Understanding polycystic ovary syndrome (PCOS)

September 29, 2023 Swedish Health Team


In this article:

  • Roughly one in 10 women of childbearing age are affected by polycystic ovary syndrome (PCOS).

  • PCOS is primarily a metabolic condition caused by increased levels of male hormones called androgens and insulin resistance.

  • A reproductive health expert at Swedish shares the basics about PCOS and explains when it’s time to call your physician.

An estimated one in 10 women of childbearing age are affected by polycystic ovary syndrome (PCOS), according to the U.S. Department of Health and Human Services. And yet, the condition is often misunderstood, misdiagnosed and mismanaged.

We talked to Emma Grabinski, M.D., OBGYN at Swedish to better understand PCOS — what it is, who it affects and how it’s treated.

What is PCOS?

“PCOS is primarily a metabolic condition. It’s caused by insulin resistance and increased levels of male hormones called androgens,” says Dr. Grabinski. “A healthy body is in balance. With PCOS, the chemical, hormonal and metabolic processes are imbalanced.”

In a healthy menstrual cycle, the ovaries release an egg every month. But with PCOS, the egg may not develop properly or be released during ovulation.

When this happens, tiny fluid-filled sacs called cysts can form on the ovaries. These cysts produce the female sex hormone estrogen, and because ovulation doesn't happen estrogen gets converted to androgens — male sex hormones that are present in small amounts in women.

High androgen levels can affect the menstrual cycle and cause many of the symptoms of PCOS.

Know the warning signs

Irregular menstrual periods are one of the most common signs of PCOS. People with the condition may miss periods or they may have them more frequently. In some cases, menstruation stops completely.

Monitoring your period is an essential component of maintaining good reproductive health, says Dr. Grabinski.

“Just like we think about your blood pressure or pulse being vital signs, your periods can be considered vital signs. One of the things people notice the most is that they’ll have irregular periods,” she explains.

How do you know if your periods are irregular? Just count the days.

“Your menstrual cycle is the timeframe starting at the beginning of one menstrual bleed and ending when the next menstrual bleed begins. It doesn't have to be exactly 28 days, and it’s normal for it to fluctuate slightly from month to month. A normal cycle is between 21 to 35 days long. If you’re bleeding less frequently than every 35 days, that’s abnormal,” says Dr. Grabinski. “If you’re not taking hormonal contraceptives and you’re not pregnant, it’s not normal to have irregular periods.”

Other signs of PCOS include:

  • Extra body hair on the belly, face, chest and around the nipples called hirsutism.
  • Acne on the upper back, chest and face.
  • Weight gain or difficulty losing weight.
  • Small flaps of excessive skin in the neck or armpits called skin tags.
  • Darkened skin along the groin, underneath the breasts and along neck creases.

Monitor health risks

“Because PCOS is a metabolic condition, it puts you at higher risk of things like high blood pressure, high cholesterol, diabetes, prediabetes and obesity. It’s kind of like a chicken and an egg type thing. The extra estrogen makes it harder to lose weight. The insulin resistance also makes it harder to lose weight. Then fat cells produce estrogen, which can increase androgens and that further worsens the situation,” said Dr. Grabinski.

Health risks of PCOS include:

  • Infertility.
  • Increased risk of diabetes.
  • Increased risk of endometrial cancer.
  • High blood pressure.
  • Sleep apnea.
  • Unhealthy cholesterol levels.
  • Depression and anxiety.

“Anybody diagnosed with PCOS should be aware of their added health risks and take steps to protect themselves,” said Dr. Grabinski. “They should have their cholesterol checked. They should be screened for diabetes. They should have their waist circumference measured to look at their cardiovascular risk factor for metabolic syndrome.”

Accurate diagnosis, effective treatment

If you are experiencing irregular periods or any other signs of PCOS, it’s time to schedule a visit with your physician. Diagnosis typically begins with a thorough physical exam, including an ultrasound and bloodwork to check hormone levels, thyroid function, cholesterol and insulin resistance.

If your symptoms include depression, anxiety or other mental and emotional health challenges, behavioral health experts can help develop strategies to address the issues they cause.

“If you haven’t had a proper workup, you haven’t gotten a proper diagnosis for PCOS,” says Dr. Grabinski. “We currently diagnose PCOS using something called the Rotterdam criteria, which outlines the three diagnostic criteria. You don’t have to have all of them, but you need at least two out of three for it to be considered PCOS.”

The three conditions used to diagnose PCOS are:

  • Absence of ovulation that leads to irregular menstrual periods, including periods that occur too frequently, not often enough or not at all.
  • Signs of high androgen levels, including excess body or facial hair, acne and thinning scalp hair.
  • Multiple cysts on one or both ovaries.

Once PCOS is diagnosed, your physician will work with you to develop a personalized treatment plan. There is not currently a cure for PCOS, but there are several effective ways to minimize its impact, including:

  • Maintaining a healthy weight and engaging in regular physical activity.
  • Hormonal birth control, including the pill, patch, hormone IUD, shot and vaginal ring.
  • Excess hair removal with over-the-counter products, laser hair removal or electrolysis.
  • Medication to cause ovulation or treat other symptoms and conditions related to PCOS, such as diabetes or high blood pressure.
  • Myo-inositol, which is a dietary supplement that seems to improve insulin activity, help with weight loss and regulate menstrual cycles.

“One of the things that we have at Swedish is extensive gynecology services. We see a lot of people with PCOS and talk to them about their health risks and how to care for PCOS. We work very closely with our primary care partners. We have great nutrition and weight loss support services and counseling,” said Dr. Grabinski. “You don’t have to suffer in silence. We can help.”

Learn more and find a provider

If you have questions about PCOS and other reproductive health issues, contact Swedish Obstetrics and Gynecology and learn about their full spectrum of gynecological care.

Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction, and follow up as needed. If you need to find a provider, you can use our provider directory.

Join our Patient and Family Advisory Council.

Related resources

Don't miss the signs of ovarian cancer

Understanding women’s heart health with Dr. Sarah Speck

Is your headache a migraine?

This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.

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