Review
Polycystic ovary syndrome (PCOS) is a common hormonal condition that affects women of reproductive age. It usually starts during adolescence, but symptoms can vary over time.
PCOS can cause hormonal imbalances, irregular periods, excessive androgen levels, and ovarian cysts. Irregular periods, usually with no ovulation, can make pregnancy difficult. PCOS is the leading cause of infertility.
PCOS is a chronic condition and cannot be cured. However, some symptoms can be improved with lifestyle changes, medication and fertility treatments.
The cause of PCOS is unknown, but women with a family history or type 2 diabetes are at higher risk.
Scope of the problem
PCOS is a significant public health problem and is one of the most common hormonal disorders affecting women of reproductive age. The condition affects approximately 8-13% of women of reproductive age, and up to 70% of cases are undiagnosed.
The prevalence of PCOS is higher among some ethnic groups and these groups often experience more complications, especially related to metabolic problems.
The biological and psychological effects of PCOS, particularly those related to obesity, body image, and infertility, can lead to mental health challenges and social stigma.
Symptoms
Symptoms of polycystic ovary syndrome can vary from person to person. Symptoms can change over time and often occur without a clear trigger.
Possible symptoms include:
- heavy, long, intermittent, unpredictable or absent periods
- infertility
- acne or oily skin
- excessive facial or body hair
- male pattern baldness or thinning hair
- weight gain, especially around the abdomen.
People with PCOS are more likely to have other health conditions including:
- type 2 diabetes
- hypertension (high blood pressure)
- high cholesterol
- heart disease
- endometrial cancer (cancer of the inner lining of the uterus).
PCOS can also cause anxiety, depression and negative body image. Some symptoms such as infertility, obesity and unwanted hair growth can lead to social stigma. This can affect other areas of life such as family, relationships, work and community involvement.
Diagnosis
Polycystic ovary syndrome is diagnosed by the presence of at least two of the following:
- signs or symptoms of high androgens (unwanted facial or body hair, scalp hair loss, acne, or elevated blood testosterone levels) – after other causes have been ruled out;
- irregular menstruation or absence of menstruation – after excluding other causes for it; and
- polycystic ovaries on ultrasound examination.
Blood tests can be used to identify characteristic changes in hormone levels, although these changes are not universal. Women with polycystic ovary syndromemay have elevated levels of:
- testosterone (androgenic ovarian hormone that affects hair growth);
- estrogen (ovarian hormone that stimulates the growth of the lining of the uterus (endometrium);
- luteinizing hormone (LH, a pituitary hormone that affects the production of hormones in the ovaries and is important for normal ovulation);
- insulin (a hormone that is mainly involved in the utilization of energy from food); and
- anti-müllerian hormone (which measures the level of ovarian fertility).
When making a diagnosis, doctors also take into account that irregular periods and ovulation can be a normal part of puberty or menopause, that polycystic ovaries can run in families, and that women with a family history of PCOS or type 2 diabetes have a higher risk of PCOS. In addition, the ultrasound image is not always clear and some women with PCOS may have an ultrasound scan that does not show polycystic ovaries.
Treatment
There is no cure for PCOS, but treatments can improve symptoms.
People who have irregular periods, difficulty getting pregnant, or excessive acne and hair growth should talk to a healthcare professional.
Some symptoms of PCOS can be reduced by lifestyle changes. A healthy diet and enough exercise can help reduce weight and the risk of type 2 diabetes.
Contraceptive drugs (birth control pills) can help regulate the menstrual cycle and reduce symptoms. Other medications can reduce acne or unwanted hair growth caused by PCOS.
Treatment for infertility caused by PCOS includes lifestyle changes, medication, or surgery to stimulate regular ovulation. In vitro fertilization (IVF) can be used, but it has certain risks.
WHO response
WHO works with Member States and partners to address PCOS as part of its efforts to improve women’s health and reproductive well-being globally. WHO is working with governmental and non-governmental partners to raise public awareness of PCOS and develop guidelines for health care providers on how it can be recognized and treated. In addition, WHO promotes research into the most effective ways to prevent, diagnose and treat infertility caused by PCOS and identifies the most important unanswered questions related to it.
WHO supports the production of statistics on how common infertility is and its causes (such as PCOS). WHO is helping Member States pay more attention to infertility and its causes within national health policies, services and funding to ensure that everyone who needs infertility-related health care can get it without financial hardship.
