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1. What is polycystic ovary syndrome (PCOS)?

   PCOS is a hormonal disorder linked to hyperandrogenism (high levels of androgens such as testosterone) and irregular ovulation. Visible symptoms may include hirsutism (excess body and/or facial hair), irregular or infrequent periods, obesity, acne and/or oily skin (particularly severe acne in teenagers or acne that persists into adulthood), infertility, insulin resistance (often resulting in impaired glucose tolerance, a frequent precursor to type 2 diabetes), hair loss or balding, darkening of the skin, usually on the neck, and skin tags in the armpit or on the neck. Women with PCOS may also have, as the name suggests, ovarian cysts, which are small and numerous.

2. How is PCOS diagnosed?

   A health care professional will take a thorough history and do a complete physical examination, and may do a series of blood tests to check for hormone imbalances characteristic of PCOS. Ultrasound imaging of the ovaries may also be performed. Most women with PCOS will have irregular or absent menstrual periods.

3. Which health care professional should I see?

   Most cases require the expertise of an endocrinologist or reproductive endocrinologist.

4. Should I try an insulin sensitizer to treat PCOS?

   Certainly, if you have insulin resistance or Type II diabetes, an insulin sensitizer would be an acceptable approach to treatment. But health care professionals are undecided on whether these drugs should be used for PCOS in the absence of insulin resistance, diabetes or infertility. Studies are underway that may provide a clearer answer. Meanwhile, based on successful small studies, many women are already asking for these medications and many health care professionals are prescribing them.

5. What can I do if I can't conceive?

   The first line of treatment is usually weight loss in women with PCOS who are overweight or obese. If a woman is unable to lose weight or if modest weight loss does not restore ovulation, an ovulation-stimulating drug such as clomiphene citrate (Clomid). Potential side effects include hot flashes while the drug is taken, ovarian swelling that goes down with the onset of your period and an increased possibility of twins. If clomiphene alone doesn't work, the next step may be injectable gonadotropins or, increasingly, an insulin-sensitizing drug such as metformin in combination with other medications.

6. Do I have to take birth control pills if I have PCOS?

   No, although they are frequently prescribed to return your menstrual cycles to normal. Instead, you can take a course of progesterone, such as medroxyprogesterone acetate, micronized progesterone or norethindrone acetate, taken for seven to 14 days every one to two months. Progesterone-induced menstruation is essential, because it sloughs off the endometrial lining, helping prevent uterine cancer.

7. My ovaries have been removed. I can't possibly have PCOS, can I?

   You can still have PCOS because PCOS is a condition that not only affects the ovaries, but also the adrenal gland and the regulation of insulin. However, without ovaries, the hyperandrogenic symptoms of PCOS are lessened.

8. I've been taking medication as prescribed for weeks now and have seen no improvement. What should I do?

   Stick with the program a while longer. It takes up to six months, for example, to begin to see effects of spironolactone on hair growth. Insulin sensitizers, likewise, take two to three months to reach full effect on insulin levels. Consider adding a weight-reduction program as well if this is an issue.

9. Do the symptoms of PCOS ever suggest anything more serious?

   Yes, the possibilities include an androgen-producing tumor, Cushing's syndrome, hyperprolactinemia, adrenal hyperplasia, or hypothyroidism. A thorough diagnosis is important, especially if your levels of testosterone are above 200 ng/dL, or you have symptoms of "virilization" such as facial beard, clitoromegaly (enlarged clitoris), balding at the temples, deepening voice or muscle enlargement.

10. Should I be tested for diabetes if I have PCOS?

    Yes. Due to the link between insulin abnormalities and insulin level and PCOS, every woman diagnosed with PCOS should have a fasting glucose and insulin test to check for insulin resistance and diabetes. If you have diabetes, it is important to begin treatment and monitoring early in order to avoid complications.