Polycystic ovarian syndrome, or PCOS, is characterized by ovaries that are two to five times larger than normal ovaries. Polycystic ovaries usually have a white, thick, tough outer covering. Women are usually diagnosed with this condition when they are in their 20s or 30s. They frequently have a mother or sister with similar symptoms or who have been diagnosed with PCOS.

Symptoms of PCOS include:

• Abnormal, irregular, or very light menstrual periods
• Absent periods
• Weight gain or obesity
• Infertility
• Increased hair growth
• Virilization, or development of male sex characteristics
• Decreased breast size
• Aggravation of acne

In PCOS, underdeveloped follicles accumulate in the ovaries. Follicles are sacs within the ovaries that contain eggs. The eggs in these follicles do not mature and, therefore, cannot be released from the ovaries. Instead, they accumulate as cysts in the ovary. This can contribute to infertility. However, conception is often possible with proper surgical or medical treatments. After conception, the pregnancy is usually uneventful.

Insulin resistance also seems to play a key role in PCOS. In addition to other hormones, insulin helps regulate ovarian function. When someone is insulin resistant, this means that cells throughout the body do not readily respond to the insulin circulating in the blood. For this reason, the amount of insulin remains high in the blood. High levels of insulin can contribute to lack of ovulation, high male hormone levels, infertility, early pregnancy loss, obesity, and development of diabetes.

When testing for PCOS, providers check for abnormal levels of a variety of hormones and substances, as well as conducting other diagnostic tests including:

• Vaginal ultrasound and, possibly, abdominal ultrasound
• Abdominal MRI
• Laparoscopy
• Ovarian biopsy
• Thyroid function tests

Medications are the primary treatment for polycystic ovarian syndrome, but in rare cases surgery may be recommended.