Polycystic Ovary Syndrome (PCOS) is a hormonal imbalance that can cause irregular menses (periods), unwanted hair growth and acne. The hormone (chemical messenger) imbalance is in the communication between the brain and ovaries, either from increased luteinizing hormone (from the brain) or increased insulin (from the pancreas). These messengers then communicate to the ovaries and lead them to make extra testosterone, as well as other hormones like estrogen and progesterone.
While all genetic females produce some testosterone, those with PCOS have slightly higher than normal levels. These hormonal changes can lead to the ovaries not ovulating (releasing an egg) regularly each month, which then leads to changes in periods. Additionally, increased testosterone levels may contribute to acne and excessive body hair. The condition is named after the appearance of “polycystic ovaries” which can sometimes be found in adolescents or adults with PCOS. These are not harmful and don’t need to be removed.
PCOS is found in 5-10% of those who menstruate and affect individuals of all races and ethnicities. It is the most common cause of irregular menstrual cycles. The exact cause of PCOS is not fully understood, but genetics/having a family history of PCOS can play a role.
Signs and Symptoms of PCOS
Irregular menstrual cycles: no periods, infrequent periods or excessive uterine bleeding
Excessive hair growth on the face, chin or areas where men typically have hair
Obesity, easily gaining weight or difficulty losing excess weight
Darkening of the skin along neck creases, groin or underneath breasts
Diagnosis and Treatment
Diagnosing PCOS involves a healthcare provider evaluating adolescents with abnormal periods, acne and/or excessive hair growth. This may include a physical examination, questioning and lab tests to assess hormone levels. In some cases, an ultrasound is performed to examine the ovaries.
PCOS cannot be cured, but it can be managed effectively. Treatment goals for PCOS focus on managing menstrual cycles, addressing symptoms like acne and excessive hair growth and reducing associated health risks. Maintaining a healthy weight by eating balanced meals and exercising regularly is crucial, as it helps regulate insulin and testosterone levels. Those with PCOS (just like all adolescents!) should aim for at least 30 minutes of physical activity a day and should eat healthy, balanced meals.
Birth control pills or other hormonal medications are commonly prescribed to help manage irregular menstrual bleeding, unwanted hair growth and to lower testosterone levels. Hair removal methods such as shaving, waxing or laser treatments can be used to manage excess hair growth.
Complications and Long-Term Care
Without proper treatment, PCOS can lead to complications like uterine cancer. Other disorders are associated with PCOS include type 2 diabetes, obstructive sleep apnea, fatty liver disease, depression, high blood pressure and heart disease, so it is important your health care providers know about your PCOS diagnosis, as they may increase how often you are screened for these conditions.
Individuals with PCOS may experience difficulties getting pregnant and it may take longer or require assistance to become pregnant due to not ovulating regularly. Not everyone with PCOS will have trouble conceiving, so birth control should still be used if they are having sex and they do not want to become pregnant.
Timely intervention is essential, as early diagnosis and management can reduce long-term risks associated with PCOS. Having a healthy lifestyle also plays a significant role in controlling symptoms once treatment is initiated.
Chelsea Kebodeaux, MD is a member of the Pediatric and Adolescent Gynecology physician team as well as the Fertility and Reproductive Health Program physician team at Nationwide Children's Hospital.
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