Polycystic Ovary Syndrome (PCOS)

Last Updated: August 16, 2022

Polycystic ovary syndrome (PCOS) is a hormone disorder that is common among women of reproductive age. PCOS is often caused by high androgen levels and frequently involves infertility, cysts on the ovaries, and metabolic abnormalities.

Polycystic Ovary Syndrome (PCOS) falls under theWomen’s HealthandSkin, Hair, & Nailscategories.

What is PCOS?

Polycystic ovary syndrome (PCOS) is an endocrine (hormone-related) disorder that affects a large number of pre-menopausal women, with prevalence rates ranging from 3–10% depending on the population and diagnostic criteria used.[1] PCOS is characterized by androgen excess (e.g., high testosterone, male-pattern body hair growth) and/or ovarian dysfunction (e.g., ovarian cyst-like growths, infertility, irregular menstruation).

What are the main signs and symptoms of PCOS?

Some of the most common signs and symptoms of PCOS are irregular menstruation cycles, obesity, hirsutism (male-pattern body hair growth), loss or thinning of hair on the scalp, and acne. Common findings include high circulating androgen (e.g., testosterone) levels and cyst-like growths on the ovaries. Other signs and symptoms include insulin resistance, including the risk of type 2 diabetes. PCOS is also often associated with comorbid conditions such as: obesity, dyslipidemia, type 2 diabetes, and infertility.[2]

How is PCOS diagnosed?

A diagnosis of PCOS is typically based on meeting at least 2 of the following 3 criteria: (1) anovulation or oligo-ovulation (indicated by a lack of or infrequent menses), (2) androgen excess, and (3) small cyst-like growths on at least one of the ovaries, with other potential causes of these factors (e.g., Cushing’s syndrome, thyroid dysfunction, hyperprolactinemia) being ruled out.[3][4]

What are some of the main medical treatments for PCOS?

Medical interventions used to treat PCOS target specific patient symptoms and presentation of the condition. For example, insulin resistance is usually treated with metformin, irregular periods are often treated with oral contraceptives, spironolactone might be tried for symptoms of androgen excess, and infertility can be treated with clomiphene.[5]

Have any supplements been studied for PCOS?

One of the most well studied supplements for PCOS is inositol. Some studies have found inositol can improve insulin resistance and fertility in PCOS, though the quality of the evidence is not especially high.[6][7] Other supplements investigated for PCOS include L-carnitine, omega-3 fatty acids (e.g., fish oil), alpha-lipoic acid, berberine, and N-Acetylcysteine.[8][9]

How could diet affect PCOS?

A variety of diets (e.g., DASH, low glycemic index, low carbohydrate) have been shown to be beneficial for females with PCOS. These diets can be conducive to a reduction in calorie intake, which is beneficial for conditions secondary to PCOS such as metabolic syndrome, obesity and impaired glucose tolerance.[10][11]

Are there any other treatments for PCOS?

Since PCOS is tightly linked with metabolic abnormalities, exercise is often recommended. In addition to reductions in insulin and insulin resistance, increased physical activity has also been linked to lower androgen levels and improved reproductive function in PCOS.[12][13] More research is needed to determine which types of exercise are most beneficial.

A number of studies have investigated the effect of acupuncture on PCOS, with effects seemingly no different than placebo.[14][15]

What causes PCOS?

A combination of environmental and genetic factors have been proposed to increase a person’s predisposition towards developing PCOS.[16]

High androgen levels seem to be the main cause of the clinical features of PCOS, including infertility, hirsutism, hair loss, and acne.[16] Also, about half of the women with PCOS have abnormal insulin resistance and subsequent hyperinsulinemia (high insulin levels) which contribute to the metabolic manifestations of PCOS.[17]

