Polycystic Ovary Syndrome (PCOS)

PCOS is a set of symptoms related to a hormonal imbalance. Symptoms can affect metabolic, cardiovascular, inflammatory, reproductive, and other aspects of health. PCOS may cause menstrual cycle changes; skin changes such as increased facial and body hair and acne; growths in one or both ovaries, often clumps of ovarian follicles that have stopped developing; and infertility. People with PCOS may also have metabolic issues, such as insulin resistance or obesity.

About Polycystic Ovary Syndrome (PCOS)

PCOS is a set of symptoms related to a hormonal imbalance. These symptoms can include changes in metabolism, menstrual and reproductive health, and heart and blood function, as well as inflammatory responses and other outward characteristics.

What is PCOS?

PCOS is a set of symptoms related to a hormonal imbalance. People with PCOS usually have at least two of the following three features:1

  • Absence of ovulation (when the ovary releases a mature egg into the fallopian tube, usually monthly), leading to irregular menstrual periods or no periods at all
  • High levels of hormones called androgens, or signs of high androgens, such as increased body or facial hair
  • Growths in one or both ovaries, often clumps of ovarian follicles that have stopped developing2

Some people diagnosed with PCOS have the first two features, as well as symptoms of PCOS, but do not have growths in their ovaries. More recent genetic research suggests there may be two or more subtypes of PCOS defined by a set of genes or changes in specific genes.3

PCOS is the most common cause of anovulatory infertility, meaning that the infertility results from the absence of ovulation. Many people don't find out that they have PCOS until they have trouble getting pregnant.

People with PCOS may experience a range of symptoms that may seem unrelated to ovaries. For example, increased hair growth, dark patches of skin, acne, insulin resistance, and irregular menstrual bleeding are all possible symptoms of PCOS.

Citations

  1. American College of Obstetricians and Gynecologists. (2022) FAQs: Polycystic ovary syndrome (PCOS). Retrieved July 26, 2024, from https://www.acog.org/en/womens-health/faqs/polycystic-ovary-syndrome-pcos external link
  2. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Monash University, Melbourne, Australia, 2018. Retrieved July 26, 2024, https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf external link (PDF 1.42 MB)
  3. Dapas, M., Lin, F. T. J., Nadkarni, G. N., Sisk, R., Legro, R. S., Urbanek, M., Hayes, M. G., & Dunaif, A. (2020). Distinct subtypes of polycystic ovary syndrome with novel genetic associations: An unsupervised, phenotypic clustering analysis. PLOS Medicine, 17(6), PMID: 32574161

What are the symptoms of PCOS?

Because the characteristic features of PCOS—absence of ovulation, indicated by irregular menstrual periods or no periods at all; high androgen levels; and growths in one or both ovaries, often clumps of ovarian follicles that have stopped developing—are wide ranging, so, too, are the symptoms of the condition.

Often, people and health care providers may not suspect PCOS because the symptoms may seem unrelated. These can include:1,2

  • Menstrual irregularities:
    • No menstrual periods—called amenorrhea
    • Skipped periods—called oligomenorrhea
    • Very heavy periods
    • Bleeding but no ovulation—called anovulatory periods
  • Infertility
  • Increased hair growth on the face, chest, belly, or upper thighs—a condition called hirsutism
  • Severe, late-onset, or persistent acne that does not respond well to common treatments
  • Insulin sensitivity
  • Obesity, weight gain, or trouble losing weight, especially around the waist
  • Oily skin
  • Patches of thickened, dark, velvety skin—a condition called acanthosis nigricans

For many adolescents, these symptoms may also be part of puberty, especially early in the process. A health care provider may consider PCOS treatments for severe symptoms even without a diagnosis of PCOS.3

Because many people don't consider oily skin, increased hair growth, or acne to be symptoms of a serious health condition, they may not mention these things to their health care providers. As a result, many people aren't diagnosed with PCOS until they have trouble getting pregnant, or until they have menstrual irregularities.

Although PCOS is a leading cause of infertility, many people of reproductive age with PCOS can and do get pregnant. Pregnant people who have PCOS, however, are at higher risk for certain problems, such as miscarriage. Learn more about PCOS-related pregnancy problems.

