Polycystic ovary syndrome (PCOS) is among the most common endocrine disorders affecting women of reproductive age. According to the American College of Obstetricians and Gynecologists (ACOG), PCOS may affect up to 10% of reproductive-aged women in the United States, though prevalence estimates can vary depending on the diagnostic criteria used. The Androgen Excess and PCOS Society, a leading global organization dedicated to research and care in PCOS, underscores the complexity of the condition, not just as a reproductive disorder, but as a metabolic one too.
In this article, we’ll explore:
- The basics of PCOS, including its typical symptoms and diagnostic criteria
- Initial treatments that protect health and prevent complications
- Long-term lifestyle interventions and medication options
- Why having regular periods is critical
- How PCOS may affect future fertility, and options that can help
What is PCOS?
PCOS is a hormonal disorder defined by excess androgen (male-type hormones), irregular or absent ovulation, and polycystic-appearing ovaries on ultrasound. Women with PCOS often have menstrual irregularities, acne, excess hair growth (hirsutism), and sometimes, difficulties with weight management.
Although PCOS gets its name from the presence of “polycystic ovaries,” the ovarian appearance alone is not required for diagnosis. Instead, PCOS is recognized as a spectrum, and women may present with different combinations of signs and symptoms.
Common Symptoms
Women with PCOS may notice:
- Irregular menstrual cycles: Infrequent, unpredictable, or absent periods
- Excess hair growth: Especially on the face, chin, chest, or abdomen (hirsutism)
- Acne and oily skin
- Hair thinning or male-pattern scalp hair loss
- Weight gain or difficulty losing weight
- Darkening of the skin in areas like the neck folds, armpits, or groin (acanthosis nigricans)
- Mood changes or symptoms of anxiety and depression
It’s important to remember that not all women with PCOS will have every symptom, and severity can vary widely.
How is PCOS Diagnosed?
The two most commonly used diagnostic frameworks come from:
- The Rotterdam Criteria (2003)
- The Androgen Excess and PCOS Society guidelines (2006)
According to the Rotterdam Criteria, a diagnosis requires two out of three of the following:
- Irregular or absent ovulation (manifesting as irregular periods)
- Signs of excess androgens (either clinical, such as hirsutism or acne, or biochemical, such as elevated testosterone on blood testing)
- Polycystic-appearing ovaries on ultrasound (typically, ≥12 small follicles per ovary or increased ovarian volume)
The Androgen Excess and PCOS Society emphasizes hyperandrogenism as a required feature, alongside either ovulatory dysfunction or polycystic ovaries.
Before making a diagnosis, it’s critical to rule out other potential causes of irregular periods or excess androgens, such as:
- Thyroid disorders
- Elevated prolactin levels
- Congenital adrenal hyperplasia
- Androgen-secreting tumors
Why Treatment is Important
PCOS is not just about menstrual irregularities or unwanted hair growth—it also carries long-term health implications:
- Increased risk for type 2 diabetes and insulin resistance
- Higher risk for endometrial hyperplasia and endometrial cancer due to unopposed estrogen if periods are infrequent
- Potential increased risk for high cholesterol, hypertension, and possibly cardiovascular disease
Timely treatment can help manage symptoms, prevent complications, and improve quality of life.
Initial Interventions: Protecting Health and Managing Symptoms
For women who are not trying to conceive, the first-line treatment recommended by ACOG and the Androgen Excess and PCOS Society typically involves hormonal contraception:
- Combined oral contraceptive pills (OCPs)
- The contraceptive patch
- The vaginal ring
These treatments:
- Regulate menstrual cycles: Induce regular shedding of the uterine lining, reducing the risk of endometrial hyperplasia and cancer
- Lower androgen levels: Reduce new hair growth and improve acne
- Provide contraception: Prevent unplanned pregnancy if desired
Hormonal contraception is often combined with anti-androgenic agents (such as spironolactone) if hirsutism remains bothersome after at least six months.
Importantly, all women with PCOS should aim to have a period at least every 90 days. If hormonal contraception is not an option or is declined, a healthcare provider may prescribe cyclical progestin (for example, medroxyprogesterone acetate or micronized progesterone) every few months to induce a withdrawal bleed and protect the uterine lining.
Long-Term Interventions: Diet and Exercise
Lifestyle changes are central to the long-term management of PCOS, regardless of body size.