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References
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Examine Database References
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  2. Blood glucose - Costantino D, Minozzi G, Minozzi E, Guaraldi CMetabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trialEur Rev Med Pharmacol Sci.(2009 Mar-Apr)
  3. Blood glucose - M Nordio, E ProiettiThe combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation aloneEur Rev Med Pharmacol Sci.(2012 May)
  4. Blood glucose - Gerli S, Mignosa M, Di Renzo GCEffects of inositol on ovarian function and metabolic factors in women with PCOS: a randomized double blind placebo-controlled trialEur Rev Med Pharmacol Sci.(2003 Nov-Dec)
  5. Blood glucose - Alessandro D Genazzani, Alessia Prati, Susanna Santagni, Federica Ricchieri, Elisa Chierchia, Erica Rattighieri, Annalisa Campedelli, Tommaso Simoncini, Paolo G ArtiniDifferential insulin response to myo-inositol administration in obese polycystic ovary syndrome patientsGynecol Endocrinol.(2012 Dec)
  6. Blood glucose - Gerli S, Papaleo E, Ferrari A, Di Renzo GCRandomized, double blind placebo-controlled trial: effects of myo-inositol on ovarian function and metabolic factors in women with PCOSEur Rev Med Pharmacol Sci.(2007 Sep-Oct)
  7. PCOS Symptoms - Papaleo E, Unfer V, Baillargeon JP, Fusi F, Occhi F, De Santis LMyo-inositol may improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trialFertil Steril.(2009 May)
  8. PCOS Symptoms - Raffone E, Rizzo P, Benedetto VInsulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS womenGynecol Endocrinol.(2010 Apr)
  9. PCOS Symptoms - Unfer V, Carlomagno G, Rizzo P, Raffone E, Roseff SMyo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trialEur Rev Med Pharmacol Sci.(2011 Apr)
  10. PCOS Symptoms - Ciotta L, Stracquadanio M, Pagano I, Carbonaro A, Palumbo M, Gulino FEffects of myo-inositol supplementation on oocyte's quality in PCOS patients: a double blind trialEur Rev Med Pharmacol Sci.(2011 May)
  11. PCOS Symptoms - Enrico Papaleo, Vittorio Unfer, Jean-Patrice Baillargeon, Lucia De Santis, Francesco Fusi, Claudio Brigante, Guido Marelli, Ilaria Cino, Anna Redaelli, Augusto FerrariMyo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation inductionGynecol Endocrinol.(2007 Dec)
  12. PCOS Symptoms - Genazzani AD, Lanzoni C, Ricchieri F, Jasonni VMMyo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndromeGynecol Endocrinol.(2008 Mar)
  13. PCOS Symptoms - Iuorno MJ, Jakubowicz DJ, Baillargeon JP, Dillon P, Gunn RD, Allan G, Nestler JEEffects of d-chiro-inositol in lean women with the polycystic ovary syndromeEndocr Pract.(2002 Nov-Dec)
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  35. C-Reactive Protein (CRP) - Reihaneh Mousavi, Mohammad Alizadeh, Mohammad Asghari Jafarabadi, Lida Heidari, Roshan Nikbakht, Hossein Babaahmadi Rezaei, Majid KarandishEffects of Melatonin and/or Magnesium Supplementation on Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled TrialBiol Trace Elem Res.(2021 May 19)
  36. Acne Symptoms - Jaripur M, Ghasemi-Tehrani H, Askari G, Gholizadeh-Moghaddam M, Clark CCT, Rouhani MHThe effects of magnesium supplementation on abnormal uterine bleeding, alopecia, quality of life, and acne in women with polycystic ovary syndrome: a randomized clinical trial.Reprod Biol Endocrinol.(2022-Aug-02)
  37. Insulin - Zamani M, Zarei M, Nikbaf-Shandiz M, Hosseini S, Shiraseb F, Asbaghi OThe effects of berberine supplementation on cardiovascular risk factors in adults: A systematic review and dose-response meta-analysis.Front Nutr.(2022)
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  39. Total cholesterol - Xie L, Zhang D, Ma H, He H, Xia Q, Shen W, Chang H, Deng Y, Wu Q, Cong J, Wang CC, Wu XThe Effect of Berberine on Reproduction and Metabolism in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Control Trials.Evid Based Complement Alternat Med.(2019)
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  42. Total cholesterol - Ali Fadlalmola H, Elhusein AM, Al-Sayaghi KM, Albadrani MS, Swamy DV, Mamanao DM, El-Amin EI, Ibrahim SE, Abbas SMEfficacy of resveratrol in women with polycystic ovary syndrome: a systematic review and meta-analysis of randomized clinical trials.Pan Afr Med J.(2023)
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