PCOS: All Guides

PCOS (Polycystic Ovary Syndrome): General Information

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PCOS is a common problem among teen girls and young women. In fact, almost 1 out of 10 women has PCOS.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a hormone imbalance that can cause irregular periods, unwanted hair growth, and acne. PCOS often begins during a girl’s teen years and can be mild or severe.

What are the signs of PCOS?

Some of the most common signs of PCOS include:

  • Irregular periods that come every few months, not at all, or too frequently
  • Extra hair on the face or other parts of the body, called hirsutism (her-suit-is-em)
  • Treatment-resistant acne
  • Weight gain and/or trouble losing weight
  • Patches of dark skin on the back of the neck and other areas, called acanthosis nigricans (“a-can-tho-sis ni-gri-cans”)

Could I have PCOS?

If you have some or all of the above signs, you might have PCOS. There can be other reasons why you might have signs; however, only your health care provider can tell for sure.

What causes PCOS?

PCOS is caused by an imbalance in the hormones (chemical messengers) in your brain and your ovaries. PCOS usually happens when a hormone called LH (from the pituitary gland) or levels of insulin (from the pancreas) are too high, which then causes the ovaries to make extra amounts of testosterone.

For a more detailed explanation, take a look at the female reproductive anatomy image:

Female reproductive anatomy

Female reproductive anatomy

  1. The pituitary (pi-tu-i-tary) gland in your brain makes the hormones luteinizing (lu-tin-iz-ing) hormone (LH) and follicle (fall-i-call) stimulating hormone (FSH).
  2. After getting the signal from the hormones LH and FSH, the ovaries make estrogen (es-tro-gen) and progesterone (pro-ges-ter-own), the female sex hormones.
  3. All normal ovaries also make a little bit of the androgen testosterone (an-dro-gen tes-tos-ter-own), a male sex hormone. The pancreas (pang-cree-us) is an organ that makes insulin. High levels of insulin can also cause the ovaries to make more of the hormone testosterone.

Why are my periods so irregular?

Having PCOS means that your ovaries aren’t getting the right (hormonal) signals from your pituitary gland. Without these signals, you won’t ovulate (make eggs) every month. Your period may be irregular, or you may not have a period at all.

Let’s review a regular menstrual cycle.

  1. The menstrual cycle starts when the brain sends LH and FSH to the ovaries. A big surge of LH is the signal that causes the ovaries to ovulate, or release an egg.
  2. The egg travels down the fallopian tube and into the uterus. Progesterone from the ovary causes the lining of the uterus to thicken.
  3. If the egg isn’t fertilized, the lining of the uterus is shed. This is a menstrual period.
  4. After the menstrual period, the cycle begins all over again.
Regular vs. PCOS menstrual cycle

Regular  menstrual cycle vs. PCOS menstrual cycle

The diagram on the left shows a regular menstrual cycle, and the diagram on the right shows a PCOS cycle with no ovulation.

Now, let’s look at what happens during a menstrual cycle with PCOS.

  1. With PCOS, LH levels are often high when the menstrual cycle starts. The levels of LH are also higher than FSH levels.
  2. Because the LH levels are already quite high, there is no LH surge. Without this LH surge, ovulation does not occur, and periods are irregular.

Girls with PCOS may ovulate occasionally or not at all, so periods may be too close together, or more commonly too far apart. Some girls may not get a period at all.

What types of tests will my health care provider do to diagnose PCOS?

Your health care provider will ask you a lot of questions about your menstrual cycle and your general health, and then do a complete physical examination. You will most likely need to have a blood test to check your hormone levels, blood sugar, and lipids (including cholesterol). Your health care provider may also want you to have an ultrasound test. This is a test that uses sound waves to make a picture of your reproductive organs (ovaries and uterus) and bladder (where your urine is stored). In girls with PCOS, the ovaries may be slightly larger (often >10cc in volume) and have multiple tiny cysts.

Does PCOS mean I have cysts on my ovaries?

The term “polycystic ovaries” means that there are lots of tiny cysts, or bumps, inside of the ovaries. Some young women with PCOS have these cysts; others only have a few. Sometimes these cysts are not seen on ultrasound. Even if there are not cysts seen on ultrasound, you may still have PCOS. If you do have polycystic ovaries, they’re not harmful and they don’t need to be removed.

Why do I get acne and/or extra hair on my body?

Acne and extra hair on your face and body can happen if your body is making too much testosterone. All women make testosterone, but if you have PCOS, your ovaries make a little bit more testosterone than they are supposed to. Skin cells and hair follicles can be extremely sensitive to the small increases in testosterone found in young women with PCOS.

Why do I have patches of dark skin?

Many adolescents with PCOS have higher levels of insulin in their blood. Higher levels of insulin can sometimes cause patches of darkened skin on the back of your neck, under your arms, and in your groin area (inside upper thighs).

Will PCOS affect my ability to have children some day?

Women with PCOS have a normal uterus and healthy eggs. Many women with PCOS have trouble getting pregnant, but some women have no trouble at all. If you’re concerned about your fertility (ability to get pregnant) in the future, talk to your health care provider about all the new options available, including medications to lower your insulin levels or to help you ovulate each month.

What can I do about having PCOS?

The most important treatment for PCOS is working towards a healthy lifestyle that includes healthy eating and daily exercise. There are also excellent medications to help you manage irregular periods, hair growth, and acne. Ask your health care provider about the various treatment options.

What is the treatment for PCOS?

The most common form of treatment for PCOS is the birth control pill; however, other kinds of hormonal therapy may include the “vaginal ring” and “the patch”. Even if you’re not sexually active, birth control pills may be prescribed because they contain the hormones that your body needs to treat your PCOS. Birth control pills (either taken continuously or in cycles) can:

  • Correct the hormone imbalance
  • Lower the level of testosterone (which will improve acne and lessen hair growth)
  • Regulate your menstrual periods
  • Lower the risk of endometrial cancer (which is slightly higher in young women who don’t have periods regularly)
  • Prevent an unplanned pregnancy if you are sexually active

Is there any other medicine to treat PCOS?

