What Is the Main Cause of PCOS?

Reviewed on 6/22/2021

PCOS (polycystic ovarian syndrome) is a common cause of ovarian cysts and infertility. Its actual cause is unknown, but certain risk factors increase the likelihood of getting PCOS, including having a mother or sister with PCOS, being obese, having an irregular menstrual cycle, and certain reproductive system abnormalities.
PCOS (polycystic ovarian syndrome) is a common cause of ovarian cysts and infertility. Its actual cause is unknown, but certain risk factors increase the likelihood of getting PCOS, including having a mother or sister with PCOS, being obese, having an irregular menstrual cycle, and certain reproductive system abnormalities.

PCOS (polycystic ovarian syndrome) is a disorder caused by an imbalance of reproductive hormones that is a common cause of infertility and cysts in the ovaries. Monthly ovulation does not always occur in women who have PCOS and levels of male hormones (androgens) are elevated. 

The cause of PCOS is unknown but it is believed that genetic and environmental factors play a role in the development of the condition. Risk factors for developing PCOS include: 

  • Genetic factors 
    • Women who have a mother or sister with PCOS are at higher risk
  • Obesity
  • Irregular menstrual cycle
  • Reproductive system abnormalities
    • High levels of male hormones (androgens) 
    • Abnormal levels of the pituitary hormone luteinizing hormone (LH

What Are Symptoms of PCOS?

Symptoms of PCOS (polycystic ovarian syndrome) may include:

  • Irregular menstrual cycle
    • Missed menstrual periods 
    • No menstrual periods
    • Less frequent periods (fewer than eight periods in a year)
    • Unpredictable periods
    • Heavy or prolonged periods
  • Weight gain, obesity, or difficulty losing weight
    • Up to 80% of women with PCOS are obese
  • Multiple small fluid-filled sacs in the ovaries
  • Excess hair growth (hirsutism)
    • Occurs on the face, chin, sideburn area, neck, chest, abdomen, upper arm, inner thighs, or other parts of the body where men tend to grow hair
  • Oily skin 
  • Severe acne or acne that does not respond to usual treatments
  • Infertility/difficulty conceiving 
  • Thinning hair or hair loss on the scalp; male-pattern baldness
  • Darkening of skin (acanthosis nigricans), especially in neck creases, the groin, and underneath the breasts
  • Skin tags
  • Increased risk of heart disease and heart attack
  • Sleep apnea
  • Anxiety 
  • Depression 
  • Problems with sexual function 
  • Eating disorders, such as bulimia and binge eating

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How Is PCOS Diagnosed?

PCOS is diagnosed when other conditions have been ruled out and at least two of the following symptoms occur: 

  • Irregular periods
  • High blood levels of androgens
  • Signs of high levels of androgens such as:
    • Excess male-pattern hair growth (hirsutism)
    • Thinning of scalp hair
    • Acne
  • Multiple cysts on one or both ovaries

In order to rule out other conditions that may cause symptoms similar to PCOS, tests may include:

What Is the Treatment for PCOS?

The goal of treatment for PCOS (polycystic ovarian syndrome) is to manage symptoms; there is no cure for PCOS. Women who have PCOS usually require a combination of treatments, such as:

  • Hormonal birth control, including the pill, patch, shot, vaginal ring, and hormonal intrauterine device (IUD) to regulate the menstrual cycle, reduce acne and excess male-pattern hair growth, and lower the risk of endometrial cancer
  • Anti-androgen medications such as spironolactone to help with acne, excess unwanted hair growth, and scalp hair loss
    • Not approved by the Food and Drug Administration (FDA) to treat PCOS, but may be used off-label
    • May cause problems during pregnancy
  • Metformin (Glucophage) to help lower insulin and androgen levels
    • Not approved by the Food and Drug Administration (FDA) to treat PCOS, but may be used off-label
  • Prescription skin treatments or oral antibiotics to treat acne
  • Eflornithine HCl cream to slow hair growth in unwanted places
  • Infertility medications

Home treatments to help relieve PCOS symptoms include: 

  • Weight loss
    • This is one of the most effective approaches to help manage a number of symptoms of PCOS
  • Regular exercise
  • Hair removal treatments
  • Hair replacement or wigs for scalp hair loss

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Reviewed on 6/22/2021
References
https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome

https://www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics?search=pcos&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2

https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/causes