Many women will experience some abnormal or irregular menstrual bleeding from time to time. However, missing a period for several months or having irregular intervals between periods that may be accompanied with abnormally heavy bleeding, may be a sign of polycystic ovary syndrome, or PCOS.

PCOS is the most common hormonal disorder among women of reproductive age, affecting approximately 6% to 10% of women under the age of 35, says Sydney Randall, MD, Nebraska Medicine obstetrician and gynecologist. 

It occurs when the ovaries, the organ responsible for producing and releasing eggs, create too many hormones. This causes an imbalance in your reproductive hormones, which can lead to irregular periods, missed periods and erratic ovulation. Small follicle cysts filled with immature eggs may form on the ovaries due to lack of ovulation. However, these are not threatening or painful and not everyone with PCOS develops cysts. They are usually visible with ultrasound.

Symptoms of PCOS

Symptoms of PCOS often begin in adolescence or early adulthood. Some women may not have any symptoms or very mild symptoms. Many women are not diagnosed until they try to get pregnant. 

The most common signs and symptoms of PCOS include:

• Irregular, heavy or absent menstrual periods.
• Hair growth on the face, chest and abdomen. 
• Infertility due to lack of ovulation.
• Insulin resistance.
• Obesity – approximately 40% to 80% of women with PCOS are obese and have trouble maintaining a healthy weight.
• Acne on the back, chest and face.
• Patches of hair loss on the head or balding.
• Patches of dark skin in the folds of the neck, armpits, groin and under the breasts.

The most serious consequences of PCOS include increased risk for endometrial cancer (when cycles are irregular or absent, the endometrium does not shed regularly, which can increase cancer risk), elevated cholesterol, high blood pressure, obesity, diabetes, fatty liver disease, sleep apnea, heart disease and infertility, notes Dr. Randall.

Diagnosis and treatment

Early diagnosis and treatment can help reduce the risk of long-term complications. Your physician can also recommend therapies to manage your individual symptoms and to promote fertility.

Diagnosis is achieved through a physical examination and discussion of symptoms. Your doctor may also order blood tests as well as an ultrasound.

“For women who are not planning to become pregnant, the best way to treat PCOS is birth control pills to suppress hormone production,” says Dr. Randall. “If you are trying to get pregnant and you are not having regular cycles, we can put you on medications to promote ovulation.”

While most women with PCOS are able to become pregnant, the condition does increase your risk for certain pregnancy complications. These include a 20% to 40% risk of miscarriage, a higher risk for gestational diabetes, preterm birth and C-section. 

Medications to treat other symptoms, such as excessive hair growth, acne and insulin resistance, are also available if needed.

“The exact cause of PCOS is not well understood, says Dr. Randall, “however, we do believe that genetics may play a role. There also appears to be a relationship between obesity and insulin resistance and PCOS.”

“This is a lifelong condition that needs to be managed,” says Dr. Randall. “Talk to your doctor if you think you may have PCOS. Early diagnosis is key to successfully managing the condition and having a successful pregnancy if this is in your plans.”