Polycystic Ovary Syndrome: What It Is, How to Manage It

​By Hilda Hutcherson| September 4, 2020

"Often misunderstood and misdiagnosed, PCOS can play havoc with your fertility. Here’s how to recognize the symptoms and take action to protect your reproductive health."

Credit...Michelle Mildenberg

"Caroline’s mother was concerned when she turned 15 and hadn’t had her first period. It finally came, but it wasn’t until three months later that she’d get her second. Her gynecologist assured her that irregular periods were common for someone her age, so Caroline’s mother didn’t worry. Then, at 18, her periods disappeared for six months. This time, her college ob-gyn said that the stress of college often causes menstrual periods to wane, and that the best treatment was hormonal therapy to make her periods regular. So she started taking birth control pills.

Thirteen years later, she was ready to have a baby and stopped taking them, assuming that since she was older and not under as much stress, her periods would become more regular. But they didn’t. She also noticed increased acne and facial hair. After six months of trying unsuccessfully to conceive, she started taking her temperature and using an ovulation predictor kit. Both revealed that she was ovulating infrequently and irregularly. The question was why?

Many women with irregular periods are told it’s no big deal. Even her acne and facial hair didn’t throw up a red flag. Fortunately, tests eventually led to an accurate diagnosis: she had polycystic ovary syndrome (PCOS), a hormonal disorder that disrupts women’s fertility and may cause a host of other health issues. As many as 15 percent of women between 18 and 45 have PCOS, making it the most common hormonal disorder among women of childbearing age.

For this guide, I reviewed the current literature and interviewed Beth Rackow, M.D., a reproductive endocrinologist and director of the pediatric and adolescent gynecology program at Columbia University Irving Medical Center.

What to do: 

• Know the signs and symptoms
• Know what’s involved in diagnosing PCOS
• Understand how PCOS may affect your fertility
• Prepare for potential pregnancy complications if you conceive
• Know the other health risks of PCOS
• Consider possible treatments

Know the signs and symptoms
Polycystic ovary syndrome is a common hormonal disorder among women, yet often goes underdiagnosed by health care providers. Some women have few, if any, symptoms. Others have many — irregular or absent periods, excess facial or body hair growth (hirsutism), obesity and infertility — but they may be mistaken as signs of other health conditions.

​Irregular, unpredictable periods are one important symptom. Periods may come twice a month, be infrequent (greater than 35 days apart) or disappear for months at a time. They may be light or they may be heavy enough to cause anemia. You may suspect PCOS if you also have acne that doesn’t respond to treatment or increased growth of facial or body hair. These are signs of excess androgen hormone. Eighty percent of women with hirsutism have PCOS.

PCOS may appear as early as adolescence. “Girls with PCOS typically present when they haven’t had their first period when they should have, their periods are very infrequent or they are having frequent, heavy periods,” said Dr. Rackow.

It’s common for menses to be irregular in girls during the first year or two after the first period. Acne is also common during adolescence. However, if menstrual periods continue to be abnormal after the first two years, or if bleeding is persistently heavy at any time, an evaluation is needed."

Learn more about the misunderstood/misdiagnosed PCOS and what to do about it