PCOS (Polycystic Ovary Syndrome)

Medically reviewed by Julia Raber, MD · Updated September 11, 2026

Polycystic ovary syndrome is the most common hormonal condition in women of reproductive age. Despite its name, it is not primarily a disease of ovarian cysts. It is a disorder of hormone signaling in which the ovaries produce more androgen, the group of hormones that includes testosterone, than they should, and ovulation becomes irregular or stops. The small "cysts" seen on ultrasound are immature follicles that started to develop but never released an egg.

For most women with PCOS, insulin resistance is the engine underneath. When the body's cells respond poorly to insulin, the pancreas makes more of it, and high insulin pushes the ovaries to make more androgen while also disrupting the signals that trigger ovulation. That is why PCOS is a metabolic condition as much as a gynecologic one, and why it raises the long-term risk of type 2 diabetes, high cholesterol, and cardiovascular disease.

At NYMD Center our gynecologists diagnose and treat PCOS alongside our internal medicine and weight management teams. We explain what is driving your particular symptoms, treat the ones that matter most to you, protect against the long-term risks, and plan around pregnancy when you want it.

Who it affects and the symptoms that bring people in

PCOS usually begins around puberty, though many women are not diagnosed until their twenties or thirties, often when they try to conceive. It runs in families and is more common in women with a family history of diabetes. Weight gain worsens it, but a significant number of women with PCOS are at a normal weight.

The symptoms that bring people in fall into three groups. The first is cycle irregularity: periods that come every few months, or not at all, or bleeding that is unpredictable and sometimes heavy after long gaps. The second is androgen excess: acne that persists past the teenage years, coarse hair on the face, chest, or abdomen, and thinning hair at the scalp. The third is metabolic: weight that is hard to control, darkened velvety skin at the neck or underarms, and prediabetes that arrives surprisingly early. Difficulty getting pregnant is often the first thing that prompts a visit.

How we evaluate it at NYMD Center

The diagnosis rests on finding two of three features: irregular or absent ovulation, signs or lab evidence of excess androgen, and polycystic-appearing ovaries on ultrasound. Just as important is ruling out the other conditions that mimic PCOS, because thyroid disease, elevated prolactin, adrenal disorders, and, rarely, androgen-producing tumors can look similar and need different treatment.

The visit starts with a detailed history of your cycles, skin and hair changes, weight, and family history. We examine for signs of androgen excess and insulin resistance. Our on-site lab checks total and free testosterone, other androgens, thyroid function, prolactin, and, depending on the picture, additional hormones. A pelvic ultrasound in the office looks at ovarian volume and follicle pattern and checks the thickness of the uterine lining, which matters in women who have gone months without a period.

Because insulin resistance is central, we also do a metabolic evaluation at the first visit: fasting glucose and hemoglobin A1c, a lipid panel, and blood pressure. When these show early changes, we coordinate with our internal medicine team rather than waiting for a diagnosis of diabetes to appear.

Treatment options

There is no single treatment for PCOS. The plan depends on which features bother you, whether you want to become pregnant soon, and what your metabolic evaluation shows. We start with what changes the underlying physiology and add targeted treatment for specific symptoms.

Lifestyle and weight management

For women who carry extra weight, losing even a modest amount improves insulin sensitivity, lowers androgen levels, and frequently restores ovulation on its own. This is the treatment with the fewest side effects and the broadest benefit, and it is worth pursuing even when medication is also needed. Our weight loss program offers structured support, including medical options when diet and exercise alone are not enough. For lean women with PCOS, regular exercise still improves insulin sensitivity and is worth the effort.

Metformin and insulin sensitizers

Metformin improves the body's response to insulin, which lowers insulin levels and, in turn, ovarian androgen production. Over several months it often makes cycles more regular and helps with weight. It is inexpensive and has a long safety record. The main side effect is stomach upset, which usually fades with a slow start and the extended-release form. It is a reasonable first medication for women with evidence of insulin resistance, particularly those who want to preserve the option of pregnancy, since it does not prevent conception.

Hormonal contraception

For women not trying to conceive, combined hormonal contraception is the most effective way to regulate bleeding and lower androgen. It suppresses ovarian androgen production and raises the protein that binds testosterone in the blood, so acne and unwanted hair improve over three to six months. It also protects the uterine lining from the overgrowth that can follow long stretches without a period. It does not treat insulin resistance, and symptoms return when it is stopped. Our contraception page covers the options in detail; a hormonal IUD protects the lining but does less for androgen symptoms.

Treating androgen symptoms directly

When acne or hair growth remain troublesome despite the above, an anti-androgen medication can be added. These block the effect of testosterone at the skin and hair follicle. They must be paired with reliable contraception because they can affect a developing male fetus. Results take months, since hair follicles cycle slowly. Hair removal methods and dermatologic acne treatment work alongside these and are not replaced by them.

Fertility planning

When you are ready to conceive, the first step is restoring ovulation. Weight loss and metformin help many women. If cycles remain irregular, oral ovulation-inducing medications are effective for most, and we monitor the response with ultrasound. We handle these initial steps in the office and refer to a reproductive endocrinologist when injectable medications or IVF are needed. Because PCOS raises the risk of gestational diabetes, we address blood sugar before pregnancy, not after. Our fertility investigation page describes the workup for couples.

Long-term metabolic protection

PCOS does not end with menopause; the metabolic risk persists. We recommend periodic screening for diabetes and cholesterol, blood pressure monitoring, and attention to sleep apnea, which is more common with PCOS. When lipids or blood sugar cross treatment thresholds, our internal medicine team manages them in the same office.

What to expect at your visit

Bring a record of your recent cycles, a list of medications and supplements, and any prior lab work or ultrasound reports so we do not repeat tests unnecessarily. Come fasting if you can, so metabolic labs can be drawn the same day.

The first appointment includes the history, exam, ultrasound, and lab draw. We usually have results within days and review them with you by telehealth or at a follow-up visit, at which point we lay out a plan. Because treatment is adjusted over months, we schedule follow-ups to check on cycles, symptoms, and side effects, and repeat labs as needed.

Dr. Raber and our women's health team see PCOS patients at both our Midtown Manhattan and Forest Hills locations.