It might start with excess hair growth on your face or chest. Or your menstrual period might be irregular and unpredictable. Or maybe you have been trying to get pregnant for a while without any luck.

Up to one in ten women have polycystic ovary syndrome (PCOS), an endocrine system disorder that causes excess male hormones in the bloodstream and problems with ovulation.

Symptoms

PCOS can take a toll. The symptoms are many and can cause a lot of distress, especially as they often appear during adolescence as women enter their reproductive years. They include:

• Irregular menstrual cycles
• Weight gain, difficulty losing weight
• Excess hair growth
• Dark patches and tags on skin
• Infertility
• Insulin resistance, risk for diabetes
• Cysts on the ovaries
• Sleep apnea
• Depression, anxiety, stress
• Decreased sex drive

For something so common, PCOS can be difficult to get diagnosed. Some symptoms, like irregular periods, are easy to treat with birth control pills without a PCOS diagnosis.

“Birth control pills may be the right treatment and eliminate symptoms, but it’s still important for symptomatic women to be fully evaluated for PCOS,” says Paula Amato, M.D., reproductive endocrinologist at the OHSU Center for Women’s Health. “PCOS has other health impacts women need to understand.”

For example, women with PCOS are at increased risk for diabetes and possibly heart disease later in life. According to the U.S. Department of Health and Human Services, more than half of women with PCOS develop diabetes or prediabetes by age 40.

Why is PCOS so common?

“There is certainly a genetic component,” says Dr. Amato. A woman whose mother has PCOS is at far greater risk of having it herself.

PCOS is also connected to obesity, which has increased in the United States in recent decades. Not only is PCOS associated with difficulty losing weight, but obesity can make the symptoms of PCOS worse or even cause them to develop in the first place.

“There are women at risk for PCOS due to genetics who may never develop symptoms if they maintain a healthy weight,” Dr. Amato says.

While the majority of women with PCOS are overweight or obese, women of a healthy weight can still experience PCOS. In the same vein, not every obese woman has PCOS.

Treatment

While PCOS is a lifelong diagnosis, there are a variety of treatments that can help. “The most important part of treatment for obese patients is lifestyle changes,” says Dr. Amato. “Exercise and a healthy diet are very important.”

Studies have shown that as little as a 5 percent reduction in body weight can improve irregular cycles and infertility symptoms for women with PCOS.

Which medical treatment to try depends on your goals. For women trying to get pregnant, infrequent and unpredictable menstrual cycles are a huge barrier. There are medications that improve fertility by stimulating ovulation.

For women who are not trying to become pregnant, hormonal birth control is usually the best option. “It protects the uterine lining from overgrowth, stabilizes menstrual cycles, and also helps with other symptoms by decreasing male hormone levels in the bloodstream,” Dr. Amato says.

She also recommends paying attention to other symptoms, particularly sleep apnea and the psychological impacts of experiencing PCOS.

“We all know the importance of sleep,” says Dr. Amato. “And PCOS is associated with higher rates of depression, anxiety, and eating disorders. These issues should not be neglected.”