Polycystic Ovary Syndrome (PCOS): 10 Things Doctors Want You to Know

Medically Reviewed By William C. Lloyd III, MD, FACS
Written By Lorna Collier on January 27, 2020
  • Woman talking with doctor
    Tips for Living With PCOS from Specialists
    Your experience with polycystic ovary syndrome  (PCOS) may be different from another woman's, since symptoms of this complex endocrine disorder can vary. Doctors increasingly are finding this condition to involve reproductive and metabolic systems, affecting not just fertility but cardiovascular health, with effects that can be life-long. We talked to three polycystic ovary syndrome doctors—gynecologists who specialize in reproductive endocrinology—to gather their advice about living with PCOS.
  • Portrait of smiling business women standing together
    1. "You don't have to be overweight to have PCOS."
    "It's not just obese women that have this diagnosis," says Rachel Mejia, DO, a reproductive endocrinologist at the University of Iowa Hospitals & Clinics in Iowa City. "Women who are normal weight have PCOS as well." Yet, the misconception that PCOS is a disease only affecting heavy women is even shared by some doctors, says Carolyn Givens, MD, a reproductive endocrinologist in San Francisco. "They think to have a diagnosis of polycystic ovary syndrome you have to be obese...yet a lot of women are very lean and have PCOS." (Research indicates that 40 to 80% percent of women with PCOS are overweight or obese.)
  • close-up-of-woman-looking-at-acne
    2. "We look at three key criteria when diagnosing polycystic ovary syndrome."
    Most doctors follow the "Rotterdam criteria," developed in 2003, to determine how to diagnose polycystic ovary syndrome, says Dr. Givens. Only two of three major features of PCOS need to be present for the diagnosis to be made. The signs are: having hyperandrogenism (excess male hormone, which can cause extra body hair and severe acne); no ovulation or irregular ovulation; and multiple cysts on the ovaries. Doctors also must rule out other conditions that can cause these signs—such as congenital adrenal hyperplasia and thyroid disorders—before arriving at a PCOS determination, Dr. Givens says.
  • woman in bathroom looking at eyes in mirror
    3. "Sometimes women aren't diagnosed with PCOS until going off the pill."
    Most often, women are diagnosed with PCOS in young adulthood, according to Dr. Mejia. But some patients come to her in their late 20s or 30s after noticing symptoms of PCOS that arise after they stop taking oral contraceptives, which they have been on for a decade or more. "The pill was taking care of symptoms like irregular menstrual cycles and excess hair growth for them," she says—essentially, treating a PCOS that they didn't realize they had when they started on the medication.
  • woman-sleeping-in-bed-snoring
    4. "Your PCOS puts you at risk of sleep apnea—even if you aren't overweight."
    Sleep apnea is "very prevalent" with PCOS patients, regardless of whether the patient is overweight or normal weight, says Daniel Dumesic, MD, a reproductive endocrinologist at the University of California Los Angeles. He blames male hormones: "We think probably there's some subtle actions of testosterone on the sleep center of the brain," he says. Some physicians "don't recognize that PCOS women are at [higher] risk for sleep apnea, because they associate that with heavy people," says Dr. Dumesic. People with PCOS need to be aware they are at risk of developing apnea, which is linked to other health conditions, such as heart disease, he says; also, being overweight can make sleep apnea worse.
  • abdominal-weight-female-patient
    5. "The emotional impact of having PCOS should not be ignored."
    "There's a very high risk of mood affective disorder in PCOS women—essentially depression, along with poor body image," says Dr. Dumesic. Often doctors don't bring this up with patients, because "it's a complicated issue, which takes a lot of time and discussion. And physicians don't have a lot of time." He recommends therapy, either individually or in groups. "So many women with PCOS feel alone," says Dr. Givens, who recommends support groups as a coping mechanism—though she cautions that women who attend need to be wary about "misinformation that gets passed around in those settings."
  • Dark hair woman smling and looking at a baby boy
    6. "Polycystic ovary syndrome can affect your baby's health."
    PCOS doesn't just cause fertility problems, but also raises risks of gestational diabetes, miscarriage, premature birth, and long-term consequences for your child's health, says Dr. Dumesic. Babies born to PCOS moms who have struggled with their weight are more likely to be overly heavy at birth and can inherit metabolic problems leading to childhood obesity, he says. He advises women to lose weight "way before they are even interested in conception" to reduce risks, rather than waiting until a few months before getting pregnant.
  • male doctor with concept of healthy female reproductive system showing vaginal canal, cervix, uterus, fallopian tubes and ovaries
    7. "PCOS and endometriosis both cause infertility, but are very different conditions."
    Polycystic ovary syndrome and endometriosis each affect about 10% of women, can cause infertility and can be misdiagnosed for years. But they are "two completely different diagnoses," says Dr. Mejia, and "are evaluated and managed very differently." Endometriosis occurs when endometrial glands implant outside the uterus, such as in the abdomen, she explains. PCOS, on the other hand, can cause endometrial tissue to build up within the lining of the uterus (or endometrium), which creates a precancerous condition called endometrial hyperplasia.
  • Food with unsaturated fats
    8. "The best polycystic ovary syndrome diet is low-carb."
    If a woman with PCOS is struggling to lose weight, Dr. Givens often prescribes the diabetes drug Metformin, which can help some women drop pounds. She also encourages dietary changes. "The real big killer is carbs," she says. "PCOS patients need to eat a Mediterranean diet with low carbs and more fats. We need more of our calories from fat so that we don't eat more carbs, which leads to more insulin resistance."
  • Composition with containers of dietary supplements and capsules
    9. "One alternative PCOS remedy has shown promise in recent studies."
    The over-the-counter supplement myo-inositol, an insulin sensitizer, may help make women with PCOS "physiologically a little bit more normal," providing better success with embryo implantation, says Dr. Givens. The supplement, when combined with alpha-lipoic acid, also helps restore menstrual pattern and a normal hormone balance, research shows. "A typical dose would be 2,000 milligrams twice daily, or 2 grams," Dr Givens says. "I would definitely purchase it from a well-known company," she cautions, noting that supplement companies aren't well-regulated.

