It is the most common hormonal disorder in women of child-bearing age, affecting up to one in 10 American girls and women aged 16 to 40 years across all race and ethnicity groups. Globally, it affects up to 20 percent of this population.

Rather than having standard types, PCOS has phenotypes based on observable traits.

The syndrome can manifest in four distinct phenotypes, classified as follows:

• Phenotype A: All three diagnostic criteria sets are present.
• Phenotype B: Hyperandrogenism and ovulatory dysfunction are present.
• Phenotype C: Hyperandrogenism and polycystic ovarian morphology are present.
• Phenotype D: Ovulatory dysfunction and polycystic ovarian morphology are present.

PCOS is also informally classified by health providers into types based on its presumed underlying cause. The most common types include:

• Insulin-resistant PCOS: Women with PCOS frequently experience insulin resistance, where their bodies produce insulin but cannot use it effectively. This condition raises the risk of Type 2 diabetes.
• Inflammatory PCOS: PCOS is linked to chronic inflammation, which can disrupt ovulation and hormone production. Research shows that PCOS patients often have higher levels of inflammatory markers. This inflammation is exacerbated by obesity and high insulin levels, with studies highlighting the interrelated effects of hyperinsulinemia, obesity, hyperandrogenism, and inflammation.
• Adrenal PCOS: A subgroup of women with PCOS may have elevated levels of adrenal hormones than average.
• Hidden-cause PCOS: People use this term to describe PCOS cases where the typical symptoms and signs of the condition are present, but the underlying cause or contributing factors are not immediately apparent.

Girls who undergo puberty early (for instance, developing underarm or pubic hair before age 8) may have a higher risk of developing PCOS later in life.

Women with PCOS can experience a variety of symptoms, which may range from mild to severe and can change over time. Some patients may even be asymptomatic. However, common PCOS symptoms include:

• Absent or irregular menstruation: PCOS can cause high levels of androgens and insulin, disrupting the menstrual cycle. This may result in heavy, light, irregular, or absent periods, and some girls may not start menstruating at all.
• Irregular or absent ovulation: Irregular ovulation can lead to infertility. Bleeding without ovulation, known as an anovulatory period, can also take place.
• Infertility or reduced fertility: While PCOS is a leading cause of infertility, many women with the condition can still become pregnant, but they face a higher risk of complications.
• Hirsutism (excess hair growth): Due to increased androgen levels, PCOS can lead to the development of excess hair, which is typically thicker and darker than usual and often appears in areas where men commonly grow hair, such as the chin, upper lip, and around the nipples. About 60 percent of women with PCOS experience this symptom. Despite having similar androgen levels, women of Eastern European descent are more likely to exhibit hirsutism, while Asian women tend to have little or no excess hair growth.
• Acne or seborrhea (excessive oily skin): In PCOS, increased androgen levels can enlarge oil glands in the skin, leading to acne breakouts. As a result, young women with PCOS may experience persistent and severe acne.
• Acanthosis nigricans (dark skin patches): In areas such as the armpits or neck, rough, dark, and soft patches of skin may appear.
• Anxiety and depression: PCOS can make women feel stressed out, anxious, and depressed. Additionally, other symptoms of PCOS (e.g., infertility or hirsutism) may lead to these feelings.
• Weight issues: Women with PCOS may face a higher risk of unhealthy weight. Managing weight can be challenging due to hormonal imbalances affecting appetite and regulating hunger. Obesity affects up to 50 percent of PCOS patients. However, some patients are underweight, though this is rare.
• Cystic or enlarged ovaries: Cystic ovaries contain multiple tiny fluid-filled sacs, or cysts.
• Hyperlipidemia (high blood fats): Hyperlipidemia is characterized by increased triglycerides, total cholesterol, and low-density lipoprotein (LDL) cholesterol (“bad” cholesterol), along with decreased high-density lipoprotein (HDL) cholesterol (“good” cholesterol).
• Sleep problems: One example is sleep apnea.
• High blood pressure.
• Pelvic pain.
• Skin tags.
• Alopecia (hair loss).
• Fatigue.
• Low energy.
• Headaches.
• Mood swings.

