Polycystic ovary syndrome (PCOS) is a common condition that affects an estimated 10-13% of reproductive-aged women worldwide, according to the World Health Organization. Despite its prevalence, the exact cause is unknown, the diagnosis can be challenging to obtain, and there is no known cure. And while PCOS can impact fertility for some, there are many treatment options available. In my practice, I’ve treated many patients with PCOS, and I have the condition myself.
You may also start seeing this condition referred to by a new name: polyendocrine metabolic ovarian syndrome, or PMOS. In May 2026, a global consensus process spanning more than a decade and dozens of medical and patient organizations formally retired the name PCOS in favor of PMOS, publishing the change in The Lancet.
As a reproductive endocrinologist, I think this change is overdue. "Polycystic" put the focus on ovarian cysts, but cysts aren't actually part of the diagnostic criteria for many people with this condition, and that mismatch has contributed to missed and delayed diagnoses for years. PMOS also better reflects what the condition actually is: not just a reproductive issue, but one that touches metabolic and mental health too.
Because most people are still searching for and familiar with the term PCOS, we'll still include it throughout this article. But the name is changing for a reason. Let’s explore more about this condition and what you need to know about how it impacts fertility.
What causes PCOS or PMOS?
Although the exact cause of PCOS is unknown, there are many factors that have been found to potentially play a role. For example, androgens are a kind of hormone that all bodies produce in different amounts. Typically, these levels are higher in males than females. People with PCOS are often found to have higher levels of androgens –– known as hyperandrogenism. In other cases, they can be sensitive to androgens and have clinical signs of this sensitivity, such as excess hair growth, hair loss, or acne.
Insulin is a hormone that plays a significant role in regulating blood sugar. When the body doesn't make enough insulin, or the insulin it releases doesn't work appropriately, that impacts the whole body, including the reproductive system. The prevalence of insulin resistance is higher in those with PCOS, another reason why PMOS better reflects the scope of this condition. Insulin resistance increases the risk of developing type 2 diabetes, cardiovascular disease, and can also play a role in some of the symptoms associated with PMOS. For example, increased insulin levels can lead to increased androgens, which can result in arrested follicular development. This causes ovulatory dysfunction — when someone doesn’t ovulate predictably.
What are the symptoms of PCOS?
Symptoms of PCOS/PMOS can vary significantly between people, especially in severity. But common symptoms can include:
- Hair loss or thinning hair (also called androgenic alopecia)
- Irregular menstrual cycles (also called ovulatory dysfunction)
- Excess hair growth on the face and/or body (also called hirsutism)
- Persistent and/or severe acne
- Enlarged ovaries, or ovaries with a high number of follicles (polycystic ovaries or PCO)
- Obesity
- Infertility
- Discoloration or darkening of the skin in areas such as the neck, underarms, and under breasts, and other folds (also called acanthosis nigricans)
How is PCOS diagnosed?
PCOS is diagnosed when a person has at least two of three criteria: irregular or absent periods, signs of excess androgens (like acne or excess hair growth), and polycystic ovaries on ultrasound, often after ruling out other conditions with similar symptoms. In one international survey of over 1,300 women with PCOS, nearly half saw three or more healthcare providers before being diagnosed, and about a third waited more than two years for a diagnosis
Many people begin to use oral contraceptive pills or similar medications in their teens or early twenties. Sometimes this is for birth control, and other times it can be for heavy or painful periods. Oral contraceptive pills regulate the individual’s bleeds through the exposure and withdrawal of hormones, and because of this, it can mask PCOS symptoms like irregular periods or sometimes even associated acne.
Because irregular periods and acne are relatively common in the first few years after menarche (the first period) and teenage years, sometimes these symptoms are chalked up to “being a teenager” and many are told “it’s a phase and you will grow out of it.” For this reason, many times the diagnosis of PCOS is delayed until many years later. In fact, it’s not uncommon to first learn that you may have PCOS after going off birth control and trying to get pregnant.