    Supplement brands with the USP Verified Mark only receive this designation after thorough testing for purity and quality by United States Pharmacopeia.
  • Female doctor talking to a patient
    10. "Doctors need to take a holistic, individualized approach to treating PCOS."
    Patients are often dissatisfied with PCOS care, says Dr. Dumesic. It can take a long time to get diagnosed, and they often have to see doctors in different specialties to get help. "There's this piecemeal care that PCOS women go through and you end up going to many doctors to get at what's going on," he says, with few doctors approaching PCOS as "a combined metabolic-reproductive dysfunction." Dr. Dumesic calls for more attention to preventive healthcare and long-term planning with patients to address their symptoms, risk factors, and concerns—a holistic approach that will "ultimately improve the health of the woman overall."
Polycystic Ovary Syndrome (PCOS): 10 Things Doctors Want You to Know
Contributors
  • Rachel Mejia, DO - Healthgrades - Polycystic Ovary Syndrome: 10 Things Doctors Want You to Know
    Reproductive endocrinologist, clinical assistant professor, and Director of Fertility Preservation, University of Iowa Hospitals & Clinics, Iowa City, Iowa.
  • Carolyn Givens, MD - Healthgrades - Polycystic Ovary Syndrome: 10 Things Doctors Want You to Know
    Reproductive endocrinologist at Pacific Fertility Center in San Francisco, Calif.
  • Daniel Dumesic, MD - Healthgrades - Polycystic Ovary Syndrome: 10 Things Doctors Want You to Know
    Reproductive endocrinologist, Ronald Reagan UCLA Medical Center in Los Angeles and UCLA Medical Center in Santa Monica, Calif; professor and Division Chief of Reproductive Endocrinology and Infertility at UCLA.

About The Author

Lorna Collier has been reporting on health topics—especially mental health and women’s health—as well as technology and education for more than 25 years. Her work has appeared in the AARP Bulletin, Chicago Tribune, U.S. News, CNN.com, the APA’s Monitor on Psychology, and many others. She’s a member of the American Society of Journalists and Authors and the Association of Health Care Journalists.
  1. Sam S. Obesity and Polycystic Ovary Syndrome. Obesity Management. 2007:3(2), 69-73. doi:10.1089/obe.2007.0019
  2. PCOS (Polycystic Ovary Syndrome) and Diabetes. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/pcos.html
  3. Endometriosis. U.S. Department of Health & Human Services. Office on Women's Health (Womenshealth.gov), https://www.womenshealth.gov/a-z-topics/endometriosis
  4. Advani K, Batra M, Tajpuriya S, et al. Efficacy of combination therapy of inositols, antioxidants and vitamins in obese and non-obese women with polycystic ovary syndrome: an observational study.Journal of Obstetric Gynaecology. 2019 Jul 24:1-6. doi: 10.1080/01443615.2019.1604644
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Jan 15
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