Nishmat's Women’s Health and HalachaIn memory of Chaya Mirel bat R' Avraham

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Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is a medical condition in which a woman has an excess of male hormones (androgens). Symptoms of PCOS can include increased hair growth in a male pattern (on the face, hands and torso), male pattern baldness or thinning, male pattern weight gain (around the waist) and acne. PCOS can also lead to other medical problems such as elevated blood pressure, elevated cholesterol, and type 2 diabetes.

These excess male hormones also impact significantly on the menstrual cycle. In a normally cycling woman, about 20 eggs start to mature each cycle in tiny sacs known as follicles or cysts. Generally, one follicle takes the lead. As this dominant egg grows, fluid accumulates around it. When it matures, the follicle breaks open, releasing the egg to travel towards the fallopian tube – the process known as ovulation. The remaining cells that surrounded the follicle secrete progesterone. In women with PCOS, the ovary doesn't make all of the hormones needed for any of the eggs to fully mature. They can start to grow and accumulate fluid. However, no egg matures sufficiently to become dominant and thus ovulation does not occur. Furthermore, the hormone progesterone is not produced. The lack of ovulation and progesterone leads to very irregular or absent menses. In addition, the cysts produce male hormones, which continue to prevent ovulation.

The diagnosis of the condition is primarily clinical. A history of irregular periods, especially combined with the physical finding of excess hair or excess weight, is suggestive of the diagnosis – although not all women have all of the symptoms. A pelvic exam and an ultrasound can reveal enlarged cystic ovaries – although not all women with PCOS in fact have polycystic ovaries. As this is not only a reproductive condition, it is important that blood pressure, glucose and cholesterol levels be measured as well to assure that women suspected of having this condition have all possible complications monitored.

It is not uncommon for women with PCOS to experience irregular bleeding or spotting. Others can have no idea when to expect their menses as they are so few and far between. Both possibilities have obvious significance for women keeping the laws of niddah.

A number of treatments are available for these menstrual abnormalities. Attempting weight loss is a first step. For many women, even a 10% weight loss can improve the menstrual irregularities. If that is not sufficient and the woman is not trying to get pregnant, hormonal contraception regimens can generate a more predictable cycle. While this controls the symptoms, it does not cure PCOS and the menstrual cycle will become abnormal again if the pill is stopped. Intermittent use of progesterone and its withdrawal can also help regulate the shedding of the uterine lining. Shedding of the uterine lining is important for health reasons, as a persistent overly thick endometrium increases the risk of endometrial cancer.

The lack of spontaneous ovulation with PCOS generally leads to difficulty with conception. In fact, PCOS is the most common cause of infertility in the halachically observant population. Fortunately, it can generally be treated with medication to induce ovulation. However, women with PCOS are at particular increased risk for multiple births when using these medications. Therefore, in some cases In Vitro Fertilization (IVF) is recommended to control the chance of having triplets or more.

Women with PCOS are also at higher risk for diabetes, high cholesterol, high blood pressure, and heart disease. Getting the symptoms under control at an earlier age may help to reduce this risk. Therefore, it is important that women with this condition be monitored and/or treated for these conditions as well.

For More Information…
You can find out more about PCOS by contacting the National Women's Health Information Center (NWHIC) at 800-994-WOMAN (9662) or the following organizations:

National Institute of Child Health and Human Development (NICHD), NIH, HHS
Phone: (800) 370-2943
Internet Address:

American Association of Clinical Endocrinologists (AACE)
Phone: (904) 353-7878
Internet Address:

American Society for Reproductive Medicine (ASRM)
Phone: (205) 978-5000
Internet Address:

Center for Applied Reproductive Science (CARS)
Phone: (423) 461-8880
Internet Address:

International Council on Infertility Information Dissemination, Inc. (INCIID)
Phone: (703) 379-9178
Internet Address:

PolyCystic Ovarian Syndrome Association, Inc. (PCOSA)
Phone: (877) 775-7267
Internet Address:

The Hormone Foundation
Phone: (800) 467-6663
Internet Address:

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All health and health-related information contained within Nishmat's Women's Health & Halacha Web site is intended to be general in nature and should not be used as a substitute for consulting with your health care professional. The advice is intended to offer a basis for individuals to discuss their medical condition with their health care provider but not individual advice. Although every effort is made to ensure that the material within Nishmat's Women's Health & Halacha Web site is accurate and timely, it is provided for the convenience of the Web site user but should not be considered official. Advice for actual medical practice should be obtained from a licensed health care professional.