My PCOS story is similar. I've had irregular cycles my whole life and, now even in my 40s, I continue to have acne. I had brought up the symptoms to my care providers many times over the years, but was told “that’s because you are young” or “there are a lot of women with irregular cycles, but at least you are getting some periods. You are fine.” For many years, I believed it, and did not push for further evaluation. However, in my twenties, as I learned more about PCOS, I had further testing completed including an ultrasound to visualize my ovaries. I met PCOS diagnostic criteria, and ended up, in a way, diagnosing myself. I’m glad I did, because women with PCOS have an increased risk of developing metabolic syndrome, cardiovascular disease, and diabetes. With this diagnosis, I was empowered to be more proactive towards optimizing my health and taking measures like dietary and lifestyle modifications to decrease this risk.
How can PCOS impact fertility?
Many people with PCOS also have ovulatory dysfunction — they either don’t ovulate at all or ovulation is irregular and unpredictable. In some, this can be related to their elevated androgen levels. In others, they can have an elevated weight and insulin resistance and sometimes, with lifestyle modifications and weight loss, their periods can resume.
It’s important to know that with ovulation, the oocyte (egg) is only viable for 12-24 hours. For women who cannot predict ovulation, and time intercourse, it can be difficult to get pregnant.
How can I get pregnant with PCOS?
For most people with PCOS, it is still possible to get pregnant. For instance, even if ovulation is irregular, rare and/or unpredictable, it is important to take measures to prevent pregnancy if not trying to get pregnant, because spontaneous ovulation can still occur.
For those wanting to get pregnant, many interventions can help regulate ovulation and improve the likelihood of getting pregnant. Healthcare providers may recommend exercise and a healthy diet to help you reach a healthy weight and manage symptoms of PCOS that could impact fertility. A healthy weight plays a significant role in managing insulin resistance, regulating periods, and improving egg quality. Studies have shown that even a 5% reduction in weight can result in more predictable ovulation, sometimes decreasing the need for additional fertility interventions to get pregnant.
A healthcare provider may prescribe medications to induce ovulation, such as letrozole or clomiphene citrate. In many cases, this may be enough. But in other cases, additional interventions may be needed, such as intrauterine insemination (IUI) or in vitro fertilization (IVF).
How does Carrot help members with PCOS?
Carrot includes a diverse range of family-forming options and access to Carrot experts, like nutritionists, that can offer guidance to members trying to manage their lifestyle and diet. Carrot also provides personalized plans that allow members to navigate their paths to parenthood in the best way possible for their specific needs.
If you’re a Carrot member interested in learning more about your fertility, sign in to your account to get started.
PCOS in the workplace: What employers and HR teams should know
PCOS is a workforce issue. In a 2024 survey of over 1,000 women with PCOS, 72% said it diminished the quality of their work, 50.4% had missed work because of it, and 51.5% felt it held back their career advancement. It's also linked to a higher long-term risk of type 2 diabetes, cardiovascular disease, and mental health conditions such as anxiety and depression. For a condition affecting an estimated 10-13% of reproductive-aged women, that adds up to a measurable cost in productivity, absenteeism, and turnover, on top of a direct U.S. healthcare spend estimated at more than $8 billion annually.
Why PCOS is often missed, and why that costs employers
PCOS is frequently underdiagnosed or diagnosed late, in part because symptoms are dismissed or attributed to other causes and in part because oral contraceptives can mask them for years. For employers, a late or missed diagnosis usually means an employee is managing symptoms and their impact on work without support, treatment, or an accurate name for what they're dealing with.
What employers can do
Benefits and HR teams need to make sure employees with PCOS can get care without unnecessary delay or cost. That typically means: fertility and family-forming benefits that cover PCOS-related diagnosis and treatment, from initial evaluation through IVF; access to specialists like reproductive endocrinologists and nutritionists; and manager education, since PCOS's day-to-day symptoms — fatigue, pain, and mental health effects — directly affect work performance.
Carrot's employer solutions give members access to fertility specialists, PCOS-informed nutrition support, and a personalized care plan starting from the point of symptom recognition.
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