People with PCOS are also at higher risk for the following health issues:

  • Cardiovascular disease
  • Depression, anxiety, and other mental health issues
  • Endometrial hyperplasia external link, a condition in which the lining of the uterus becomes too thick, and endometrial cancer, also called uterine cancer
  • Insulin resistance, when the body doesn’t use insulin well
    • Too much glucose and insulin in the blood can contribute to metabolic syndrome and type 2 diabetes.
    • More than one-half of people with PCOS have insulin resistance.6
    • Patches of thickened, dark, velvety skin, called acanthosis nigricans, are associated with insulin resistance.
  • Metabolic syndrome, a group of risk factors for heart disease and type 2 diabetes
    • About 25% to 45% of people with PCOS have metabolic syndrome.7
  • Obesity
    • Obesity is a risk factor for many health problems, including diabetes, heart disease, high blood pressure, and sleep apnea.
    • About 4 out of 5 people with PCOS also have obesity.5
  • Obstructive sleep apnea, a disorder that causes pauses in breathing during sleep
    • Sleep apnea increases the risk of high blood pressure, heart attack, and diabetes.8
    • People with PCOS are at much higher risk for obstructive sleep apnea than others, including those without PCOS and those with obesity.9
  • Type 2 diabetes
    • If not managed, diabetes can damage the kidneys and can lead to blindness, nerve damage, and foot problems.10 Type 2 diabetes also increases the risk for heart disease and high blood pressure.
    • More than one-half of people with PCOS will have either type 2 diabetes or prediabetes before their early 40s.11

Just because a person is diagnosed with PCOS does not mean they will experience all these issues. However, they and their health care providers may want to monitor their health for signs of these issues as part of their regular care.

Citations

  1. American College of Obstetricians and Gynecologists. (2022) FAQs: Polycystic ovary syndrome (PCOS). Retrieved July 26, 2024, from https://www.acog.org/en/womens-health/faqs/polycystic-ovary-syndrome-pcos external link  
  2. Office on Women’s Health. Polycystic ovary syndrome. Retrieved July 26, 2024, from https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
  3. ACOG Committee on Adolescent Health Care. (2019; Reaffirmed 2024). Committee Opinion No. 789. Screening and management of the hyperandrogenic adolescent. Retrieved July 26, 2024, from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/screening-and-management-of-the-hyperandrogenic-adolescent external link
  4. National Heart, Lung, and Blood Institute (NHLBI). The Heart Truth®. Retrieved July 26, 2024, from https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-truth
  5. ACOG. (2018). Practice Bulletin No. 194: Polycystic ovary syndrome. Retrieved July 26, 2024, from https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/06/polycystic-ovary-syndrome external link
  6. Goodarzi, M. O., Dumesic, D. A., Chazenbalk, G., & Azziz, R. (2011). Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nature Reviews: Endocrinology, 7(4), 219–231. PMID: 21263450
  7. Ehrmann D. A. (2005). Polycystic ovary syndrome. The New England Journal of Medicine, 352(12), 1223–1236. PMID: 15788499
  8. NHLBI. (2022). What is sleep apnea? Retrieved July 26, 2024, from https://www.nhlbi.nih.gov/health/sleep-apnea
  9. Fogel, R. B., Malhotra, A., Pillar, G., Pittman, S. D., Dunaif, A., & White, D. P. (2001). Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome. The Journal of Clinical Endocrinology and Metabolism, 86(3), 1175–1180. PMID: 11238505
  10. National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Preventing diabetes problems. Retrieved July 26, 2024, from https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems
  11. Lorenz, L. B., & Wild, R. A. (2007). Polycystic ovarian syndrome: An evidence-based approach to evaluation and management of diabetes and cardiovascular risks for today's clinician. Clinical Obstetrics and Gynecology, 50(1), 226–243. PMID: 17304038

What causes PCOS?

Research has shown that genetic and environmental factors contribute to the development of PCOS, but its exact cause remains unknown.

The symptoms of PCOS tend to run in families, so genetics have long been a focus of PCOS research.

Recent research suggests that there are 19 possible changes, or variants, in genes that can increase a person’s risk of developing PCOS.1 These variants could explain why the features and symptoms of PCOS are so different from one person to the next.