A medicine which helps the body lower the insulin level is called Metformin. It’s particularly helpful in girls who have high levels of insulin, or have pre-diabetes or Type 2 diabetes. Some girls are treated with both Metformin and birth control pills at the same time

Ask your health care provider about treating hair growth. Only you and your health care provider can decide which treatment is right for you. Options may include bleaching, waxing, depilatories, spironolactone (spi-ro-no-lac-tone), electrolysis, and laser treatment. Spironolactone is a prescription medicine that can lessen hair growth and make hair lighter and finer. However, it can take up to 6-8 months to see an improvement.

Ask your health care provider about treatment for acneThere are various ways to treat acne, including the birth control pill, topical creams, oral antibiotics, spironolactone, and other medications.

Ask your health care provider about a weight loss plan if you are overweight. If you’re overweight, losing weight may lessen some of the symptoms of PCOS. Talk to your health care provider or nutritionist about healthy ways to lose weight such as exercising more and following a nutrition plan that helps manage insulin levels. Healthy eating can also keep your heart healthy and lower your risk of developing diabetes.

Weight Management Tips:

  • Choose nutritious, high-fiber carbohydrates instead of sugary or refined carbohydrates
  • Balance carbohydrates with protein and healthy fats
  • Eat small meals and snacks throughout the day instead of large meals
  • Exercise regularly to help manage insulin levels and your weight
Top 10 PCOS Tips

What if I have worries about having PCOS?

If you’ve been told you have PCOS, you may feel frustrated or sad. You may also feel relieved that at last there is a reason and treatment for the problems you have been having, especially if you have had a hard time keeping a healthy weight, or you have excess body hair, acne, or irregular periods. Having a diagnosis without an easy cure can be difficult. However, it’s important for girls with PCOS to know they are not alone. Finding a health care provider who knows a lot about PCOS and is someone you feel comfortable talking to is very important. Keeping a positive attitude and working on a healthy lifestyle even when results seem to take a long time is very important, too! Many girls with PCOS tell us that talking with a counselor about their concerns can be very helpful. Other girls recommend online chats. The Center for Young Women’s Health offers a free and confidential monthly online chat for girls and young women with PCOS.

What else do I need to know?

It’s important to follow-up regularly with your health care provider and make sure you take all the medications prescribed to regulate your periods and lessen your chance of getting diabetes or other health problems. Because you have a slightly higher chance of developing diabetes, your health care provider may suggest that you have your blood sugar tested once a year, or have a glucose challenge test every few years. Quitting smoking (or never starting) will also improve your overall health. Because you have a higher chance of developing diabetes, your health care provider may suggest having a:

  • Blood sugar test once a year
  • A1C test (a test that tells how high your blood sugar has been the past 2-3 months) once a year
  • Glucose tolerance test every few years
Additional Resources

PCOS: Preparing for Your Oral Glucose Tolerance Test

PCOS iconsIf you have PCOS and you’re getting ready to have an oral glucose tolerance test, you may be wondering how to prepare for the test and what the results may mean. The test can help your health care provider figure out whether you have a high risk of developing diabetes and whether lifestyle changes and medications such as Metformin might be helpful in treating your PCOS.

What is Glucose?

Glucose is a type of sugar and the main source of energy used by your body. The glucose that your body uses for energy comes from many kinds of foods called carbohydrates, such as cereal, bread, rice, pasta, and other grains, not just sugary foods. Dairy products, fruits, and vegetables all contain carbohydrates as well. Your body uses the glucose it needs and then stores the rest as “glycogen” in your liver and muscles.

What is an Oral Glucose Tolerance Test (OGTT)?

An OGTT is a way to measure your body’s ability to use glucose. Your pancreas (a gland located behind the stomach) makes a hormone called insulin, which helps your body use the glucose in your blood. If your pancreas doesn’t make enough insulin or if your body is unable to use the insulin it makes, you may have a high blood glucose level. The OGTT involves fasting overnight and then having your blood checked early in the morning. You will then drink a special glucose drink and have your blood tested again after 2 hours. Sometimes blood sugar levels are also checked at other times such as 1 hour, 3 hours, or 4 hours after the glucose drink.

What if my blood glucose level is high?

If the OGTT shows that your blood glucose levels are higher than normal, your health care provider may tell you that you have “impaired glucose tolerance”. This often means that you are at risk for developing diabetes. Rarely, diabetes is diagnosed after an OGTT. Diabetes is an illness that can develop if your body does not make enough insulin, or when your body has trouble using the insulin that it does make. Your health care provider may suggest a fasting glucose level, an A1C, or an oral glucose test (especially if you are overweight). Depending on the results, these tests are often repeated yearly or every few years.

What do I need to do before the OGTT?

Your health care provider will most likely give you either a glucose drink to take home or a prescription to bring to your pharmacy or the lab. Some tests are done in a health care provider’s office, but most often the test is done in a lab at a hospital or clinic. The test takes several hours (most of it is waiting between blood tests), so you’ll need to plan on being at the lab or your HCP’s office for most of the morning. If you need to fill a prescription, be sure you call your pharmacy ahead of time to see if they have the glucose drink in stock, because some pharmacies may not carry this item, or they may need to order it.

Do I need to eat anything special before the test?

3 DAYS BEFORE THE OGTT: Plan on eating three healthy meals and snacks for 3 days before the test. You do not need to buy special food, but you do need to make sure you have healthy foods to eat. Your meals should be balanced with plenty of carbohydrates.

Foods containing carbohydrates include:

  • Fruits
  • Breads
  • Cereal
  • Pasta
  • Rice
  • Crackers
  • Starchy vegetables (corn/peas/carrots)

12 HOURS BEFORE THE OGTT: DO NOT eat, smoke, or participate in heavy exercise 12 hours before the test. (For example: If your test is scheduled for first thing in the morning, i.e.: at 8 AM—Do not eat, smoke, or participate in heavy exercise after 8pm the night before). You may drink plain, NOT flavored, water.

What happens on the morning of the test?

When you are ready to leave your home to have your test done, be sure to remember to bring:

  • Your laboratory slips
  • Your glucose drink (unless the lab provides it)
  • Reading material/book/magazine
  • Earbuds if you want to listen to music while you’re waiting (optional)
VERY IMPORTANT! DO NOT DRINK the glucose drink until you arrive at the lab. The lab technician will tell you when to drink the glucose drink.


First: A fasting blood glucose test is done. This is a simple blood test that checks your blood sugar before you drink the glucose drink.

Next: The lab technician will tell you to drink the glucose drink. It will taste very sweet. It’s important to drink the whole amount fairly quickly.