PCOS often begins as early as age 11 or 12, around the time of a girl’s first menstruation. Although PCOS is a hormonal disorder, its exact cause remains unknown. It likely has multiple causes with a significant genetic component. Lifestyle and environmental factors may also play a role in its development. Researchers believe that the following issues may influence the development of PCOS:

1. Genetics

PCOS is likely linked to multiple genes and often runs in families. About one-third of women with PCOS have a female relative with the condition, and this rate may be higher in certain ethnic groups. Several susceptible genes have been identified as contributors to the pathophysiology of the disease, particularly those involved in steroidogenesis (a process wherein cholesterol is converted into steroid hormones) and androgenic (male hormone) pathways. Research estimates the heritability of these genes to be around 70 percent.

2. Hormone Imbalance

Many women with PCOS have hormone imbalances that contribute to their symptoms. Several hormones may be involved, including:

• Testosterone: Although testosterone is the primary male hormone, it is also produced in small amounts by women. Women with PCOS may produce more testosterone than usual, leading to symptoms such as excess hair growth, acne, and irregular periods.
• Luteinizing hormone: Luteinizing hormone helps trigger ovulation. However, in women with PCOS, high levels of this hormone can affect the ovaries abnormally, contributing to the production of more male hormones and further disrupting the menstrual cycle.
• Sex hormone-binding globulin (SHBG): SHBG is a protein that binds to testosterone in the blood while reducing its effects. If SHBG levels are low, there will be more unbound testosterone, exacerbating PCOS symptoms.
• Estrogen: Women with PCOS may have lower estrogen levels.

Hormone imbalances can have various causes. One leading cause implicated in PCOS is insulin resistance, which approximately 85 percent of women with PCOS experience.

Insulin is a hormone that helps regulate blood sugar by moving glucose into cells for energy. High insulin levels can cause the ovaries to produce too much testosterone, which disrupts signals from the brain that typically trigger follicle development and ovulation, causing ovulation to occur irregularly or not at all. When ovulation doesn’t happen, the ovaries may develop cysts. These cysts can then produce male hormones known as androgens, such as testosterone.

Factors that put people at a higher risk of developing PCOS include:

• Family history of PCOS.
• Infections: Infectious mediators can contribute to PCOS.
• Toxin exposure: In animal studies, endocrine-disrupting chemicals, such as those found in synthetic fragrances and the industrial plasticizer bisphenol A (BPA), have been shown to induce androgen production and insulin resistance. Women with PCOS tend to accumulate more BPA in their bodies, which could lead to an increase in symptom severity.
• Obesity or metabolic disorders.
• Early puberty.
• Age: Women in their 20s and 30s are more at risk due to being in their prime reproductive years.
• Race: The prevalence among patients aged 16 to 40 was 5.2 percent across all racial and ethnic groups. Incidence rates were as follows: 6.8 percent for Hispanics, 5.2 percent for whites, 4 percent for Asians, 6.9 percent for Native Americans, 4.6 percent for African Americans, and 7.6 percent for Hawaiians and Pacific Islanders. Therefore, Native Americans and Hawaiian/Pacific Islanders face an increased risk.

According to the World Health Organization (WHO), as many as 70 percent of women with PCOS go undiagnosed worldwide. PCOS is a diagnosis of exclusion. Many disorders mimic PCOS symptoms, such as thyroid disease, hyperprolactinemia, and nonclassical congenital adrenal hyperplasia. Therefore, despite its relatively high prevalence, PCOS is often underdiagnosed.

