Children's Hospital Colorado

Polycystic Ovary Syndrome (PCOS)

What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a health issue that can affect women and teens of the reproductive age. This condition occurs when teens have extra testosterone (a male hormone) in their body. Due to the increased amount of testosterone, the physical symptoms of PCOS start to show. PCOS affects the menstrual cycle, hair growth, skin, weight and the ability to have children.

What causes polycystic ovary syndrome (PCOS)?

PCOS is thought to be caused by a mixture of genetic factors and weight gain. Many teens who have PCOS are overweight, and more than half have family members with either PCOS or type 2 diabetes.

Weight gain is a cause of PCOS

For overweight teens, decreased physical activity causes weight gain, which increases the amount of insulin in the body. As a result, the increased level of insulin causes more testosterone to be released from the ovaries. The extra testosterone causes the physical symptoms of PCOS, like hair growth.

Excess testosterone is a cause of PCOS

In women who are not overweight, it is thought that the ovaries make too much testosterone.

In all women with PCOS, the ovaries don't work very well. In a healthy female, once a month the ovaries make a follicle (where an egg grows). As the follicle grows, it makes hormones and then it releases an egg. This is commonly referred to as ovulation.

However, the ovary in a woman who has PCOS makes many small follicles instead of one big one. The follicle looks like a cyst on ultrasound and gives us the name polycystic ovaries. Although the follicles are harmless, hormone levels become out of balance and ovulation doesn't happen every month the way it is supposed to due to the increased amount of follicles. As a result, periods become irregular or stop altogether. 

Who gets polycystic ovary syndrome (PCOS)?

Genetics do play a role in causing PCOS, but the condition is also caused by weight gain and other unknown factors.

Is this a common condition?

Yes – about 5-10% of all women have PCOS.

What are the signs and symptoms of polycystic ovary syndrome (PCOS)? 

Some of the symptoms of PCOS are very noticeable, and others your teen may keep hidden because she may be embarrassed discussing these issues with parents and caregivers.

Signs and symptoms are commonly associated with PCOS:

  • Fewer than eight periods per year
  • Not starting periods by age 15
  • Weight gain
  • Thick, dark hair in places where only men tend to grow hair – including the upper lip, chin, sideburn area, chest and belly
  • Hair loss on the top of the head or around the forehead
  • Severe acne on the face, back or chest
  • Dark skin on the back of the neck, in the armpits or at the waist

What tests are used to diagnose polycystic ovary syndrome (PCOS)?

There is no single test for diagnosing PCOS. Your teen may be diagnosed with PCOS based on her symptoms alone or with blood testing and/or a pelvic ultrasound.

Diagnosis of PCOS is based on three main factors

  • Health history
  • A physical exam
  • Blood tests to measure hormone levels

In order to diagnose PCOS, other causes of irregular periods must be ruled out. Thyroid hormone, prolactin (a hormone needed for making breast milk) and adrenal gland hormone problems produce similar symptoms. Sometimes, these tests are ordered, too.

Most doctors don't routinely order an ultrasound of the ovaries because the diagnosis can be made by physical exam and laboratory findings alone.

Why choose Children's Hospital Colorado to test for PCOS?

Children's Colorado has the only multidisciplinary adolescent PCOS Clinic in the region. Doctors from different areas of medicine all work together in one clinic to provide your child with the most accurate and efficient care. The specialties involved in the clinic include endocrinologists (doctors who manage weight gain and diabetes risk), gynecologists (doctors who manage irregular periods and other women's issues), dermatologists (doctors who can help with acne and unwanted hair growth), psychologists and lifestyle experts (to help with nutrition and exercise).

What to expect from polycystic ovary syndrome (PCOS) testing

Blood test results generally take 1-2 weeks. The only discomfort is from a quick needle-stick to draw the blood.

How is polycystic ovary syndrome (PCOS) treated?

The goals of treatment for PCOS are to:

  1. Keep the lining of the uterus healthy to prevent heavy and irregular periods, as well as other problems
  2. Reduce cosmetic signs such as acne or excess hair growth
  3. Screen for health issues related to PCOS, including high blood pressure, fatty liver disease, high cholesterol, diabetes, sleep disorders and depression

At Children's Colorado, our pediatric gynecologists provide patients with different treatment options for PCOS, including healthy lifestyle changes that teens and parents can manage on their own. However, when lifestyle changes aren't enough, medication may also be prescribed. 

Option one: lifestyle changes

In girls who are overweight, or who are not overweight but are not exercising, the most important treatment is making lifestyle changes in diet and exercise. A 5-7% reduction of total body weight can control periods in many teens with PCOS. Patients and their families using this treatment method have access to lifestyle specialists in our multidisciplinary clinic to help implement these changes.

Option two: medicinal choices

  • Metformin: for girls who are overweight and have high insulin levels.

    This medication can lower insulin levels and help the body use insulin more effectively. In 6-12 months, Metformin can help control periods, clear up acne and reduce hair growth. The most common side effect is nausea (upset stomach) but, generally, the drug is well tolerated. Metformin improves the health of the ovaries, and makes it easier to get pregnant. All young women who are sexually active should use birth control while taking Metformin.

  • Birth control pills: for girls who have irregular periods, severe hair growth, acne or those who are sexually active.

    These pills work by decreasing the amount of free testosterone in the body. Regular periods may start within the first month. It is normal to have some irregular bleeding at first, but this will improve with time. It usually takes 3 months for acne to clear up and 6 months for decreases in hair growth.

  • Provera: a progesterone-only pill that is taken for 10 days to cause a period; best for teens who have not had a period in more than 3-6 months.

  • Spironolactone: works by blocking the action of testosterone.

    This medication is used to minimize hair growth and acne in 6-12 months. Taking birth control while on spironolactone is suggested due to the risks of birth defects while taking this medication.

  • Rogaine: an over-the-counter product that blocks the hair follicle from "seeing" testosterone.

    It's used for balding and the loss of hair at the front of the scalp. It takes 3-9 months to work and can be purchased at drug stores or grocery stores.

  • Laser hair removal: for girls with light skin tone and dark hair growth.

    There is a dermatologist in our multidisciplinary clinic to discuss laser hair removal, if desired.

  • Vaniqa: a prescription cream that can decrease hair growth.

    Hair growth is minimized only while using the cream. It does not change hair growth over time.

  • Long-acting, progestin-only methods

    Both the progesterone-IUD (Mirena) and the under-the-skin implant (Nexplanon) provide a steady, low-dose of progestin. Progestin keeps the lining of the uterus healthy and reduces menstrual bleeding. The IUD works for 5 years and the implant works for 3 years. Either method can be removed at any time.

Why choose Children's Colorado for your child's polycystic ovary syndrome (PCOS)?

The pediatric experts in the Department of Gynecology place a strong emphasis on communicating with adolescents and their families in caring and sensitive ways. We recognize that the teenage years are a difficult time in a young woman's life, and struggling with irregular periods and obesity as a result of PCOS can be very difficult.

Although PCOS is a common condition, the diagnosis and management of adolescents with PCOS is very different from adults. It requires a unique expertise and medical training in pediatric healthcare. The efforts of health professionals from several different departments, including gynecology, endocrinology, dermatology, psychology, lifestyle medicine and nutrition are needed to effectively manage this condition.

The multidisciplinary PCOS Clinic at Children's Colorado provides you and your daughter with direct access to the all of these medical specialists at one location, in order to ensure your teen is receiving not only the best care possible, but that treatment is tailored specifically to her individual needs.