Waiting: After you finish drinking all of the glucose drink, you’ll be asked to sit until it’s time for your next blood test (about 2 hours later). You may read, listen to music, talk, or do another quiet activity while you are waiting.

VERY IMPORTANT! DO NOT EAT or DRINK anything except plain water while you’re waiting.

AFTER THE OGTT: Once your tests are done and the lab technician gives you permission to leave, you may go about your normal daily activities. You can go back to school or work, eat, drink, and do the regular exercise that you normally do.

When can I expect to get my test results?

The lab will usually send your results to your health care provider within a few days. You may already have a follow–up appointment scheduled or your health care provider may call you to review your results and let you know if there are any concerns.

What do the results mean?

The first test or “baseline” glucose test is your blood glucose level before you drank the glucose drink. Normal fasting blood glucose levels are less than 100 mg/dl. Your health care provider may also check your insulin level. A high level of insulin means that your body does not use insulin well (even if your glucose levels are normal). The second result of your 2–hour blood glucose test measures your glucose two hours after you drank the glucose drink. This level should be less than 140mg/dl. Normal levels of glucose mean that your body is able to use glucose the way it’s supposed to. High levels of glucose mean you are at high risk of diabetes or meet the diagnosis for diabetes. This means that your body has a hard time using glucose, and puts you at risk for developing diabetes. If your glucose levels continue to be very high, it could mean that you have diabetes.

What is the connection between impaired glucose tolerance (IGT) and PCOS?

Health care providers have known for some time that many of the symptoms of PCOS are caused by too much of the hormone testosterone. With PCOS, the ovaries make too much of this hormone which can result in extra facial and body hair and menstrual problems. Many young women with PCOS also have high levels of insulin that can stimulate the ovaries to make testosterone. The high levels of insulin also increase the chance of getting diabetes. Your HCP will look at your OGTT results along with other test results to figure out the best treatment for you including exercise, weight loss (if you’re overweight), and sometimes, medication.

Understanding how to prepare for an OGTT test and what the results mean can help you take charge of your PCOS. Making healthy food choices, exercising, and talking about your medication options with your health care provider are the best ways to keep your body healthy.

PCOS: The Oral Contraceptive Pill

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Adolescent girls and young women are frequently prescribed oral contraceptive pills (also called the “Pill”) for Polycystic Ovary Syndrome and for irregular or absent menstrual periods, menstrual cramps, acne, PMS, and endometriosis. Oral contraceptive pills lower hormone levels in girls with PCOS and regulate their menstrual periods. Hormone patches (Ortho-Evra, Xulane) and vaginal hormone ring (NuvaRing) can also help lower the hormone levels in girls with PCOS.

What are oral contraceptive pills?

Oral contraceptive pills contain two types of synthetic female hormones, progestin and estrogen. Similar hormones are made by the ovaries. There are many different kinds of oral contraceptives.

What are some of the possible medical benefits of oral contraceptive pills for young women with PCOS?

  • Regular and Lighter Periods: Oral contraceptive pills can help to regulate your menstrual cycle so your period comes about every 28 days or less often on extended pill cycles. The Pill usually causes lighter periods, too. This is important because not having your periods may result in excess growth of the lining inside your uterus, called the endometrium. Excess growth can lead to prolonged and heavy periods, or eventually a condition called endometrial hyperplasia. This is a precursor to endometrial cancer, therefore it is very important to ensure the endometrium is being shed in a daily or cyclic fashion.
  • Less Unwanted Hair: Oral contraceptive pills can lower androgen hormone levels and lessen the amount of excess hair growth (also called “hirsutism”). It can take 6 months before there’s a decrease in unwanted hair on the face, chest, back, and stomach.
  • Clearer Skin: Oral contraceptive pills can improve acne. The hormones in most types of the Pill can help stop acne from forming. Be patient though, it can take a few months to see an improvement.
  • Fewer or Milder Cramps, or No Cramps: Oral contraceptive pills can help to lessen menstrual cramps.
  • Other Medical Benefits: Because there is less menstrual bleeding with the use of oral contraceptive pills, girls taking the Pill are less likely to become anemic. Oral contraceptive pills also decrease your chance of getting endometrial (lining of the uterus) cancer, ovarian cancer, and ovarian cysts.

What are the possible side effects of the oral contraceptive pill?

Most women have no side effects when taking the oral contraceptive pill, but it’s possible to have irregular periods, nausea, headaches, or weight change. Each type of oral contraceptive pill can affect a young woman differently.

  • Spotting (you usually don’t need to use a regular pad, just a panty shield) or very light bleeding: This may occur during the first 1–3 weeks of starting the Pill, or if you miss a pill. If the bleeding becomes heavier or lasts more than a few days or the bleeding happens after you have been on the pill for a few months, you should talk with your health care provider.
  • Nausea (or feeling like you need to throw up): Nausea occasionally occurs when you first start taking the Pill and will often go away in a few days. It is less likely to occur if the Pill is taken after dinner or with a bedtime snack.
  • Headaches: Headaches may occur because of stress at school or home, too little sleep, sinus infections, or migraines. The Pill can make headaches better or worse. If your health care provider thinks your headaches are related to the Pill, he/she may prescribe an oral contraceptive pill with a lower amount of estrogen or have you stop the Pill for a short time. If you have migraine headaches, talk to your health care provider about whether the Pill is right for you.
  • Mood changes: Feeling up and down emotionally can sometimes happen to anyone and is unlikely to be caused by the Pill. Exercising regularly and following a healthy diet may help along with talking to a counselor. Make sure you let your health care provider know how you are feeling.
  • Sore or enlarged breasts: Sometimes, your breasts may become tender and/ or get larger, but usually they will stay the same.
  • Weight change: Some teens gain weight and some teens lose weight while on the Pill, but most stay exactly the same. Remember to choose healthy foods, watch your portion sizes, drink lots of water, and get plenty of exercise.
  • Blood clots: A blood clot in your leg or lung is a very rare, but a serious side–effect. If you suddenly have pain or swelling in your leg, or shortness of breath and chest pain, see your health care provider right away. If you have a history of blood clots, you should not take the Pill. Tell your health care provider if any of your relatives have ever had blood clots, especially when they were young. Blood clots are more likely to develop if you are a smoker, overweight, having surgery, have a family history, or sitting on a plane for a long time. To lessen your chance of blood clots, don’t smoke, and if you’re on a long plane trip, get up, walk around, and drink lots of water. If you have a family history of blood clots, talk to your HCP. If you’re scheduled for surgery, talk to your health care provider about stopping the Pill for 3–4 weeks before surgery and after the surgery until you have recovered.
If side effects from the Pill occur, they’re usually mild and go away in the first three to four cycles. If you do have side effects, talk with your health care provider. If the side effects are uncomfortable or if they don’t go away, your health care provider may switch you to a different kind of oral contraceptive pill.