PCOS is characterized by two or more of the three diagnostic criteria called the Rotterdam criteria. Specifically, they are:

• Oligo- or anovulation: Infrequent or absent ovulation (amenorrhea). Ovulatory dysfunction like this occurs when a woman has irregular or fewer than nine periods per year or does not ovulate.
• Hyperandrogenism: Hyperandrogenism refers to the presence of excessive levels of male sex hormones, such as testosterone. Clinical signs include excessive hair growth, acne, or male pattern baldness.
• Polycystic ovaries: Each ovary cyst represents a follicle holding an egg. Twelve or more follicles in at least one ovary measuring 2 to 9 millimeters in diameter or increased ovarian volume (>10 cm³).

A complete medical history and physical exam are critical for diagnosing PCOS, as two of the three diagnostic criteria rely on history and physical examination. A physical exam typically includes a pelvic exam, which may show enlarged ovaries with many small cysts or an enlarged clitoris (very rare).

Tests

Blood tests can check hormone levels and include the following:

• Estrogen level.
• Follicle-stimulating hormone (FSH) level.
• Luteinizing hormone level.
• Testosterone level.
• Progesterone level.
• Fasting glucose (blood sugar) and other tests for insulin resistance.
• Lipid level.
• Pregnancy test (human chorionic gonadotropin test): A pregnancy test is performed in diagnosing PCOS primarily to rule out pregnancy as a cause of symptoms such as missed periods or irregular menstrual cycles since these symptoms are common in both pregnancy and PCOS.
• Prolactin level: Although the causality of the association between increased prolactin levels and PCOS remains unclear, higher prolactin levels could inhibit ovulation and result in polycystic ovarian morphology.
• Thyroid function tests.

Ovarian morphology assessment is more accurate when performed via transvaginal ultrasound. Advances in ultrasound technology have made diagnosing PCOS easier. Recent studies suggest that measuring anti-Mullerian hormone (AMH) levels can also help diagnose PCOS when an accurate ovarian ultrasound is not available.

Women with PCOS are more likely to develop other serious health problems, especially if they are overweight. These complications include:

• Prediabetes: Up to 35 percent of women with PCOS develop prediabetes, characterized by elevated blood glucose levels that are higher than normal but not yet high enough to be classified as diabetes.
• Type 2 diabetes: By age 40, approximately 10 percent of overweight women with PCOS develop abnormally high blood glucose levels.
• Subfertility or infertility: Up to 70 percent of women with PCOS experience fertility issues.
• High blood pressure.
• Cardiovascular problems: In the long run, excess male hormones increase the risk of cardiovascular disorders.
• Uterine cancer: Uterine cancer is the most prevalent cancer of the female reproductive system, originating as a malignant tumor in the cells of the uterus. Its two types include the common endometrial cancer and rare uterine sarcoma. PCOS may lead to uterine cancer due to irregular and infrequent menstruation, along with increased estrogen levels.
• Gestational diabetes: Blood sugar levels rise during pregnancy.
• High LDL cholesterol.
• Sleep apnea.
• Stroke.
• Obesity-related complications.
• Metabolic syndrome: Increased male hormones can also cause metabolic syndrome and contribute to obesity.
• Depression and anxiety: Women with PCOS also have higher rates of major depression, recurrent depression, anxiety, and suicide attempts.
• Nonalcoholic fatty liver disease (NAFLD): Women with PCOS have a higher risk of developing NAFLD.
• Sexual health problems.
• Endometrial hyperplasia: Endometrial hyperplasia, the thickening of the uterine lining, is a particular concern for women with PCOS who are obese, diabetic or prediabetic, insulin resistant, or have a long history of menstrual irregularities. This condition is relatively uncommon.

There is currently no cure for PCOS. Treatment aims to reduce the risk of complications and improve lifestyle.

If pregnancy is desired, treatment may include:

• Change in diet and activity: A healthy diet and increased physical activity can aid in weight loss, alleviate PCOS symptoms, improve insulin efficiency, lower blood glucose levels, and potentially enhance ovulation.
• Medication to cause ovulation: These medications carry risks, including an increased risk of multiple births (such as twins) and ovarian hyperstimulation, which can lead to symptoms such as abdominal bloating and pelvic pain.