Although PCOS usually is considered to be a condition related to the ovaries, researchers found these genetic variants in both females and males. In fact, males with these genetic variants experienced cardiac and metabolic symptoms similar to those experienced by females with PCOS.2

Researchers identified subtypes of PCOS based on these genetic variants. One group of NICHD-funded researchers identified two subtypes: reproductive, which has higher reproductive hormone levels; and metabolic, which had higher Body Mass Index (BMI), insulin, and glucose levels.3

Other NICHD-funded work found four subtypes,4 which they called “clusters.” The genetic clusters correlated with distinct sets of symptoms: the obesity/insulin resistance cluster had higher BMI; the hormonal/menstrual cycle changes cluster had increased age at first menstruation; the blood markers/inflammation cluster had decreased blood markers, including platelets; and the metabolic changes cluster had high triglycerides and metabolic hormone levels.

Research conducted in animal models suggests that exposure to increased levels of androgen hormones in the womb may also increase the likelihood of PCOS in offspring.5,6

What causes the symptoms of PCOS?

Many symptoms of PCOS result from an imbalance of hormones, chemicals that control functions in the body.

The ovaries, testes, and adrenal glands produce reproductive hormones that are involved in regulating reproductive processes and health. One reproductive hormone, called estrogen, plays a role in regulating the menstrual cycle (in females), breast health, bone development, and other important functions.7 Another such hormone, called androgen, contributes to hair growth, muscle development, sperm production (in males), and voice deepening.8

People with PCOS have higher levels of androgens and may have lower levels of estrogen. High levels of androgens can interfere with signals from the brain that control ovulation, making it occur sporadically or not at all. High androgen levels can also cause ovarian follicles—small, fluid-filled sacs where eggs grow and mature—to stop developing and clump together.9,10 Androgen levels also play a role in increased hair growth and acne.10

Many people with PCOS also have problems with another hormone called insulin, which helps move sugar (also called glucose) from the bloodstream into cells to use as energy. When cells don't respond normally to insulin, the level of sugar in the blood rises. High insulin levels are linked to a skin condition called acanthosis nigricans, which results in thickened dark, velvety patches of skin.10

In addition, the body produces more and more insulin to get glucose into the cells. To balance out the high levels of insulin, the body makes more androgens,9 which contribute to symptoms of PCOS. It is difficult to disrupt this cycle, which is why treating PCOS can be challenging.

Citations

  1. Welt C. K. (2021). Genetics of polycystic ovary syndrome: What is new? Endocrinology and Metabolism Clinics of North America, 50(1), 71–82. PMID: 33518187
  2. Zhu, J., Pujol-Gualdo, N., Wittemans, L. B. L., Lindgren, C. M., Laisk, T., Hirschhorn, J. N., & Chan, Y. M. (2022). Evidence from men for ovary-independent effects of genetic risk factors for polycystic ovary syndrome. The Journal of Clinical Endocrinology and Metabolism, 107(4), e1577–e1587. PMID: 34969092
  3. Dapas, M., & Dunaif, A. (2022). Deconstructing a syndrome: Genomic insights into PCOS causal mechanisms and classification. Endocrine Reviews, 43(6), 927–965. PMID: 35026001
  4. Stamou, M. I., Smith, K. T., Kim, H., Balasubramanian, R., Gray, K. J., & Udler, M. S. (2024). Polycystic ovary syndrome physiologic pathways implicated through clustering of genetic loci. The Journal of Clinical Endocrinology and Metabolism, 109(4), 968–977. PMID: 37967238
  5. Goodarzi, M. O., Dumesic, D. A., Chazenbalk, G., & Azziz, R. (2011). Polycystic ovary syndrome: etiology, pathogenesis, and diagnosis. Nature Reviews: Endocrinology, 7(4), 219–231. PMID: 21263450
  6. Tata, B., Mimouni, N. E. H., Barbotin, A. L., Malone, S. A., Loyens, A., Pigny, P., Dewailly, D., Catteau-Jonard, S., Sundström-Poromaa, I., Piltonen, T. T., Dal Bello, F., Medana, C., Prevot, V., Clasadonte, J., & Giacobini, P. (2018). Elevated prenatal anti-Müllerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood. Nature Medicine, 24(6), 834–846. PMID: 29760445
  7. Delgado, B. J., & Lopez-Ojeda, W. (2023). Estrogen. In StatPearls. StatPearls Publishing. PMID: 30855848
  8. Nassar, G. N., & Leslie, S. W. (2023). Physiology, Testosterone. In StatPearls. StatPearls Publishing. PMID: 30252384
  9. Rodriguez Paris, V., & Bertoldo, M. J. (2019). The mechanism of androgen actions in PCOS etiology. Medical Sciences (Basel, Switzerland), 7(9), 89. PMID: 31466345
  10. American College of Obstetricians and Gynecologists. (2022) FAQs: Polycystic ovary syndrome (PCOS). Retrieved July 26, 2024, from https://www.acog.org/en/womens-health/faqs/polycystic-ovary-syndrome-pcos external link