Are there any reasons why I shouldn’t take the oral contraceptive pill?

Most teens can take the oral contraceptive pill for PCOS, but for some, taking the combined Pill (with both estrogen and progestin) is not an option because of certain medical conditions, called “contraindications.” If you can’t use the combined Pill, your health care provider will talk to you about other medications to treat your PCOS.

Reasons why you should NOT take combined oral contraceptives:

  • History of blood clots Migraine headaches with aura (spots and flashing lights or difficulty seeing 5 to 30 minutes before the headache starts), or neurological symptoms (numbness, loss of speech)
  • Certain kinds of heart disease
  • High blood pressure that is not controlled with medication
  • Active hepatitis (liver disease) – for starting the Pill
  • Jaundice (yellowing of your skin or eyes during a previous pregnancy)

Taking the Oral Contraceptive Pill

The most common pill packs come with 21 active hormone pills and seven placebo pills, but some packs have 24, 26, or even 28 active pills. The example shown is for a 28–day pill pack in which you take 21 active hormone pills, and then seven placebo pills that contain no active hormones. These last seven pills are just “reminder” pills in most pill brands. They are taken during the fourth week, including during your period. With packages that have 24 active pills, the last 4 are “reminder” pills. There are also pill packages that have 84 active pills for extended continuous hormones and 7 “reminder” pills. Your health care provider will tell you whether you will be taking the active pills continuously or in cycles as shown below.


How to take birth control pills

How to take birth control pills

  1. To take the oral contraceptive pill, follow the instructions on the package. Your health care provider will explain how to use your pill pack. You will be told to start taking the oral contraceptive pill on a Sunday, on the first day of your menstrual period, or the day you are seen by your health care provider.
  2. You should take one oral contraceptive pill each day, at the same time of day until you finish the pack. Take the Pill at the same time as something that you do regularly so you don’t forget. For example, you could keep them near your toothbrush, or set your cell phone alarm as a reminder. The best time is ½ an hour after a complete meal such as dinner, or at bedtime. You may have slight nausea the first month, but this usually goes away with time. Some young women who take the Pill first thing in the morning find that they are more likely to have nausea, especially if they skip breakfast, so taking the pill after dinner or at bedtime may cure this symptom.
  3. After completing a 28–day pack, you should immediately start a new packet of pills the next day. During your fourth week on the pill cycle, you should get your menstrual period. Your menstrual period should stop once you begin the new packet of pills.

If your hormone levels continue to be high or your excess hair growth doesn’t improve, your health care provider may re–check your hormone levels, or may suggest that you take the Pill continuously. This means that you would take just the “active pills” for 3–4 months or longer. You would not have a menstrual period until you stop taking the active hormone pills. Some girls may have spotting while taking the Pill continuously.

The Oral Contraceptive Pill & PCOS FAQs

Do I need a pelvic exam before going on the oral contraceptive pill?

No. Although it’s important for teens to have checkups as part of their general health care, a pelvic exam is not needed for girls with PCOS just to start oral contraceptive pills. Girls with PCOS may have an external genital examination or a pelvic exam as part of their first visit for PCOS, and/or they may have a pelvic ultrasound to look at their ovaries.

Is there any trouble getting pregnant after using the oral contraceptive pill?

There is no change in fertility with the use of the oral contraceptive pill. However, if you have PCOS and your periods were irregular before you started taking the Pill, it is likely that your periods will be irregular again when you stop taking it.

Does the oral contraceptive pill cause birth defects?

No, the Pill does not cause birth defects or affect the health of future children.

Does the oral contraceptive pill cause cancer?

No. The Pill actually protects against cancer of the ovaries and cancer of the lining of the uterus. A woman is half as likely to get cancer of the uterus or ovaries if she takes the Pill. Most experts believe that taking oral contraceptive pills does not cause any increased risk of developing breast cancer. Even girls with a family history of breast cancer can take the Pill.

How long can I be on oral contraceptives?

It’s safe for you to be on the Pill for years, whether to regulate your menstrual cycle, treat your cramps, or as hormone replacement or birth control.

Do I need to take a break from the Pill?

There’s no medical reason that you need to take a “break” from the Pill.

What if I am also using the oral contraceptive pill for birth control?

If you’re also taking the oral contraceptive pill for birth control, you should know that oral contraceptive pills do not protect you from sexually transmitted infections. Condoms help to prevent most sexually transmitted infections and they are also an important backup method of birth control if you miss more than one pill in a row, or if you are sick (vomiting). All of these things can lower the effectiveness of the birth control pill. Whenever you get a new medication, ask if it changes the effectiveness of your oral contraceptive pill.

What if my period is very light while I’m taking the oral contraceptive pill?

Your period may be so light when you are on the oral contraceptive pill that you may have only a brown smudge on a tampon, pad, panty shield, or underwear. The amount of hormones in the pills is very low. This means that the lining of your uterus doesn’t become very thick, so very little blood needs to come out each month.

What if I forget to take one or more combined oral contraceptive pills?

  • If you miss 1 Pill, take the pill as soon as possible and then continue taking your pills at the usual time. You may take 2 pills on the same day (one at the moment you remember and the other at the regular time) or even 2 at the same time.
  • If you miss 2 or more active pills in a row, take the most recently missed Pill as soon as possible and then continue taking your pills at the usual time. You may take 2 pills on the same day (one at the moment you remember and the other at the regular time). If you are sexually active, use a backup method of birth control, such as condoms, or do not have sexual contact until you have taken the active hormone pills for 7 days (1 pill every day for 7 days in a row.)
  • If you missed the active pills in the third week, don’t take the inactive (hormone free pills). Instead, finish the current active hormone pills and then start a new pack right away. If you can’t start a new pill pack right away and you are sexually active, use a backup method of birth control (such as condoms) or do not have sexual contact until you have taken active pills for 7 days (1 pill every day for 7 days in a row).
  • Talk to your health care provider about whether you should use emergency contraception, especially if you missed pills in the first week of the package, or had unprotected sex anytime during the past 5 days.

