What Is Polycystic Ovary Syndrome or PCOS?

Polycystic ovary syndrome or PCOS impacts 10 to 15% of women yet many patients don’t get a diagnosis until their 30s. Recognizing the signs and risk factors associated with PCOS may help patients get care earlier leading to positive health outcomes later in life.

PCOS is a disorder of increased androgen production which can lead to irregular periods and insulin resistance. Despite its name, PCOS does not refer to ovarian cysts, which are cysts that can grow in or on an ovary. Instead, those with PCOS tend to have ovaries with many follicles, which are completely normal in younger patients.

It’s not known what causes PCOS, but it may be linked to a combination of environmental factors and genetics. Therefore, those with a family history of PCOS or diabetes may be at increased risk. Left untreated it can lead to obesity, hypertension, infertility, depression, anxiety and endometrial hyperplasia, a condition where the lining of the uterus thickens abnormally which can lead to cancer.

What are the symptoms of PCOS?

The biggest red flag for PCOS is a combination of symptoms. These can include:

• Irregular or missed periods
• Cystic inflammatory acne
• Increased facial and body hair
• Struggles with weight gain

 “Some of the symptoms of PCOS are also normal symptoms of adolescence. It’s very common to have irregular periods for the first three to five years after you start having periods; however, going more than 90 days between periods is considered abnormal and warrants evaluation by a specialist,” said Anne Smith, MD, pediatric gynecologist with the Yale New Haven Children’s Hospital Adolescent Gynecology and Endocrinology Program (AGE-P) and assistant professor of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine. 

Because of this, patients cannot get an official diagnosis until eight years after they first get their period. However, the AGE-P is unique in that adolescent patients who experience symptoms can still be evaluated to determine whether they are considered “at risk” for PCOS.

Patients are then treated for their symptoms by a multidisciplinary team that includes a focus on both gynecologic and endocrine care. For example, those with irregular periods may benefit from a hormonal medication that includes progesterone and estrogen. Others may benefit from a medication called Metformin to help reduce insulin resistance.

Weight loss with PCOS

One treatment that is helpful for all patients regardless of their age or symptoms is regular exercise and a healthy diet. Studies show in patients who are overweight, losing five to 10% of their body weight can regulate periods and decrease unwanted hair growth and acne.

“I cannot emphasize enough that lifestyle modifications are of the upmost importance in this process and the treatment of PCOS,” said Alla Vash-Margita, MD, pediatric gynecologist with AGE-P and associate professor in the department of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine. “PCOS or being at risk for PCOS doesn’t just start when a woman tries to have a family and has difficulties. It starts much earlier in life, usually, after menarche (first period) or even before and there are ways and means to prevent consequences.”

There are no “quick fixes” and making a lifestyle change is something that will be important throughout a patient’s life. However, Dr. Smith and Dr. Vash-Margita emphasize that it is possible to manage signs and symptoms and they hope increased awareness will encourage patients to speak up if they have issues with their periods.

Learn more about the Yale New Haven Children’s Hospital Adolescent Gynecology and Endocrinology Program (AGE-P).