How do health care providers diagnose PCOS?

Because symptoms of PCOS can differ widely, researchers and health care providers focus on specific features to diagnose the condition.

There are currently different approaches to diagnosing PCOS, but most require two of the following features:

  1. Absence of or irregular ovulation, resulting in menstrual irregularities such as light periods or skipped periods
  2. High levels of androgens that do not result from other causes or conditions, or signs of high androgens, such as increased body or facial hair
  3. Growths of a specific size in one or both of the ovaries, often clumps of ovarian follicles that have stopped developing, as detected by ultrasound

One diagnostic approach requires only features 1 and 2, while another looks for any two of the three for a PCOS diagnosis. The third approach requires feature 1, plus 2 or 3.

Please note that current diagnostic guidelines apply to adults. There are currently no diagnostic criteria for PCOS in adolescents.

Some adolescents may be deemed “at risk” for PCOS if they have some of its characteristic features, so the health care provider can reevaluate their symptoms and health later in life.1, 2 Researchers are also exploring whether people with PCOS have detectable markers of the condition in childhood and the teen years, to better pinpoint diagnosis and improve care.

Citations

  1. Teede, H. J., Tay, C. T., Laven, J. J. E., Dokras, A., Moran, L. J., Piltonen, T. T., Costello, M. F., Boivin, J., Redman, L. M., Boyle, J. A., Norman, R. J., Mousa, A., & Joham, A. E. (2023). Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. The Journal of Clinical Endocrinology and Metabolism, 108(10), 2447–2469. PMID: 37580314
  2. Pal, L. (2019). Polycystic Ovary Syndrome in Adolescents [Webinar]. American Society for Reproductive Medicine Grand Rounds Webinar Series in Reproductive Endocrinology and Infertility. Retrieved on July 26, 2024, from https://www.youtube.com/watch?v=zIT6Vs1rUGc external link

What are the treatments for PCOS?

Treatments for PCOS, its specific symptoms, and its associated health problems vary, but they may include medications, lifestyle changes, and ways to address increased hair growth and acne.

Because PCOS has a broad range of symptoms, health care providers may use a variety of treatments for this condition and its symptoms.1

The treatment(s) your health care provider suggests will depend on your symptoms, overall health, and plans for pregnancy.

Because some of the common treatments for PCOS symptoms can prevent pregnancy or may harm the fetus during pregnancy, it's important to discuss your fertility goals with your health care provider when discussing treatment options. Be sure you fully understand your treatment options and their effects on pregnancy before deciding on a course of treatment.

Please note that treatments have risks and side effects, some of them serious. You should discuss the risks and possible side effects of treatments with your health care provider. Because some lifestyle choices, such as smoking cigarettes, can increase these risks, you should discuss all these factors with your health care provider before making decisions about treatments.

Many of the treatments discussed are not approved by the U.S. Food and Drug Administration (FDA) specifically for treating PCOS, meaning they cannot cure or prevent the condition. However, your health care provider may recommend them to treat symptoms of PCOS, such as acne and irregular periods.

The following information describes available treatments for different symptoms of PCOS. You can also review the treatment options for infertility related to PCOS.

