What Is Polycystic Ovary Syndrome?

Some people with hidradenitis suppurativa (HS) may also have polycystic ovary syndrome, or PCOS. When someone has 2 or more conditions at once, the conditions are called comorbidities. Having comorbidities can make treating each condition a little more complicated.^1-3

PCOS is a common comorbidity of HS. About 9 out of 100 people with HS also have PCOS. Women who have HS are twice as likely to also have PCOS than those without HS.¹

What is PCOS?

PCOS is a condition caused by imbalanced hormones. It occurs during the reproductive years.⁴

When someone has PCOS, their ovaries make too much androgen. Ovaries are the female organ that store and release eggs. Androgen is a male sex hormone that females have in small amounts. Women with PCOS have high levels of androgen.^4,5

The first word of this condition, polycystic, refers to the many cysts that can form on the ovaries. Cysts are fluid-filled sacs. Some women with PCOS develop lots of cysts, and others may have none. But having cysts on your ovaries does not mean you have PCOS.⁵

What causes PCOS?

Experts do not yet fully understand what causes PCOS. But they have some ideas.^4-6

• When an egg is released from the ovary, it is called ovulation. Some women with PCOS do not ovulate or only ovulate once in a while. Many small cysts often form when ovulation does not happen. These cysts release androgen.
• PCOS may be connected to insulin resistance. Insulin is the substance that helps your body convert food to energy. Having high levels of insulin may lead to high levels of androgens too.
• PCOS runs in families and likely has a genetic component.

What are the symptoms of PCOS?

Symptoms often appear around the first menstrual cycle, or period. But sometimes symptoms show up later.⁴

Common symptoms include:^4,5

• Irregular periods (infrequent, missed, or longer than normal)
• Ovaries with many cysts
• Larger than average ovaries
• Weight gain, especially around the belly
• Trouble getting pregnant
• Extra hair on the face or body
• Extra bits of skin (skin tags) around the neck or armpits
• Skin that is dark or thick around the neck, armpits, or breasts

Less common symptoms include severe acne and baldness.⁴

How is PCOS diagnosed?

To diagnose PCOS, your doctor will ask questions about your medical history and symptoms. If you suspect you have PCOS, make a list of your symptoms. Bring the list to your appointment.⁵

Your doctor will also do a physical exam. This may include a pelvic exam, in which they check your reproductive organs. Your doctor may examine both outside and inside your body.⁵

You may need an ultrasound and a blood test. Ultrasounds use sound waves to make images of your uterus and ovaries. A blood test will show your levels of sex hormones, blood sugars, and fats.⁵

How is PCOS treated?

There is no cure for PCOS. But some treatments can help manage it.⁶

Treating PCOS is based on a few different factors. First, there are several kinds of PCOS. These are categorized by the type of hormonal imbalance you have. Second, treatment depends upon your concerns and goals.⁶

Your treatment may focus on:⁶

• Minimizing your androgen imbalance
• Minimizing period irregularities
• Protecting the lining of your uterus
• Improving how fast you can burn calories (metabolism) to maintain a healthy weight
• Improving your ability to get pregnant (fertility)

Medicines for PCOS

If you are not trying to conceive, your doctor may recommend a contraceptive. This is a type of hormone therapy. It may be either a pill you swallow or a patch worn on your skin. You may be offered a contraceptive that has 1 or more hormones.⁶

Depending on your symptoms, you may also be prescribed a drug to block androgens. These drugs include spironolactone, flutamide, and finasteride.⁶

Medicines applied to the skin may also be recommended to treat unwanted hair. An example is eflornithine hydrochloride. Your doctor might also recommend a drug called metformin to manage insulin resistance.⁶

Lifestyle changes

Your doctor may also recommend lifestyle changes to lose weight. These may include exercising more or changing what you eat.⁶

What are common comorbidities of PCOS?

If you have PCOS, you are at risk of developing other conditions at the same time. These comorbidities include:⁶

• Type 2 diabetes
• Fatty liver disease
• Metabolic syndrome
• High blood pressure
• Blood clots
• Mood disorders
• Increased risk of clogged arteries, heart attack, and stroke
• Certain cancers of the ovaries or lining of the uterus

Note that having a risk for a condition does not mean you will get it. But you and your doctor should be aware of the risk and watch for any symptoms of these related health conditions.

Other things to know

While HS and PCOS are linked, there is still a lot doctors and researchers do not know. Connecting with other people who share your condition or comorbidities may help you feel empowered. Joining a support group can help you better understand your condition, learn about helpful resources, and reduce stress.⁷