Polycystic ovary syndrome (PCOS) | Huahua hua kūao

Also known as polycystic ovarian syndrome (PCOS)

Key points about PCOS

  • Polycystic ovary syndrome (PCOS or huahua hua kūao) is a hormonal condition that affects how your ovaries work.
  • PCOS is associated with increased levels of 2 hormones in your body: insulin and testosterone (male-type hormones).
  • Symptoms range from mild to severe. They can include irregular or heavy periods, acne, excess facial or body hair, scalp hair loss and weight gain.
  • The 3 diagnostic features of PCOS are irregular periods, excess testosterone and polycystic ovaries. If you have 2 of these you may be diagnosed with PCOS.
  • There are things you can to reduce the symptoms and the long-term effects on your health.
  • Living with PCOS can be challenging, so getting good support and taking care of your emotional wellbeing is important.
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If you’re of childbearing age, you generally produce an egg from an ovary every month. This process requires a fine-tuned response from a complex hormonal system. If you have PCOS, more testosterone and insulin is produced than is needed.


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This excess hormone stops the release of eggs from your ovary, but it doesn't stop them being produced. The eggs continue to build up in your ovaries, which is why the condition is referred to as polycystic ovaries (many cysts in your ovaries)

Video: PCOS

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(Fertility NZ, 2013)

Video: What is PCOS? (Brief animation)

(Monash Centre for Health Research and Implementation, Australia, 2022)

PCOS can begin at puberty or even in early to mid-20s. It is the most common hormonal condition affecting women of childbearing age, about 8–13 out of every 100 people.

You may not know you have PCOS until you have difficulty getting pregnant.

The cause of PCOS is not yet known but it might run in families. If any of your relatives are affected with PCOS, your risk of developing it may be increased.

The symptoms are related to increased hormone levels, mainly testosterone and insulin.

  • Testosterone is a hormone produced by the ovaries. If you have PCOS, your ovaries produce much more testosterone than they need to. This excess is what causes many of the symptoms of PCOS.
  • Insulin is a hormone that controls the level of glucose (a type of sugar) in your blood. If you have PCOS, your body may not be able to use the insulin as it should (this is known as insulin resistance(. As a result, the level of glucose in your blood becomes too high. To try to lower your blood glucose levels, your body produces even more insulin. High levels of insulin can lead to weight gain, irregular periods and fertility problems.

The symptoms vary from person to person. Some have very few or mild symptoms, while others are affected more severely by a wider range of symptoms.

Common symptoms of PCOS

Periods and fertility

  • irregular, infrequent or no period
  • difficulty becoming pregnant
  • multiple cysts on your ovaries
  • endometrial hyperplasia.

Hair, skin and body

  • acne on face or body, can be severe
  • excess hair on face, chest or tummy  (hirsutism)
  • hair loss or thinning of hair on your head (alopecia)
  • being overweight or experiencing a rapid increase in weight
  • having difficulty losing weight.

Mental/emotional health

Hormonal changes and dealing with the symptoms of PCOS can cause:

These feelings can affect your overall quality of life. Read more about PCOS and emotional wellbeing.

Related conditions

Having PCOS may increase your chance of developing:

PCOS can be a complex condition to diagnose because there are many symptoms, and you don’t have to have all of them to be diagnosed with PCOS. Very few people have the same set of symptoms, and the symptoms can change at different stages of your life.

To diagnose PCOS, your doctor will assess your symptoms, medical history and physical appearance. You may need to do some tests to confirm it and/or rule out other medical conditions.

Diagnostic criteria for PCOS

To make a diagnosis of PCOS, 2 out of 3 of the following are required:

1. Irregular periods or no periods.

2. Higher levels of testosterone, as shown by:

  • a blood test or
  • symptoms such as:
    • excess body or facial hair
    • acne
    • scalp hair loss.

3. Polycystic ovaries visible on ultrasound (only done if you have been having periods for 8 years or more).

If the first 2 criteria are both present, an ultrasound scan is not usually required.

