What Is Polycystic Ovary Syndrome (PCOS)?

Polycystic ovary syndrome (PCOS), now medically referred to as polyendocrine metabolic ovarian syndrome (PMOS), is a common hormonal condition that affects how the ovaries work. It's estimated to affect about 1 in 8 women of reproductive age. The updated name reflects what doctors have understood for years: PCOS isn't really about ovarian cysts. It's a broader hormonal and metabolic condition that can affect periods, fertility, skin, weight, and long-term health.

If you are experiencing unexplained weight fluctuations, irregular menstrual cycles, or any of the other symptoms listed below, please know that support is available. Consult with an OB-GYN specialist at M Health Fairview to discover effective strategies for managing and treating PCOS.

What Are Polycystic Ovary Syndrome Symptoms? 

Polycystic ovary syndrome symptoms can vary widely from person to person, with some people exhibiting very few symptoms. Common PCOS (PMOS) symptoms include: 

• Irregular, infrequent, or absent periods: One of the most common signs of PCOS is irregular ovulation, which can cause menstrual cycles to occur fewer than eight times a year, more than 35 days apart, or stop altogether. This is often the first symptom people notice and a common reason they seek medical evaluation. 
• Excess androgen (male hormone) symptoms: Elevated androgen levels can lead to acne, excess facial or body hair (hirsutism), or thinning hair on the scalp. These symptoms vary from person to person and may initially be mistaken for unrelated skin or hair concerns. 
• Weight gain or difficulty losing weight: Insulin resistance is another common symptom of polycystic ovary syndrome. It can make it harder to manage weight, even with a consistent diet and exercise. Because many factors can contribute to weight changes, this symptom alone isn't enough to diagnose PCOS. 
• Skin changes: Insulin resistance associated with PCOS can also cause dark, velvety patches of skin (acanthosis nigricans) or skin tags, most commonly around the neck or underarms. While these changes are usually painless, they should be discussed with a healthcare provider during an evaluation. 
• Enlarged ovaries with multiple small follicles: A pelvic ultrasound may reveal enlarged ovaries with multiple small follicles. However, having multiple follicles alone does not necessarily mean someone has PCOS, since this can occur in other conditions as well. 
• Difficulty getting pregnant: Irregular or absent ovulation can make conceiving more challenging without treatment. Since the condition often develops gradually, fertility challenges are sometimes the first sign that leads to a diagnosis. 

What Causes Polycystic Ovary Syndrome?

Unfortunately, there isn’t one single cause of PCOs. Instead, it is likely a combination of genetic and lifestyle factors that affect hormone levels. Common contributing factors include:

• Insulin resistance: Many people with PCOS have cells that don't respond normally to insulin, causing the body to produce more of it. Excess insulin can raise androgen (male hormone) production, which disrupts ovulation.
• Excess androgen production: The ovaries may produce higher-than-typical levels of androgens, which can prevent regular ovulation and lead to symptoms like acne and excess hair growth.
• Low-grade inflammation: Some research links PCOS to inflammation, which may further stimulate androgen production from the ovaries.
• Family history: PCOS tends to run in families, suggesting a genetic component. Your risk may be higher if a parent or sibling has the condition.

Who’s at Risk for Polycystic Ovary Syndrome (PCOS)? 

PCOS is most often diagnosed in people in their 20s and 30s, but it can begin as early as puberty. Risk factors include:

• Family history of PCOS
• Obesity or rapid weight gain
• Type 2 diabetes or prediabetes
• Irregular periods since adolescence 

What are the Types of PCOS? 

PCOS isn't a single, uniform condition. It can present differently from person to person depending on which symptoms and hormone changes are present. 

Healthcare providers often classify PCOS into four phenotypes based on a combination of three key features: irregular ovulation, elevated androgen (male hormone) levels, and polycystic ovaries seen on ultrasound. Identifying your phenotype helps guide treatment and provides insight into your potential metabolic and reproductive health risks.

• Phenotype A (Classic PCOS): Includes all three features: irregular ovulation, elevated androgen levels, and polycystic ovaries. This is the most common presentation and is often associated with the highest risk of insulin resistance, metabolic syndrome, and fertility challenges.
• Phenotype B: Includes irregular ovulation and elevated androgen levels but does not involve polycystic ovaries on ultrasound. People with this phenotype commonly experience irregular periods, acne, excess facial or body hair, or scalp hair thinning despite having normal-appearing ovaries.
• Phenotype C (Ovulatory PCOS): Includes elevated androgen levels and polycystic ovaries, but ovulation remains regular. Although menstrual cycles may be predictable, symptoms such as acne, hirsutism, or hair loss can still occur due to excess androgen production.
• Phenotype D (Non-Hyperandrogenic PCOS): Involves irregular ovulation and polycystic ovaries without elevated androgen levels or noticeable androgen-related symptoms. This phenotype is generally associated with a lower risk of metabolic complications, though it can still affect fertility and menstrual regularity.

It's important to remember that a PCOS phenotype isn't permanent. Hormone levels, ovulation patterns, and symptoms can change over time due to factors such as age, weight changes, pregnancy, or treatment. Your healthcare provider at M Health Fairview may reassess your phenotype as your condition evolves to ensure your treatment plan continues to meet your needs.

How Is Polycystic Ovary Syndrome Diagnosed & Treated? 

There's no single test that can diagnose PCOS. Instead, your healthcare provider will:

• Review your medical history
• Discuss your menstrual cycle and symptoms
• Perform a physical exam
• Order blood tests to evaluate hormone levels
• Screen for conditions with similar symptoms 

A pelvic ultrasound may also be recommended to assess the ovaries and gather additional information before confirming a diagnosis.

Treatment is personalized based on your symptoms, health goals, and whether you're trying to become pregnant. Your care plan may include:

• Lifestyle changes to improve insulin sensitivity and support weight management
• Medications to regulate menstrual cycles or manage hormone-related symptoms
• Treatment for insulin resistance, when appropriate
• Fertility treatments for those trying to conceive

See PCOS treatments and services at M Health Fairview to learn more.

What Are the Benefits of Diagnosis & Treatment? 

Early diagnosis and treatment of PCOS can reduce your chances of experiencing longer-term complications. Treatment can also improve your chances of getting pregnant, though you may face a higher risk of miscarriage, gestational diabetes, or high blood pressure during pregnancy.

Recent research from the Harvard Apple Women's Health Study also links irregular menstrual cycles to broader long-term health risks, including cardiovascular health, which is part of why early diagnosis matters.

Left untreated, PCOS is associated with a higher risk of:

• Obesity
• Type 2 diabetes
• Cardiovascular conditions, including high blood pressure, high cholesterol, and metabolic syndrome
• Infertility
• Diabetes or high blood pressure during pregnancy
• Sleep apnea
• Abnormal uterine bleeding
• Cancer of the uterine lining (endometrium)
• Depression and anxiety
• Non-alcoholic fatty liver disease
• Metabolic syndrome