Emergency contraception is recommended if you’ve had unprotected intercourse during the time you missed your pills.

  1. The first “morning–after” emergency contraception pill methods approved in the United States are: Plan B One–Step™, Next Choice®, and MyWay®. These products contain one kind of hormone, a progestin, and come as 1 or 2 pills. EC works best if taken within 3 days (72 hours) of unprotected sex, but can be taken up to 5 days but the earlier it is taken the more effective it is. No prescription is needed. Anyone can buy it without needing to show an ID. It prevents ovulation; it does not affect pregnancy or work after ovulation. It might be less effective in overweight women.
  2. Ella™ (ulipristal acetate or UPA) is an emergency contraceptive that works by stopping or delaying ovulation. It’s one pill (one dose) that can be taken up to 5 days or 120 hours after unprotected intercourse. A prescription is needed. It’s best to check a pregnancy test first.
  3. Another type of emergency contraception uses regular birth control pills, which contain two hormones, estrogen and progestin. There are 2 doses. The first dose may be 2, 4, or 5 pills depending on the brand of birth control pills used, and is taken within 120 hours (5 days) of unprotected sex. The second dose is taken 12 hours after the first dose. A health care provider must prescribe how many pills should be taken for this kind of emergency contraception. This method is less effective than the other two, and is more likely to cause nausea. So you are unlikely to use this medication.

Are there any serious side effects that I should be worried about?

Most young women who take the oral contraceptive pill have few or no problems. If you do have any of the following problems, call your health care provider right away.

Remember: ACHES

  • Abdominal or stomach pain (severe)
  • Chest pain (severe), cough, shortness of breath
  • Headache (severe), dizziness, weakness, or numbness
  • Eye problems (vision loss or blurring), speech problems
  • Severe leg pain (calf or thigh)

The oral contraceptive pill is much more than a birth control pill. Adolescent girls and young women are frequently prescribed the oral contraceptive pill just for its medical benefits. It’s a very safe and effective treatment for many types of medical problems, including PCOS, irregular menstrual periods, menstrual cramps, acne, PMS, and endometriosis.

PCOS: Insulin and Metformin

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Young women with PCOS often have elevated insulin levels and are more likely to develop diabetes. Metformin is a medication often prescribed for women with PCOS to help prevent or treat diabetes. A lifestyle that includes healthy nutrition and daily exercise is an important part of a PCOS treatment plan.

What is insulin?

Insulin is a hormone made by an organ in the body called the pancreas. The food you eat is broken down into simple sugar (glucose) during digestion. Glucose is absorbed into the blood after you eat. Insulin helps glucose enter the cells of the body to be used as energy. If there’s not enough insulin in the body, or if the body can’t use the insulin, sugar levels in the blood become higher.

What is insulin resistance?

If your body is resistant to insulin, it means you need high levels of insulin to keep your blood sugar normal. Certain medical conditions such as being overweight or having PCOS can cause insulin resistance. Insulin resistance tends to run in families.

What can insulin resistance do to me?

High insulin levels can cause thickening and darkening of the skin (acanthosis nigricans) on the back of the neck, axilla (under the arms), and groin area. In young women with PCOS, high insulin levels can cause the ovaries to make more androgen hormones such as testosterone. This can cause increased body hair, acne, and irregular or few periods. Having insulin resistance can increase your risk of developing diabetes.

How can I lower my insulin levels?

You can help lower your insulin levels naturally by eating fewer starches and sugars, and more foods that are high in fiber and low in refined carbohydrates. Low glycemic foods, on the other hand, don’t raise your blood sugar or insulin levels as much as foods that are high in sugar or refined carbohydrates. Exercising is another way to improve your PCOS. Fitting in 60 minutes of exercise each day is recommended, but any amount of exercise you do will help manage your PCOS. Exercise decreases insulin resistance.

What else will lower my insulin level?

Metformin (also known as Glucophage®) helps to regulate the amount of glucose (sugar) in your blood. It makes your body more sensitive to insulin, and decreases the amount of glucose your liver releases. Young women with high insulin who take Metformin are less likely to develop type 2 diabetes than those who don’t take a medication that lowers insulin. Research studies have shown that young women with PCOS who are overweight and who were treated with Metformin and a healthy lifestyle (healthy nutrition and regular exercise) were able to lose weight and lower their fasting blood sugar. Taking Metformin and maintaining a healthy weight also improves cholesterol levels. Metformin is not approved by the FDA (Food and Drug Administration) for PCOS, but it is commonly prescribed for adolescents with impaired glucose tolerance.

How do I take Metformin?

Metformin is available as a pill or liquid. It is usually taken 2–3 times a day with your meals (usually breakfast and dinner). Your health care provider will tell you to begin at a very low dose and slowly increase the amount of medicine you take over a few months—”start low, go slow.” Your health care provider may prescribe once a day long acting (XR–extended release) Metformin instead. It’s important that you take this medication exactly as prescribed by your health care provider. Do not break, chew, or crush the pills. Be sure to swallow the whole pill(s).

How do I store Metformin?

Keep your Metformin tightly closed, in the same bottle it came in. Do not remove the label on the bottle. Store it at room temperature away from high temperatures and any moisture. Do not store Metformin in the bathroom. Be sure to keep your medicine away from young children.

Are there any reasons not to take Metformin?

People with kidney or liver problems should not take Metformin. Your health care provider will check your blood to make sure that you do not have blood, kidney or liver problems before you start Metformin and then usually once a year after that. If you get sick and throw up or have diarrhea, call your health care provider and stop your Metformin until you feel completely well. It’s very important not to be dehydrated (not having enough fluids in your body) while taking Metformin. You should not binge drink alcohol and take Metformin. Also, if you’re going to have surgery or a medical or dental procedure where you can’t have anything to eat or drink, talk to your health care provider about stopping the Metformin for 48 hours before the procedure. If you’re scheduled for an X–ray that includes a “contrast material” (a dye that helps the radiologist see the images better), you should talk to your health care provider about stopping your Metformin for up to 48 hours before and after the test. Getting dehydrated, having kidney problems, or having a serious infection can cause the rare condition called “lactic acidosis”, so it’s important to talk to your health care provider about any of these problems.