While there is no cure for PCOS, with the right support you can greatly reduce the symptoms and long-term effects on your health. Because PCOS can have many symptoms, a range of treatments might be necessary to manage the condition well. The key to managing PCOS well is working in partnership with your healthcare team to find the best strategies for you. PCOS support groups can also be inviable sources of helpful information.

Managing PCOS with lifestyle

Healthy lifestyle has been shown to be the most effective approach to managing PCOS successfully and reducing the severity of symptoms. A healthy lifestyle includes eating a balanced and nutritious diet, being as active as possible, maintaining a healthy weight and minimising harmful habits such as smoking and excessive drinking.

Healthy eating

What you eat plays an important role in the management of PCOS. When it comes to achieving a healthy weight,  eating a healthy diet is more effective than exercise alone.

A healthy diet helps not only with weight control, but also with reducing the risk of related health conditions such as type 2 diabetes and cardiovascular disease.

If you need to lose weight, the recommended way to do so is to reduce your overall food intake and eat a nutritionally balanced diet.3 It may take a bit of trial and error to find an approach that works best for you, with the focus being to find a plan that you can continue with in the long term.

Learn more about healthy eating.

Physical activity

Being physically active every day can help with PCOS symptoms and reduce the risk of developing related long-term health conditions. Try to include some kind of exercise in your daily routine. This could include moderate or vigorous aerobic exercise or resistance (using weights) exercise. Research has shown any type of regular exercise is effective in improving PCOS symptoms. 

Learn more about exercise and physical activity.

Healthy weight

Having PCOS can mean you are more likely to gain weight and are at higher risk of developing unhealthy weight (up to 60% of those with PCOS are an unhealthy weight). This may be because the hormones involved in controlling appetite and hunger aren't regulated properly. 

If you are overweight, even a small weight loss will help improve the symptoms of PCOS. Losing 5–10% of your body weight can have a significant impact on PCOS symptoms. Maintaining a healthy weight can help relieve PCOS-related symptoms and lead to more regular periods, less acne, a decrease in excess hair growth and improved mood and self-esteem.

Due to hormonal influences, losing weight if you have PCOS can be a challenge. However, losing weight may help to lower your blood glucose levels, improving the way your body uses insulin and helping your hormones reach normal levels. If you are struggling to find a weight loss plan that works for you, ask a dietitian for advice.

Learn more about healthy weight loss

Managing PCOS with medicines

Medication alone has not been shown to be any better than healthy lifestyle changes in managing PCOS. You may be able to successfully manage your symptoms and long-term health risks without medical intervention.

There are a number of medications used to manage the different symptoms of PCOS, including for acne, excess hair growth, problems with your periods and fertility issues. Some medicines may help more than one symptom. PCOS affects everyone differently and your doctor will work out which medicines best meet your needs.

Sometimes excessive hair growth is best managed with both medical treatment and electrolysis or laser therapy. Your doctor can advise what’s best for you.

Contraceptive pill

The contraceptive pill is commonly prescribed to help regulate periods. The pill increases levels of sex hormone binding globulin (SHBG), which binds to testosterone in your blood. This reduces the activity of testosterone and therefore reduces symptoms related to higher levels of testosterone. 

No one hormonal contraceptive is optimal in PCOS. Generally, you will be started on a lower dose preparation. Higher doses are used for severe symptoms.

Progestogen

You may be prescribed progestogen (a synthetic version of the female hormone progesterone) so you have regular periods. Examples of progestogen are medroxyprogesterone (Provera) and norethisterone (also called Primolut N).

Isotretinoin

Isotretinoin is used for severe acne that hasn’t been helped by other treatments. It works by reducing the amount of oil your skin produces and shrinking the oil glands in your skin. It is usually prescribed by a specialist doctor as it has many side effects. It should not be used in pregnancy or if you become pregnant as there is a high risk of permanent damage to the unborn baby. Read more about isotretinoin and acne treatments.

Metformin

Metformin is commonly used in people with type 2 diabetes, but can also can help to reduce some symptoms of PCOS. It helps your body make better use of the insulin it produces. It can help with weight loss and blood pressure. It can also often restore your menstrual cycle, as well as helping control excess body hair caused by high testosterone levels. Common side effects are nausea (feeling sick) and tummy upset.

