What is PCOS? Symptoms, causes and treatment

Polycystic ovary syndrome, also called PCOS, is a hormonal disorder that affects sex hormones and creates many follicles in the ovaries. This means that women may have irregular periods and few or no ovulations.

If you are diagnosed with PCOS, you are far from alone. The Danish Health Authority has previously estimated that 5–10 percent of all women of reproductive age have PCOS.

What is polycystic ovary syndrome (PCOS)?

The word syndrome in polycystic ovary syndrome means that women with PCOS often have several symptoms at the same time.

To receive a PCOS diagnosis, you need to meet at least two of the following three criteria:

• An ultrasound scan by a doctor/gynecologist shows more than 20 follicles on one or both ovaries. The doctor may also measure AMH (anti-Müllerian hormone) with a blood test. A high AMH value indicates many follicles in the ovaries.
• Elevated male hormones in the blood (confirmed by a blood test). This is often seen as increased hair growth on the face or body and acne.
• Lack of ovulation, shown by cycles longer than 35 days or fewer than 8 periods per year.

Polycystic ovaries mean that the ovaries are enlarged and contain many small follicles.

Hormonal imbalances caused by PCOS can lead to few or no ovulations. Many women with PCOS therefore struggle to conceive and may be infertile, meaning they have not become pregnant after more than a year of trying.

PCO means having polycystic ovaries only – the many small cysts in the ovaries – without meeting the full criteria for PCOS.

Find our supplements and cycle tracking products for PCOS here.

What are the symptoms of PCOS?

Women with PCOS have hormonal imbalances where the body produces too many male hormones. This often causes acne, and more than half (around 70%) experience unwanted hair growth on the face and body. About half of women with PCOS do not menstruate at all, while 30% have irregular cycles.

Around 65% of all women with PCOS are overweight, which can worsen the symptoms.

What are the symptoms of PCO?

The symptoms of PCO are similar to those of PCOS. Many people do not distinguish between PCOS and PCO, since it is rare to have only polycystic ovaries without hormonal imbalance.

Women with PCO may also struggle with overweight, infertility, and type 2 diabetes, as insulin resistance often develops.

PCOS and fertility

PCOS is a hormonal disorder. It creates an imbalance with too much LH (luteinizing hormone), which triggers ovulation, and too little FSH (follicle stimulating hormone), which matures the egg before ovulation. The lack of regular ovulation can make it difficult to conceive without support.

Read more in our article PCOS and fertility – how to increase your chances of getting pregnant.

Also see our article PCOS and fertility – supplements that can support your cycle.

PCOS and the wish to conceive

About 65% of women with PCOS are overweight. Weight loss can help bring back menstruation and ovulation. Both weight loss and exercise improve insulin sensitivity in the muscles, which reduces male hormones, decreases unwanted hair growth, and makes ovulation more regular. Exercise, especially at higher intensity, at least 30 minutes per day, has also been shown to improve insulin sensitivity and help stabilize ovulation.

Still, many women with PCOS cannot conceive naturally and need fertility treatment. If you have tried to get pregnant for 6–12 months without success, you should see your doctor for referral to a gynecologist or fertility clinic.

PCOS and ovulation tests

It is possible to use ovulation tests if you have PCOS. Because the cycle is often irregular and unpredictable, ovulation tests can be a useful tool.

However, some women with PCOS find it harder to interpret results correctly, because PCOS can cause elevated LH levels throughout the cycle. This may lead to false positives.

If you want to use ovulation tests with PCOS, consider the following:

• Combine tests with other methods: such as basal body temperature (BBT) or cervical mucus tracking.
• Consistency: test at the same time every day and look for patterns across cycles.
• Talk to your doctor: you may benefit from guidance about whether ovulation tests are the right tool for you.

Find our selection of ovulation tests here.

Who is affected by PCOS?

PCOS is seen in 5–10% of all women of reproductive age. It often starts in puberty and is more common among women who are overweight, with higher blood sugar and blood pressure.

PCOS is hereditary, so your risk is higher if other women in your family are affected. It is also more common in families with diabetes or cardiovascular disease.

How is PCOS diagnosed?

If PCOS is suspected, your doctor may do an ultrasound of your ovaries to look for multiple follicles and check the thickness of the uterine lining. Blood tests are often used to measure estrogen, progesterone, and testosterone levels.

Read more about progesterone and fertility here.

Treatment of PCOS

Women with PCOS can already be referred to fertility treatment after 6 months of trying to conceive without success (compared to 12 months for women without PCOS). Since women with PCOS often have many eggs, IVF treatment is usually effective.

Read more about fertility treatment options covered by the Danish healthcare system here.

IVF outcomes are generally good. Women with PCOS usually have plenty of eggs, and most achieve the pregnancies they wish for. Some conceive naturally after lifestyle changes and weight loss.

PCOS and treatment of irregular menstruation

Birth control pills or metformin are often used. Metformin increases insulin sensitivity, lowers male hormones, and can help regulate cycles and reduce unwanted hair growth.

PCOS and treatment of unwanted hair growth

Metformin may also help reduce unwanted hair growth. In addition, women may be eligible for hair removal with electrolysis or laser through the public healthcare system.

Weight loss and PCOS

PCOS is worsened by overweight, while weight loss can reduce or even eliminate symptoms. Women with PCO also have a higher risk of developing PCOS if they become overweight.

A weight loss of just 5–10% can help some women regain ovulation and more regular periods.

PCOS diet advice

Research shows that the KISS diet can help women with PCOS. KISS stands for clinically insulin lowering diet and was developed by gynecologist Bjarne Stigsby and Charlotte Hartvig. The 10 principles are:

1. Avoid sugar
2. Cut down on fast carbs
3. Choose slow carbs
4. Eat more protein
5. Eat more fat
6. Eat fish
7. Eat a varied diet
8. Eat breakfast
9. Drink water
10. Exercise

Read more about the KISS diet in our article here.

Sources: Sundhed.dk, Netdoktor.dk, Aalborg University Hospital, Regional Hospital Viborg, Medicin.dk