Does Metformin have any side effects?

In general, healthy young people don’t experience many side effects. About a third of people who take Metformin have stomach upset such as nausea, diarrhea, gas, and loss of appetite. Some people may complain of a metallic taste. If the side effects are a problem for you, it’s important to talk with your health care provider. You may be able to lower your dose for a few days and slowly build back up to your regular dose.

What if I miss a dose of my Metformin?

When you first start taking Metformin, it’s a good idea to ask your health care provider what to do if you miss a dose. Write down the answer so you will have a plan if it happens. In general, you will probably be told NOT to take the pills that you missed, especially if it’s almost time for your next dose. Never double up on pills to make up for a missed dose.

Can I get pregnant while taking Metformin?

Yes. If you’re sexually active and you’re not taking oral contraceptive pills or using another method of birth control, it’s possible that you’ll have menstrual cycles and ovulate (release an egg). If your egg is fertilized (sperm from a male comes together with an egg of a female), you could become pregnant. Women with PCOS are more likely to get pregnant while taking Metformin. You should talk with your health care provider about a method of birth control that’s right for you.

Important things to remember when taking Metformin:

  • If you’re prescribed Metformin for PCOS, be sure to tell your health care provider and pharmacist about all the prescription medications and over–the–counter medicines that you’re taking.
  • If you’re having surgery, including dental surgery, tell your health care provider or dentist that you’re taking Metformin for PCOS. Ask when you should stop taking it before the procedure.
  • Metformin can lower your body’s ability to absorb certain vitamins (B12 and folate), so it’s a good idea to take a multivitamin (with B vitamins).
  • Alcohol can be dangerous while taking Metformin. You’re more likely to get dehydrated or develop liver problems. If you have 3–4 drinks at a time, Metformin is not a good treatment option for your PCOS. Ask your health care provider about other treatment options or decrease your use of alcohol.
  • If you’re sexually active, be sure to talk with your health care provider about taking the oral contraceptive pill or about using another reliable birth control method.
  • Talk to a dietitian about planning meals and snacks that are PCOS–friendly.
  • Try to fit in about 60 minutes of exercise every day.
  • Keep all of your medical appointments and be sure to go for any lab tests that your health care provider might order.
Talk to your health care provider about the pros and cons of taking Metformin. Remember that Metformin will not cure PCOS or help you lose weight. Choosing foods that have a low glycemic index (lower in sugar and higher in fiber and protein) and exercising at least 60 minutes every day will most effectivelyhelp you manage your PCOS and lose weight.

PCOS: Spironolactone

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Spironolactone (pronounced: spi–ro–no–lac–tone) is a diuretic or “water pill” that’s prescribed for people who have high blood pressure and for those who have swelling due to extra fluid, but it also has other benefits. Spironolactone is often prescribed for young women with PCOS who are taking oral contraceptive pills and who are “hirsute” (have extra hair in unwanted places).

How does Spironolactone work?

Spironolactone, the generic name for Aldactone®, works by blocking the effects of androgen. Androgens are hormones that both males and females have, but males have higher levels of them. Androgens such as testosterone are responsible for hair growth on the face, chest, and stomach that some young women with PCOS have. Androgens can also cause acne. Spironolactone may work by lowering the level of androgens, which lessens hair growth and improves acne.

How effective is Spironolactone?

Spironolactone is very effective in lessening hair growth and improving acne for young women, especially those who have not seen desirable results withoral contraceptive pills. Most young women taking spironolactone medication will see positive results; however, it can take up to 6 months to see an improvement in .

Are there any side effects?

Most young women who take spironolactone have few or no side effects. The side effects are only temporary and will go away when spironolactone is stopped. Spironolactone should be prescribed along with contraception to prevent pregnancy as the drug can be harmful to a developing baby.

Possible side effects may include:

  • Irregular menstrual bleeding (if not taking the Pill)
  • Frequent
  • Rash
  • Dry mouth, thirst
  • Loose bowel movements
  • Nausea
  • Tiredness
  • Headache

Other things to know about Spironolactone:

  • Before taking Spironolactone, tell your health care provider if you have liver or kidney problems
  • Depending on the level of spironolactone you are on, your health care provider may want to repeat blood tests to monitor your potassium levels
  • Your health care provider may suggest you to take spironolactone during the daytime so that frequent urination is not disrupting your sleep
  • Don’t take spironolactone if you’re pregnant or might become pregnant
  • It’s best to take both spironolactone and contraception together
  • Don’t take potassium supplements while taking spironolactone

PCOS: Worksheets

PCOS iconsPeriod and Symptom Trackers: Keeping track of when your period starts and stops is a good way to see if there is a pattern to your menstrual cycle. It’s also important to write down how many days you have your period and the amount of flow you have. Bring your Period Trackers with you when you see your health care provider so that he or she can evaluate your cycle.

My Monthly Period & Symptom Tracker is an easy way to keep track of your menstrual flow, and it’s also a way to keep track of cramps, and/or PMS and period symptoms (if you have them) each month.

  • Review the Sample-Monthly-Period-and-Symptom-Tracker.
  • Print copies of My-Monthly-Period-and-Symptom-Tracker.
  • Make a check mark in the appropriate box (or boxes) for each day of the month. If you don’t have any flow or any symptoms on any given day, leave the box empty. Refer to the Blood Flow Key at the bottom for “Flow” definitions.
  • The numbers at the top are the same as the dates in one month. Some months don’t have 31 days, so you may leave some boxes empty.
  • Remember to bring My Monthly Period & Symptom Tracker with you to your medical appointments.


My Yearly Period Tracker: My Yearly Period Tracker is a simple and convenient way to track your period throughout the year.

  • Review the Sample-Yearly-Period-and-Symptom-Tracker.
  • Print a copy of My-Yearly-Period-and-Symptom-Tracker.
  • Refer to the Key at the bottom to learn how to fill in the box with the appropriate letter(s). Place a “T” in the box for the hormone pill taken, and place an “R” for reminder (placebo) pills.
  • Be sure to note if you’ve taken a pill during your period by putting a B/T or B/R in the box.
  • Remember to bring My Yearly Period Tracker with you to your medical appointments.
  • Talk to your health care provider about whether you should use the monthly and/or yearly tracker to track your period.