Women with PCOS have a higher chance of getting type 2 diabetes, but taking metformin can help delay or prevent this. Metformin should be used together with increased exercise and a nutritious diet, not as a replacement for lifestyle changes. Read more about metformin for PCOS.

Spironolactone

Spironolactone used to reduce male-pattern hair growth and acne. It can reduce androgen levels. Up to 80% of women with PCOS see a reduction in excess hair growth when using spironolactone. It can take up to 6 months of daily use for it to become effective. It is a diuretic (water tablet) so it gets rid of excess salt and water in your body. Common side effects are nausea, vomiting, headaches and, rarely, rashes. Read more about spironolactone.

Managing your emotional wellbeing

PCOS can be a challenging condition to live with and it can affect your mental wellbeing. This may be due to a combination of hormonal influences and dealing with the symptoms of PCOS. It’s not uncommon to experience low self-esteem, poor self-image, anxiety and depression – all of which can affect your overall quality of life. 

Managing fertility

Having PCOS does not mean you can't get pregnant. PCOS is one of the most common, but treatable, causes of infertility. If you have PCOS, the hormonal imbalance interferes with the growth and release of eggs from your ovaries (ovulation). If you don't ovulate, you can't get pregnant. Your doctor or a fertility specialist can talk with you about ways to help you ovulate and to raise your chance of getting pregnant.  

Managing excess hair

Sometimes excessive hair growth is best managed with both medical treatment and electrolysis or laser therapy. Your doctor can advise what’s best for you. 

PCOS can increase your chances of developing health problems later in life, so you need to have regular medical check-ups. Some PCOS symptoms lessen after menopause, but this is likely to be the time many of the long-term associated conditions appear.

To reduce your risk of complications: 

  • follow a healthy diet and exercise regularly long before menopause
  • ask your doctor at what age you should start having cardiovascular risk assessments and getting your blood pressure checked regularly.

Looking after your emotional wellbeing with PCOS

PCOS can be challenging to live with. Symptoms such as excess body hair, acne, weight gain, scalp hair loss and reduced fertility can be distressing and make you feel down. You may also experience challenges with sexual relationships. 

Having the diagnosis of a long-term condition like PCOS can be worrying and can generate a range of emotions including stress. Below are our tips for looking after your emotional wellbeing with PCOS:

1. Monitor your emotional wellbeing

Being aware of your mental health and wellbeing can really help you feel better. Keeping a journal or using mindfulness techniques increases your awareness of your wellbeing needs. Good stress management is also part of monitoring your wellbeing.

2. Take steps to manage early symptoms

You should consider taking action if you:

  • feel down, depressed or hopeless
  • have little interest or pleasure in doing things
  • feel nervous, anxious or on edge
  • are not able to stop or control your worrying.

Taking steps as soon as you notice these symptoms is much easier than if you let them get worse. See our tips to manage anxiety and depression

3. Seek support of family and friends 

Seek support from your family/whānau and friends to help you achieve good emotional wellbeing. Educate people close to you about PCOS and the challenges you may face to your wellbeing.

4. Be active and exercise regularly

Be as active as possible – aim for at least half an hour per day of activity. Regular activity has been shown to boost brain chemicals that help to reduce your risk of emotional challenges.

5. Do things to boost your wellbeing

Make time for the things that uplift your mood and reduce your stress and anxiety. This may include time with friends or family/whānau, having time on your own, being out in nature, doing your favourite hobby, learning something you've always wanted to and so on. Practising gratitude has been found to boost wellbeing.

6. Get help if you need it

It's not easy living with PCOS, so it's understandable if you need some help. Talk to your GP. They may give you a referral to other health professionals if needed. You can also find a counsellor or therapist yourself(external link).

Brochures

Do I have PCOS?

Monash University, Australia, 2023

PCOS, fertility, and pregnancy

Monash University, Australia, 2023

Emotional Wellbeing and PCOS

Monash University, Australia, 2023

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Peter van de Weijer, obstetrician and gynaecologist

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