With treatment, women with PCOS are very often able to get pregnant. However, during pregnancy, there is an increased risk of the following:

• Miscarriage
• High blood pressure
• Gestational diabetes
• Potentially fatal preeclampsia

For those who don’t plan to become pregnant, aside from dietary and activity level changes, treatment may include:

• Birth control pills: These treat hormonal imbalances and regulate menstruation. They can also help reduce abnormal hair growth and acne when taken for several months.
• Diabetes medication: These can reduce insulin resistance in PCOS.
• Other medications: Women with PCOS often require several medications to manage symptoms such as hirsutism, anovulation, and menstrual irregularities. One example is androgen-blocking medication.

1. Dietary and Physical Therapies

Dietary and physical therapies and lifestyle alterations are highly recommended for PCOS.

If diagnosed with PCOS, inquire about testing for Type 2 diabetes and management options. Adopting healthy habits, such as losing weight and increasing physical activity, can reduce your risk of developing Type 2 diabetes.

2. Menstrual Abnormality Treatments

These include:

• Hormonal contraceptives: The first-line treatment for menstrual abnormalities, hirsutism, and acne is hormonal contraceptives, either oral, patches, vaginal rings, or hormone-releasing intrauterine devices (IUDs). All of these may decrease luteinizing hormone levels, indirectly decreasing ovarian androgen production and increasing SHBG, and stop the abnormal growth of the uterine lining. Therefore, they are highly effective for symptoms of hyperandrogenism and controlling the menstrual cycle.
• Metformin: Metformin, a diabetes medication, is also used as a second-line treatment for menstrual irregularities in patients who cannot use hormonal contraceptives. It helps restore regular menstrual cycles, assists in weight loss, and reduces insulin resistance, particularly benefiting adolescents and obese patients. The Endocrine Society recommends starting metformin for PCOS patients with Type 2 diabetes or impaired glucose tolerance who do not respond to lifestyle changes. Additionally, it can improve waist-to-hip ratio, menstrual regularity, and vascular markers in nonobese women with PCOS.

3. Infertility Treatment

The American Society for Reproductive Medicine recommends letrozole as a first-line treatment for infertility. Compared to clomiphene citrate, letrozole is associated with higher rates of live births and ovulation among infertile women with PCOS.

Laparoscopic ovarian drilling (LOD) is a surgical option for treating fertility issues in PCOS that don’t respond to medication. It involves using a laser to destroy the tissue in the ovaries that produces androgens. LOD can lower testosterone and luteinizing hormone levels while increasing follicle-stimulating hormone levels, helping correct hormonal imbalances and restore normal ovarian function.

A 2024 study found that many women diagnosed with PCOS also suffered from cognitive dysfunction, especially later in life. Because PCOS affects hormonal balance and menstrual cycles, it can influence mood and mental state. The study of 907 women aged 18 to 30, followed over 30 years, found that those with PCOS scored lower on memory, verbal abilities, and attention tests compared to those without the condition.

Research shows that over 60 percent of PCOS patients are diagnosed with at least one kind of mental disorder. The severity of depression, anxiety, and obsessive-compulsive disorder (OCD), measured by different scales in PCOS patients, was higher than that in women without PCOS.

A 2022 study confirmed the correlation between depression, mental disorders, and PCOS. Despite higher rates of depression, the participants exhibited greater strengths in hope, judgment, perspective, and transcendence compared to healthy participants. These character strengths may help reduce psychological distress and mood disorders associated with PCOS.

This leads us to a unique and seemingly contradictory viewpoint: Imagine being grateful for PCOS. Could it build your character and lead to a healthier life? While it may seem difficult for a PCOS sufferer to express gratitude for a condition that has been a lifelong challenge, shifting the narrative to view it positively could be transformative. Scientific evidence suggests that gratitude can change our brains, thoughts, and actions. Gratitude is a thankful appreciation for what we receive externally, which increases the production of dopamine and serotonin, the “feel-good” neurotransmitters.

