Polycystic Ovary Syndrome (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).

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]

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]

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]

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]

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]

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]

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]