Research shows that, if a person with PCOS has overweight or obesity, losing a small amount of weight and being more physically active can minimize many PCOS symptoms and related health issues, especially cardiovascular risks.2

  • Weight loss can restore ovulation and help make menstrual cycles more regular, which can improve chances of pregnancy and overall health.2,3
  • Losing weight can improve both insulin and cholesterol levels.2,4
  • For many people with PCOS, weight loss also reduces symptoms such as increased hair growth and acne.2,5
  • Physical activity can help reduce depression associated with PCOS.6

Adjusting your diet to reduce foods that can cause or increase inflammation could also be beneficial.7 Talk to your health care provider about designing a diet and physical activity plan just for you.

Also called birth control pills or “the pill,” oral contraceptives containing the hormones estrogen and progestin are the primary long-term treatment option for people with intact ovaries who have PCOS but do not wish to become pregnant.2 In people with PCOS, these hormones:2

  • Make menstrual periods more regular
  • Reduce the level of androgens, leading to lower androgen activity
  • Help clear acne and reduce increased hair growth

Oral contraceptives can help lower the risk of certain types of cancers, but they may also raise the risk of other types of cancers.8 There is no one oral contraceptive that works best for people with PCOS. However, some pills contain progestin, and some types of progestin have “androgenic” side effects, such as oily skin, acne, and increased hair growth. For this reason, birth control pills that contain a low-androgenic progestin that does not activate these side effects are more effective at treating the symptoms of PCOS.9

These types of medications make the body more responsive to insulin and keep glucose levels more stable.2,10 In people with PCOS, these medications can help:

  • Clear acne and reduce hair growth
  • Improve weight loss
  • Lower cholesterol levels
  • Make periods more regular
  • Slightly reduce infertility associated with PCOS11

After 4 to 6 months of using these medications, people with PCOS who have ovaries may start ovulating naturally.12

Insulin-sensitizing medications, such as metformin, are not FDA approved to treat PCOS, but may help reduce symptoms. Talk to your health care provider about any concerns you may have about these medications.13

These medications either prevent the body from making androgens or limit the activities or effects of those hormones. In people with PCOS, anti-androgens can:

  • Lower androgen levels
  • Reduce hair growth
  • Clear acne

Because anti-androgens can cause congenital anomalies, they are often taken with oral contraceptives to prevent pregnancy.14 Be sure to talk with your health care provider about the risks of these treatments, especially if you want to become pregnant.

Anti-androgen medications are not FDA approved to treat PCOS but may help reduce symptoms. Currently, the best type of anti-androgen for treating PCOS symptoms is not known.

Those who wish to remove or otherwise address unwanted hair or increased growth for personal aesthetic reasons can use the following methods instead of or in combination with other approaches:13

  • Daily application of an eflornithine cream slows hair growth, especially on the face, by blocking an enzyme hair needs to grow. The hair will grow back when use of the cream stops, so those interested should talk with a health care provider about a long-term management plan.
    • Eflornithine is FDA approved for the treatment of unwanted facial hair, but no studies have been published about its use specifically in people with PCOS.13
    • Some studies in animal models suggest that combining the cream use with mechanical methods, such as microneedles, may improve outcomes.15
    • Pregnant people should not use this cream because it can cause harm to a fetus. Talk to your health care provider about risks, benefits, and your fertility goals before using the cream.16
  • Mechanical methods, such as shaving, bleaching, plucking, waxing, and using depilatories (creams that dissolve hair), are also effective at temporarily removing or hiding unwanted hair. Some of these methods, such as shaving and plucking, are associated with skin irritation and the development of ingrown hairs. Similarly, some depilatories can cause irritation and rashes.
  • Electrolysis, lasers, and intense pulsed light (IPL) therapy are options for permanent or long-term hair removal. These treatments may require multiple sessions to remove hair.2 Electrolysis uses an electric current applied to each hair follicle to destroy its root. Laser hair removal uses a laser beam to destroy the root of the hair follicle. IPL therapy uses an intense flash of light in a specific wavelength to target the melanin, or color, in hair to destroy the hair follicle.

Retinoids, antibacterial agents, and antibiotics are common ways to treat acne; the specific treatment recommended depends on the severity of the acne. The treatments come in a variety of forms, such as pills, creams, or gels, and in different strengths; higher strength options may require a prescription.

