Polycystic ovary syndrome (PCOS) affects women and is a complex of symptoms that are not necessarily all present in all cases. Some, but not all, affected women have multiple cysts on the ovaries (polycystic ovaries). Other characteristics include the absence of menstruation (amenorrhea) or irregular menstruation, failure of the ovary to release eggs (anovulation), elevated levels of the male hormones known as androgens (hyperandrogenism), excessive amounts of body hair (hirsutism), a high rate of miscarriage, and infertility. Three criteria often used for a diagnosis are menstrual irregularity, hyperandrogenism, and exclusion of other disease. There is some evidence that PCOS is an inherited condition.

Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience at least two of these signs:

• Irregular periods. Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods.
• Excess androgen. Elevated levels of male hormones may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.
• Polycystic ovaries. Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.

PCOS signs and symptoms are typically more severe if you're obese.

The exact cause of PCOS isn't known. Factors that might play a role include:

• Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar, your body's primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels can rise and your body might produce more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation.
• Low-grade inflammation. This term is used to describe white blood cells' production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems.
• Heredity. Research suggests that certain genes might be linked to PCOS.
• Excess androgen. The ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne.

PCOS treatment focuses on managing your individual concerns, such as infertility, hirsutism, acne or obesity. Specific treatment might involve lifestyle changes or medication.

Lifestyle changes

Your doctor may recommend weight loss through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight — for example, losing 5 percent of your body weight — might improve your condition. Losing weight may also increase the effectiveness of medications your doctor recommends for PCOS, and can help with infertility.

Medications

To regulate your menstrual cycle, your doctor might recommend:

• Combination birth control pills. Pills that contain estrogen and progestin decrease androgen production and regulate estrogen. Regulating your hormones can lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Instead of pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin.
• Progestin therapy. Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy doesn't improve androgen levels and won't prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.

To help you ovulate, your doctor might recommend:

• Clomiphene. This oral anti-estrogen medication is taken during the first part of your menstrual cycle.
• Letrozole (Femara). This breast cancer treatment can work to stimulate the ovaries.
• Metformin. This oral medication for type 2 diabetes improves insulin resistance and lowers insulin levels. If you don't become pregnant using clomiphene, your doctor might recommend adding metformin. If you have prediabetes, metformin can also slow the progression to type 2 diabetes and help with weight loss.
• Gonadotropins. These hormone medications are given by injection.

To reduce excessive hair growth, your doctor might recommend:

• Birth control pills. These pills decrease androgen production that can cause excessive hair growth.
• Spironolactone (Aldactone). This medication blocks the effects of androgen on the skin. Spironolactone can cause birth defects, so effective contraception is required while taking this medication. It isn't recommended if you're pregnant or planning to become pregnant.
• Eflornithine (Vaniqa). This cream can slow facial hair growth in women.
• Electrolysis. A tiny needle is inserted into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle. You might need multiple treatments.

Women with PCOS are at a higher risk for a number of illnesses, including high blood pressure, diabetes, heart disease , and cancer of the uterus(endometrial cancer).

• Because of the menstrual and hormonal irregularities, infertility is common in women with PCOS. Because of the lack of ovulation, progesterone secretion in women with PCOS is diminished, leading to long-term unopposed estrogen stimulation of the uterine lining. This situation can lead to abnormal periods, breakthrough bleeding, or prolonged uterine bleeding.
• Unopposed estrogen stimulation of the uterus is also a risk factor for the development of endometrial hyperplasia and cancer of the endometrium (uterine lining). However, medications can be given to induce regular periods and reduce the estrogenic stimulation of the endometrium (see below).
• Obesity is associated with PCOS. Obesity not only compounds the problem of insulin resistance and type 2 diabetes (see below), but also imparts cardiovascular risks. PCOS and obesity are associated with a higher risk of developing metabolic syndrome , a group of symptoms, including high blood pressure, that increase the chances of developing cardiovascular disease. It has also been shown that levels of C-reactive protein (CRP), a biochemical marker that can predict the risk of developing cardiovascular disease, are elevated in women with PCOS. Reducing the medical risks from PCOS-associated obesity is important.
• The risk of developing prediabetes and type 2 diabetes is increased in women with PCOS, particularly if they have a family history of diabetes. Obesity and insulin resistance, both associated with PCOS, are significant risk factor for the development of type 2 diabetes. Several studies have shown that women with PCOS have abnormal levels of LDL ("bad") cholesterol and lowered levels of HDL ("good") cholesterol in the blood. Elevated levels of blood triglycerides have also been described in women with PCOS.
• Changes in skin pigmentation can also occur with PCOS. Acanthosis nigricans refers to the presence of velvety, brown to pigmentation often seen on the neck, under the arms, or in the groin. This condition is associated with obesity and insulin resistance and occurs in some women with PCOS.