Medication List:

Why should I keep a list of my medications?

It’s a good idea to keep an up to date list of the current medicines you take (for PCOS and for any other reason). It’s super important to include any over-the-counter medications (Ex: Ibuprofen, Melatonin, etc.) and vitamins or supplements (Ex: Biotin, Collagen, etc.) that you take regularly. We suggest that you make a photocopy of the My Medication List, fill it out, and bring it with you to your next medical appointment. You’ll then be able to review your medicine with your health care provider.

How do I use “My Medication List”?

Write down each medicine (one per box), the dosage, who prescribed it, when you started taking it, the date you stopped taking it (if applicable) and any side effects that you may have when you take the medicine, such as an upset stomach. You can also write down any questions that you want to ask your health care provider, such as: “Does it matter what time of day I take my medicine?” or “What if I miss a dose?”

My Medication List

Fitness Planning: Exercise is good for you in many different ways. It can help you maintain a healthy weight and boost your overall energy level. Regular exercise lowers stress and anxiety and helps improve your mood. Exercise can and should be fun. Knowing the health benefits of exercise will help you get started. The worksheets in this section will help you figure out what motivates you (or gets you to exercise), which types of activities you’ll enjoy most, and how to fit them into your life.

Intro to Worksheet 2: Fun Fitness

A good fitness plan should include a balance of stretching, toning, and aerobic activities.

  • The Stretch It section lists stretching exercises that will keep you flexible, help you relax, and help prevent injuries such as pulling a muscle from reaching too far.
  • The Tone It section lists strengthening exercises that will help you build strong muscles and boost your metabolism.
  • The Move It section lists aerobic activities that will help keep your heart healthy and strong.

This worksheet lists exercises from each of the Fun Fitness sections. Check off the ones you want to try, and use the extra lines to fill in related exercises you’d also like to do. You can include exercises you’ve learned from a sports team, in gym class, or from a certified personal trainer. Be sure to choose items from each column for a balanced workout.

Intro to Worksheet 3: My Fitness Plan

Make sure to make time to do the activities that you’ve chosen from Worksheet 2. This will help you plan your fitness schedule so that exercising becomes part of your weekly routine.

Look back at your completed Fun Fitness Worksheet and fill in “My Fitness Plan” worksheet with the activities that you’ve chosen. Think about what activities will work best on which days and what time of day would be best to do them. Remember to balance stretching, toning, and aerobic activities. You don’t have to do all three in one day, but remember to also schedule your week so that you’re not doing only one type of exercise.

After you’ve created your fitness schedule on Worksheet 3, it’s a good idea to mark the days that you plan to exercise on your own personal calendar or planner. Put this worksheet someplace where you’ll see it as a reminder of what’s coming up.

Fitness Worksheets

Meal Assessment: Healthy eating for PCOS includes the following guidelines:

  • Eating small meals and healthy snacks every few hours instead of eating large meals.
  • Including a balance of carbohydrates, protein, and fat at meals and snacks.
  • Choosing high fiber carbohydrates including whole grains (instead of refined grains), fruits, and vegetables.
  • Choosing healthy fats (instead of saturated or trans fats).
  • Limiting sugary drinks, refined grains, processed snack foods, and sugary treats.

You can download, print, and use the Meal Assessment Worksheet located below to help you follow these guidelines. Write down everything you eat on the worksheet, and review it at the end of the day. Look at the boxes that are checked “No”. What could you eat next time to make it a “Yes”? Make a shopping list of foods that will help you stick to your healthy eating plan. If you are eating large portions, try eating smaller portions every few hours and add small healthy snacks for in between meals. The more you practice PCOS-friendly eating, the easier it will become.

Meal Assessment Worksheet

PCOS: Nutrition Basics

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Diet and exercise are important parts of managing PCOS (Polycystic Ovary Syndrome). This is because young women with PCOS often have higher levels of the hormone insulin in their blood, and many have trouble maintaining a weight that will help them meet their physical health potential. Knowing the right types of foods to eat as well as the kinds of food to limit can improve the way you feel and may help you meet your body’s intended weight. Eating well, staying active, and maintaining your weight (or losing even a small amount of weight if appropriate for your body) can improve PCOS symptoms.

What do I need to know about insulin and carbohydrates?

The insulin level in your blood goes up after you eat. It goes up the most after you eat or drink something that contains carbohydrates. Carbohydrates are found in grains (such as bread, pasta, rice, and cereal), most snack foods (such as chips, cookies, and candy), sugary drinks such as soda and juice, and fruits and vegetables.

Are all carbohydrates the same?

No. Even if you eat two foods that have the same amount of carbohydrate, they may have a different effect on your insulin level. This effect has a lot to do with the type of carbohydrate in the food. Carbohydrate foods with fiber such as whole grains, fruits, and vegetables are usually the best to eat if you’re trying to keep your insulin level down. Carbohydrate foods that are sugary or refined (such as soda, juice, white bread, and white rice) can cause insulin levels to go up higher. Foods and drinks like this are also not very filling, which means you may feel hungry shortly after eating them. Try to choose high–fiber, low–sugar carbohydrate foods most of the time.

Do I need to buy special foods?

No. You don’t need to go out of your way to buy special foods. Just like with any healthy eating plan, your meals should include a balance of vegetables, fruits, whole grains, plant–based protein, lean meats, and healthy fats. Most foods fit into a healthy eating plan for PCOS, but you should read food labels to help you pick out the healthier choices. Look for high–fiber grains such as brown rice, whole–wheat pasta, and whole–wheat bread rather than low–fiber grains such as white rice, pasta, or white bread.

Don’t be fooled by fat–free treats. They usually have a lot of added sugar. Also, some sugar–free foods (such as baked goods) are made with refined grains such as white flour and can raise your insulin levels the same way that sugar can. Other sugar–free foods are carbohydrate free. These foods, sweetened with artificial sweetener, may be a good alternative if they don’t upset your stomach. There is currently no scientific data that suggests moderate amounts of artificial sweetener are harmful to our health. However, these foods and drinks are processed. Try to stick to the most natural, whole form of each food (ie, lemon sliced in water instead of diet lemonade).

Try these healthy food “swaps” if you’re looking for alternatives to refined carbohydrates.