Because retinoids can cause congenital anomalies, those who are or wish to become pregnant should not use the treatments.2

Citations

  1. Teede, H. J., Tay, C. T., Laven, J. J. E., Dokras, A., Moran, L. J., Piltonen, T. T., Costello, M. F., Boivin, J., Redman, L. M., Boyle, J. A., Norman, R. J., Mousa, A., & Joham, A. E. (2023). Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. The Journal of Clinical Endocrinology and Metabolism, 108(10), 2447–2469. PMID: 37580314
  2. American College of Obstetricians and Gynecologists. (2022) FAQs: Polycystic ovary syndrome (PCOS). Retrieved July 26, 2024, from https://www.acog.org/en/womens-health/faqs/polycystic-ovary-syndrome-pcos external link
  3. Badawy, A., & Elnashar, A. (2011). Treatment options for polycystic ovary syndrome. International Journal of Women's Health, 3, 25–35. PMID: 21339935
  4. National Heart, Lung, and Blood Institute. (2005). Aim for a healthy weight. Retrieved July 26, 2024, from https://www.nhlbi.nih.gov/resources/aim-healthy-weight-patient-booklet
  5. Moran, L. J., Hutchison, S. K., Norman, R. J., & Teede, H. J. (2011). Lifestyle changes in women with polycystic ovary syndrome. The Cochrane Database of Systematic Reviews, (2), CD007506. PMID: 21328294
  6. Lamb, J. D., Johnstone, E. B., Rousseau, J. A., Jones, C. L., Pasch, L. A., Cedars, M. I., & Huddleston, H. G. (2011). Physical activity in women with polycystic ovary syndrome: prevalence, predictors, and positive health associations. American Journal of Obstetrics and Gynecology, 204(4), 352.e1–352.e3526. PMID: 21288501
  7. Azarbayjani, K., Jahanian Sadatmahalleh, S., Mottaghi, A., & Nasiri, M. (2024). Association of dietary inflammatory index with C-reactive protein and interleukin-6 in women with and without polycystic ovarian syndrome. Scientific Reports, 14(1), 3972. PMID: 38368454
  8. National Cancer Institute. (2018). Oral contraceptives and cancer risk. Retrieved July 26, 2024, from https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet
  9. Mathur, R., Levin, O., & Azziz, R. (2008). Use of ethinylestradiol/drospirenone combination in patients with the polycystic ovary syndrome. Therapeutics and Clinical Risk Management, 4(2), 487–492. PMID: 18728832
  10. Nandi, A., Chen, Z., Patel, R., & Poretsky, L. (2014). Polycystic ovary syndrome. Endocrinology and Metabolism Clinics of North America, 43(1), 123–147. PMID: 24582095
  11. Legro, R. S., Barnhart, H. X., Schlaff, W. D., Carr, B. R., Diamond, M. P., Carson, S. A., Steinkampf, M. P., Coutifaris, C., McGovern, P. G., Cataldo, N. A., Gosman, G. G., Nestler, J. E., Giudice, L. C., Leppert, P. C., Myers, E. R., & Cooperative Multicenter Reproductive Medicine Network (2007). Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. The New England Journal of Medicine, 356(6), 551–566. PMID: 17287476
  12. Barbieri R. L. (2003). Metformin for the treatment of polycystic ovary syndrome. Obstetrics and Gynecology, 101(4), 785–793. PMID: 12681887
  13. Radosh L. (2009). Drug treatments for polycystic ovary syndrome. American Family Physician, 79(8), 671–676. PMID: 19405411
  14. Martin, K. A., Anderson, R. R., Chang, R. J., Ehrmann, D. A., Lobo, R. A., Murad, M. H., Pugeat, M. M., & Rosenfield, R. L. (2018). Evaluation and treatment of hirsutism in premenopausal women: An Endocrine Society Clinical Practice guideline. The Journal of Clinical Endocrinology and Metabolism, 103(4), 1233–1257. PMID: 29522147
  15. Kumar, A., Naguib, Y. W., Shi, Y. C., & Cui, Z. (2016). A method to improve the efficacy of topical eflornithine hydrochloride cream. Drug Delivery, 23(5), 1495–1501. PMID: 25182303
  16. U.S. Food and Drug Administration. (2000). VANIQA™ (eflornithine hydrochloride) cream, 13.9%. Retrieved July 26, 2024, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/21145lbl.pdf (PDF 236 KB)