Dopamine influences behavior, cognition, movement, motivation, prolactin production, sleep, dreams, mood, attention, memory, and learning. PCOS symptoms affect many of these areas. If gratitude increases dopamine, which helps suppress the production of prolactin, maybe it could also help with irregular periods and infertility.

Serotonin, like dopamine, influences learning, memory, sleep, and happiness. Additionally, it regulates body temperature, digestion, hunger, nausea, wound healing, and bone health. Ninety-five percent of serotonin is found in the digestive tract, helping speed digestion to eliminate toxins. In PCOS, unbalanced serotonin levels, rather than just insulin resistance, may explain abnormal cravings and appetite issues.

Adopting a positive and grateful mindset could lead to powerful changes. Maintaining a positive outlook is crucial in managing diseases, including PCOS.

There are several natural treatments for PCOS, but further research is needed to confirm their effectiveness. Therefore, please consult a doctor before using any of them.

1. Medicinal Herbs

• Chasteberry (Vitex agnus-castus): The chasteberry plant, also known as the chaste tree, is native to the Mediterranean region and Asia. Its fruit contains natural chemicals called monoterpenoids, such as alpha-pinene. It also includes other compounds that help lower prolactin levels. These mechanisms can help prevent cyst formation in the ovaries and may be beneficial for treating PCOS.
• Turmeric (Curcuma longa): Turmeric is derived from the root of the turmeric plant and has been used for centuries in Ayurvedic and Chinese medicine. Turmeric contains over 250 phytoconstituents, carbohydrates, proteins, terpenes, and resins. Among them, curcuminoids, which comprise a small percentage of the resins, are the main secondary metabolites. These curcuminoids can effectively treat PCOS, as they help reduce the follicular sheath, enhance the menstrual cycle, and improve ovulation. Consequently, turmeric may improve the histological features of polycystic ovaries.
• Flax (Linum usitatissimum): Flaxseed is high in lignans and has been demonstrated to lower androgen levels in men with prostate cancer. In a 2020 study, 41 PCOS patients were randomly assigned to either receive 30 grams of flaxseed powder daily along with lifestyle modifications or to follow only lifestyle modifications for 12 weeks. As it turned out, the treatment of the first group was more effective than that of the second group, as flaxseed supplementation led to a significant decrease in body weight, waist circumference, and body mass index (BMI) among women with PCOS.

2. Diet

Women with PCOS often experience widespread inflammation, which is linked to heart disease and other health issues. The following diets are anti-inflammatory and may be beneficial for PCOS patients:

• Mediterranean diet: The Mediterranean diet, which excludes saturated fats, processed meats, and refined sugars, is an effective way to combat inflammation. With its focus on nonstarchy vegetables, fruits, lean proteins, healthy carbs, and low-fat dairy, this diet can also help women with PCOS improve their health and prevent complications.
• Ketogenic diet: The ketogenic diet is a high-fat, low-carbohydrate eating plan. A 2023 study found that a short-term keto diet (for at least 45 days) may help improve hormonal imbalances commonly associated with PCOS.

In addition to the diets above, these foods are considered beneficial to PCOS patients:

• Omega-3 rich fish
• Olive oil
• Legumes and beans
• Nonstarchy vegetables, including leafy greens, tomatoes, mushrooms, peppers, broccoli, cauliflower, snow peas, celery, and fennel
• Whole grains
• Whole fruits, which have a high fiber content to help with satiety and digestion and slow sugar absorption

Foods to avoid include:

• Fried foods
• Red and processed meats
• Processed snacks
• Sugary cereal
• Sugary beverages, including sodas, sweetened teas, and sports drinks
• Alcohol
• Refined flour products

