition.

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Author Bio

Pamela Cagle, R.N., has extensive experience in a range of clinical settings, including ER, surgical and cardiovascular. For the past decade, she has leveraged her nursing experience in writing for health and technology publications such as AARP, VKTR, National Council on Aging and others. She is passionate about blending her medical and storytelling expertise to bring authenticity to health and wellness topics.