Treatments for Infertility Resulting from PCOS

Fertility problems related to PCOS often are linked to the absence of ovulation (called anovulation), a key feature of PCOS. However, anovulation may not be the only factor in these problems. Before beginning treatment for infertility possibly related to PCOS, work with your health care provider to rule out other causes.1

Losing weight and other lifestyle changes can sometimes trigger body changes that facilitate conception in people with PCOS.2,3 Research shows that lifestyle changes can help restore ovulation and improve pregnancy rates among people with PCOS.3,4 Among people with PCOS who have obesity and who experienced menstrual dysfunction, losing even a small amount of weight improved menstrual function and fertility.5

Health care providers may also recommend one or more of the following treatments to improve fertility in people with PCOS. 

  • This drug is the most common treatment for infertility in people with PCOS.1 The American College of Obstetricians and Gynecologists (ACOG) recommends clomiphene as the primary medication for people with PCOS-related infertility. It is also U.S. Food and Drug Administration (FDA) approved for treating PCOS-related infertility.6
  • Clomiphene indirectly causes eggs to mature and be released.7
  • Research shows that people who conceive with the aid of clomiphene are slightly more likely to have multiples, most commonly twins.8

  • Metformin—an insulin-sensitizing agent—can be used alone9 or with clomiphene when clomiphene alone is not successful to spur or regulate ovulation in people with PCOS.2,3
  • Evidence shows that metformin, alone and in combination with clomiphene, improves ovulation, but it does not increase the rate of pregnancy.10
  • Metformin is not FDA approved for treating PCOS-related infertility.

  • This drug briefly slows estrogen production and causes the body to make more follicle-stimulating hormone (FSH), a hormone needed for ovulation.11
  • An NICHD-supported study found that letrozole was more effective than clomiphene in causing ovulation and improving live-birth rates for people with PCOS.12
  • Studies of letrozole in animal models have shown that it causes congenital anomalies if used during pregnancy, but there have been no studies of this drug in pregnant people.11, 13

  • These hormones, given as shots, cause ovulation.
  • This treatment has a higher risk of multiple pregnancies than treatment with clomiphene.4
  • Your health care provider may use frequent laboratory tests and ultrasound exams to monitor how your body responds to this treatment.4

  • Because the benefits of this surgery, by itself or in addition to medication treatment, for increasing the chance of ovulation14 is unclear, it is not recommended by all health care provider groups.
  • It may be considered if lifestyle changes and medications are unsuccessful and often in combination with other treatments.
  • In ovarian drilling, the surgeon makes a small cut in the abdomen and inserts a long, thin tool called a laparoscope. The surgeon then uses a needle with electric current to puncture and destroy a small part of the ovary.
  • The surgery may lead to lower androgen levels, which may improve ovulation. However, it does not seem to improve other metabolism problems, and its effects may be short-lived.
  • Drilling surgery does not seem to increase the risk of multiple pregnancies.15 However, it does carry the risk of scarring the ovaries.8

If these treatments are not successful, your health care provider may suggest in vitro fertilization (IVF), or another type of assisted reproductive technology (ART).16 IVF may offer the best chance of pregnancy for people with PCOS. Different types of ART have their own risks and benefits. You should discuss all the options thoroughly with your health care provider before deciding.

Citations

  1. American Society for Reproductive Medicine. (n.d.). Frequently asked questions about infertility. Retrieved July 26, 2024, from https://www.reproductivefacts.org/faqs/frequently-asked-questions-about-infertility/ external link
  2. ACOG. (2015). Polycystic ovary syndrome frequently asked questions. Retrieved July 26, 2024, from http://www.acog.org/Patients/FAQs/Polycystic-Ovary-Syndrome-PCOS external link
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  15. Fernandez, H., Morin-Surruca, M., Torre, A., Faivre,E., Deffieux, X., & Gervaise, A. (2011). Ovarian drilling for surgical treatment of polycystic ovarian syndrome: A comprehensive review. Reproductive Biomedicine Online, 22(6), 556–568.
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Polycystic Ovary Syndrome (PCOS) | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development
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