3. Supplements

• Inositol: Inositol is a type of sugar‐alcohol found in fruits, beans, grains, and nuts. A 2023 systematic review of 26 studies involving 1,691 PCOS patients found inositol an effective alternative to metformin for treating the condition. Another 2022 meta-analysis showed that oral inositol supplementation might reduce BMI and could be considered an adjunct treatment for improving BMI.
• Berberine: Berberine is a compound in various plant species, often used in traditional Chinese medicine (TCM) and the Ayurveda medical system. It may help manage PCOS by addressing multiple aspects of the condition with fewer side effects than pharmaceuticals. As per a 2021 review, it can improve insulin resistance, lower serum androgen levels, regulate lipid metabolism, and reduce chronic inflammation in PCOS patients. Berberine is often combined with metformin, cyproterone, and other medications to enhance therapeutic outcomes for PCOS.
• Chromium: Chromium is an essential trace metal. In a 2017 meta-analysis, chromium supplementation was found to lower serum insulin and free testosterone levels while improving body weight in PCOS patients. In a 2018 study examining the effects of eight weeks of chromium supplementation in infertile women with PCOS who were preparing for in vitro fertilization (IVF), chromium was found to improve their glycemic control, reduce some cardiometabolic risk factors, and lower oxidative stress.
• Seed cycling: Seed cycling means eating different seeds during the two phases of the menstrual cycle. A 2023 article showed that seed cycling effectively improves hormonal disturbances in women with PCOS. Additionally, a 2021 study indicated that omega-3 fatty acids from flaxseeds, pumpkin, sesame, and sunflower seeds could be a novel treatment for PCOS.

4. Acupuncture

Acupuncture is a safe and effective treatment for PCOS, offering benefits without the adverse effects associated with pharmacological interventions. It may help by increasing blood flow to the ovaries, reducing ovarian volume and cysts, improving insulin sensitivity, lowering blood glucose and insulin levels, decreasing cortisol levels, and supporting weight loss and appetite regulation.

5. Electro-Acupuncture

One 2011 study with 84 women found that combining electro-acupuncture with exercise for 16 weeks improved reproductive hormone levels, menstrual frequency, and hyperandrogenism. In addition, electro-acupuncture alone was more effective than exercise in this randomized controlled trial.

6. Yoga

Yoga, a holistic mind-body practice, is a low-impact exercise that supports balance across physical, psychological, mental, emotional, and spiritual aspects. A 2012 study found yoga more effective than traditional physical exercises in improving glucose, lipid, and insulin levels, including insulin resistance, in adolescent girls with PCOS. One small 2020 randomized controlled trial showed that regular yoga practice may lower serum androgen levels in PCOS patients, making it a valuable complementary therapy.

7. Mindfulness-Based Stress Reduction

Many PCOS patients experience psychological issues such as depression. Mindfulness-based stress reduction (MBSR), including meditation, can alleviate emotional symptoms such as anxiety and stress and improve physical symptoms like pain. MBSR also helps lower blood pressure, blood glucose, and inflammation by enhancing autonomic nervous system function, potentially reducing the risk of diabetes and cardiovascular disease in PCOS patients.

8. Tai Chi

Tai chi, a distinctive Chinese exercise, integrates physical activity and gentle breathing exercises, making it accessible without high intensity. The essence of tai chi lies in concentration and slow movements. It helps maintain the balance of qi and blood and regulate the opposing energetic forces of yin and yang to lower BMI, reduce cardiovascular risk factors, and enhance psychological health. Research indicates that tai chi is beneficial for managing long-term complications associated with PCOS, such as obesity, cardiovascular disease, diabetes, and psychological issues.

Currently, there is no known method to prevent PCOS for most individuals. However, as researchers better understand insulin resistance, its early identification and treatment may eventually help prevent some cases of PCOS. Measures that may minimize the risk of developing the condition include:

• Avoiding smoking and excessive drinking
• Maintaining a healthy weight
• Eating a balanced diet composed of fruits, vegetables, whole grains, lean meats, fish, and chicken while reducing sugar, salt, and caffeine intake
• Eating regular meals (for instance, not skipping breakfast)
• Exercising regularly, getting at least 150 minutes of exercise a week