Surprisingly, it's not very accurately named.
What is PCOS?
Polycystic ovary syndrome (PCOS) is a hormonal condition that can have many different symptoms, but is named for one of its most striking: cyst-like abnormalities on the ovaries. It’s caused by an excess of androgens (“male” hormones, including testosterone) in people who menstruate, and can also cause resistance to insulin (the hormone that regulates blood sugar). We don’t currently know what causes the overproduction of androgens.
There’s been some debate in recent years about whether to change the name of PCOS or classify the syndrome that has increased risk of insulin resistance as a separate syndrome altogether. For one thing, not everyone who has PCOS gets cysts on their ovaries. For another, the ‘cysts’ are different than other types of ovarian cysts can burst and be quite painful. The ‘cysts’ of PCOS don’t burst and don’t cause pain. The ‘cysts’ are actually just an excess of the normal cell all people with ovaries have called a follicle. Each ovary has tens of thousands of them, and each month one follicle produces an egg. So the name ‘polycystic ovary syndrome’ is misleading and somewhat inaccurate.
Common symptoms of PCOS
Many people with PCOS experience irregular or infrequent periods, and PCOS almost always presents with resistance to insulin, which means that many people who have PCOS are either obese or diabetic, or both. And since PCOS involves elevated levels of androgens, it often causes acne, hair loss, and excess or abnormal body hair. Because fat (adipose tissue) affects the way your body processes hormones, obesity can make the symptoms of PCOS worse, so weight loss through diet and exercise is one of the common first-line treatments for PCOS, along with hormonal birth control.
How is PCOS diagnosed?
To diagnose whether or not you have PCOS, your doctor may:
- Ask about your health history. They’re specifically looking for the common outward symptoms of PCOS: acne, excess body hair, irregular periods, and obesity.
- Perform an ultrasound. This is usually a transvaginal ultrasound, meaning a wand is inserted into the vagina to enable a better view of the ovaries. Typically, PCOS ‘cysts’ will appear like spherical lumps on the ovary. While not everyone who has PCOS has cysts, it’s still very helpful to know whether you do or not.
- Do a blood test. The doctor will determine whether the levels of androgens in your blood are higher than normal.
Have symptoms? See a doctor.
PCOS isn’t typically painful. For some trans men and nonbinary people who are assigned female at birth (AFAB), the androgenic effects of PCOS have even helped them feel more at home in their gender identity. In fact, some small studies have found high rates of PCOS in AFAB trans and nonbinary people, which may mean PCOS could be related to gender identity for some people.
However, even if PCOS is not painful, or if it has positive effects for you, it’s still important to see a doctor if you have symptoms. PCOS can put you at higher risk for infertility, pregnancy complications, diabetes, and endometrial cancer, and can also be an indicator that you have other metabolic conditions. Although there’s no cure for PCOS, most of its symptoms are highly treatable with medication and lifestyle changes.