Weight management
For women with overweight or obesity, even modest weight loss of 5–10% of body weight can:
- Restore ovulation and improve menstrual regularity
- Lower androgen levels, reducing acne and hirsutism
- Improve insulin sensitivity and reduce diabetes risk
Balanced nutrition
No single “PCOS diet” fits everyone, but evidence supports:
- Reducing refined carbohydrates and sugary foods to lower insulin spikes
- Focusing on whole grains, lean proteins, healthy fats, fruits, and vegetables
- Considering the Mediterranean diet, which may help reduce inflammation
Physical activity
Regular exercise (at least 150 minutes of moderate-intensity activity per week) helps:
- Improve insulin sensitivity
- Support weight management
- Improve mood and reduce anxiety and depression, which are more common in women with PCOS
It’s important that lifestyle changes are sustainable and individualized—rigid diets or extreme exercise regimens are generally discouraged.
The Role of Metformin
Metformin, an insulin-sensitizing medication, is sometimes prescribed for women with PCOS, particularly if:
- They have impaired glucose tolerance or type 2 diabetes
- They are not candidates for hormonal contraception
- They are seeking help to restore regular ovulation
Metformin can:
- Improve insulin sensitivity
- Modestly lower androgen levels
- Help restore more regular menstrual cycles in some women
However, metformin is less effective than combined hormonal contraception in reducing hirsutism and acne, and it is not a first-line treatment solely for these symptoms.
Fertility Considerations
One of the most common concerns women with PCOS raise is: “Will I be able to get pregnant?”
The good news is that many women with PCOS can conceive—sometimes naturally, sometimes with help.
If ovulation is irregular or absent, several effective options can induce ovulation, including:
- Letrozole (Femara): Now often considered first-line for ovulation induction
- Clomiphene citrate (Clomid): An older, still effective option
- Metformin: Sometimes used as an adjunct, especially in women with insulin resistance
- Gonadotropins (injectable hormones): Used under specialist care if first-line treatments are unsuccessful
- In vitro fertilization (IVF): For women who don’t respond to other treatments or have additional fertility factors
Many women with PCOS also benefit from lifestyle changes—even modest weight loss can improve ovulation rates.
Living Well with PCOS
PCOS is a lifelong condition, but early recognition, education, and a comprehensive treatment plan can make a significant difference.
Key takeaways:
- PCOS is diagnosed based on a combination of irregular periods, excess androgens, and sometimes polycystic ovaries
- Hormonal contraception protects the uterine lining, regulates cycles, and improves acne and hirsutism
- Lifestyle interventions—balanced nutrition, regular exercise, and healthy weight management—are essential for long-term health
- Metformin may help some women, especially those with insulin resistance
- It’s critical to have a period at least every 90 days; if not, speak to an OB/GYN about medication to protect the uterus
- While PCOS can cause fertility challenges, many women go on to have healthy pregnancies—with or without medical help
Final Thoughts
Living with PCOS can feel overwhelming, but support and individualized care make a huge difference. If you suspect you have PCOS or have been diagnosed, consider talking to your OB/GYN or an endocrinologist to create a care plan tailored to your goals—whether that’s clearer skin, regular periods, long-term health protection, or building a family.
For more evidence-based information, explore resources from:
- The American College of Obstetricians and Gynecologists (ACOG): acog.org
- The Androgen Excess and PCOS Society: androgen excess.org
Together, education and partnership with your healthcare team can help you manage PCOS and live your healthiest life.
If you’d like, I can also format this into a Word or PDF file, or add references to key ACOG and Androgen Excess Society statements. Let me know!
El Camino Women’s Medical Group offers the latest Minimally Invasive Solutions for gynecologic problems. Drs. Amy Teng, Erika Balassiano, Pooja Gupta, and Vivian Wan, all members of AAGL (American Association of Gynecologic Laparoscopy), are highly trained and experienced in the field of Minimally Invasive Gynecologic Surgery. Dr. Erika Balassiano has also completed a Minimally Invasive Gynecologic Surgery Fellowship under the supervision of world-renowned Dr. Camran Nezhat. Angel Wong, PA-C, is a physician assistant who sees patients for routine and lower-acuity care.
All of our physicians are El Camino Hospital doctors and operate and deliver at the Mountain View campus.
As part of El Camino Women’s Medical Group’s commitment to comprehensive care for women, we offer in-network mental health services with world-renowned psychiatrist Dr. Rania Awaad and experienced therapist Daniya Ahmed, LMFT. For women seeking to improve their health through a healthier diet, Mariam AlAgha, MS, is an excellent nutritionist with over a decade of success helping women achieve their health goals. Her services are also in network.
Serving Mountain View, Los Altos, Los Altos Hills, Atherton, Palo Alto, Redwood City, Burlingame, Saratoga, Cupertino, Sunnyvale, Los Gatos, Campbell, San Jose, Santa Clara, Silicon Valley, Milpitas, Fremont, South Bay, East Bay, and North Bay.