Instead of:

  • Sweetened juice, canned fruit in heavy syrup, or sweetened applesauce
  • Starchy vegetables such as potatoes, corn, and peas
  • Refined grains made with white flour such as white bread and pasta, bagels, or white rice
    Sugared cereals such as Lucky Charms®, Fruit Loops®, or Frosted Flakes®, and other sweetened grains such as cereal bars (Nutrigrain Bars®), breakfast pastries (PopTarts®), and donuts
  • Sugary drinks such as soda or juice
  • Sugary foods such as cookies, cakes, and candy
  • Snacks such as potato chips, Fritos®, Doritos®, and tortilla chips


  • Fresh fruits or frozen/canned fruit without added sugar, or unsweetened applesauce
  • Non–starchy fresh vegetables or frozen/canned vegetables such as broccoli, spinach, tomato, mushroom, peppers, and carrots
  • Whole grains such as whole wheat pasta, brown rice, oats, quinoa, and whole wheat bread
  • High fiber cereals such as Kashi®, shredded wheat, and All Bran®. (Look for cereals that have at least 5 grams of fiber per serving or sprinkle ½ cup of bran cereal or unprocessed bran on a low–fiber cereal to increase the fiber)
  • Water or seltzer, flavored with fruit if desired, unsweetened iced tea
  • High fiber baked goods made from whole wheat flour and oats
  • Crackers and snacks with fiber such as Triscuits®, Wasa®, or popcorn

Are “carbs” unhealthy?

No! Carbs (carbohydrates) give your body energy. Some people think that eating carbs will make them gain weight, but carbs are essential to a balanced diet. Many other important nutrients like vitamins and minerals come from carbohydrate foods, so cutting out carbs completely is not a good idea. Because high–fiber carbohydrate foods are higher in nutrients and help you feel full longer than sugary low-fiber carbohydrates, it’s best to choose high-fiber carbs as often as possible. If you think you’re eating more carbohydrates than your body needs, try to check in to see if the carbohydrate is taking up more than ¼ of your plate and then reduce your appropriate serving size based on your hunger and fullness if it is much larger than that.

What about foods that have fats and proteins in them?

Protein foods such as beans, hummus, nuts, peanut butter, tofu, eggs, fish, chicken, meat, and vegetarian meat substitutes, and fats such as olive oil, nuts, and avocado are an important part of a PCOS–friendly eating plan. Combining foods that contain protein and/or fat with a carbohydrate will help to slow down the absorption of the carbohydrate and keep insulin levels low. For example, instead of plain rice, have rice with beans and a little avocado.

Keep in mind that some fats are much healthier than others. Healthy fats, also referred to as unsaturated fats, are found in olive oil, canola oil, nuts, avocados, and fish. Try to incorporate healthy unsaturated fats and proteins as alternatives to butter, margarine, mayonnaise, full–fat cheese, creamy sauces or dressings, and red meat.

Do I need to follow a diet that is extra high in protein?

No. Extremely high protein diets (such as the Atkins, Paleo, or Ketogenic diet) are not a good diet option for teens because they can be low in some important nutrients such as fiber, the B vitamins, and vitamin C. It’s also important to remember that even if you limit your carbohydrate intake, overeating fat or protein can cause unintentional weight gain. You should aim for a way of eating that has a balance of protein, high-fiber carbohydrates, and some fat.

What does low glycemic index mean?

Glycemic index is a term used to describe how a food affects blood sugar. The higher a food raises blood sugar, the higher the glycemic index. High–fiber carbs have a lower glycemic index than sugary or refined carbs. Combining a carbohydrate food with another food can lower the glycemic index because it allows your body to absorb the carbohydrate more slowly. For example, if you have a cupcake immediately after a meal it will not raise your blood sugar as high as it would if you ate the cupcake on its own an hour or two after a meal.

What fruits and vegetables have a low glycemic index?

Vegetables such as asparagus, broccoli, carrots, cauliflower, celery, cucumber, green beans, spinach, tomatoes, and zucchini and fruits such as apples, berries, grapes, oranges, peaches, and plums have a low glycemic index. Fruits and vegetables with more sugar or starch have a higher glycemic index (such as dried fruit, tropical fruit, corn, potatoes, squash, and peas).

Should I avoid dairy, sugar, gluten, or soy?

There is no current scientific data to support restricting or avoiding specific food groups or types of foods in order to improve PCOS symptoms. Following the dietary advice presented here, in addition to exercising, are healthy ways to manage weight and decrease symptoms.

If I choose the right foods, do I still need to be worried about the amount of food I eat?

Yes; in addition to what you eat, how much you eat also affects your insulin levels. For example, your insulin will go up much more if you have 3 cups of pasta than if you have 1 cup of pasta, even if the pasta is whole grain. This means it’s usually better to have several small meals and snacks during the day than it is to have a few really big meals. Having more frequent smaller meals and snacks will keep your insulin level lower throughout the day.

What is the Nutrition Facts label?

The Nutrition Facts label explains what nutrients (components of food your body needs to grow and stay healthy) and how much of those nutrients are in found in one serving of the food. It’s located on the outside of most food packages, but isn’t on most fresh foods (such as fruits and vegetables or meats). The Nutrition Facts label can help you make choices about the food you eat.

What will every Nutrition Facts label have on it?

The label will have some or all of the following nutrients listed:

  • Serving Size: Serving size equals one serving of the product. All the other nutrient values listed on the label are based on this amount.
  • Servings per Container: This number is how many servings you can get from one package. Some containers have a single serving, but most have more than one serving per package. If you eat more than one serving, all of the rest of the information on the label needs to be multiplied by the number of servings you consume.
  • Calories (total): Calories are a unit of energy that comes from carbohydrates, protein and fat. Calories give us energy so we can think and be active.
  • Calories from Fat: This number is the amount of calories that comes from fat. It’s not the percent of fat in the food.
  • % Daily Value: This value is the percentage of the recommended daily value for a nutrient that you get in one serving. A food that has more than 20% of the Daily Value of a nutrient is an excellent source; however, for some nutrients such as fat, sodium, and cholesterol, the lower the percent, the better.
  • Total Fat:Fat is essential for our bodies. There are 4 kinds of fat. Monounsaturated and polyunsaturated fat are the kinds of fat that are healthy for the heart.
  • Trans Fat: Trans fat is unhealthy for your heart, and should be avoided.
  • Cholesterol:Cholesterol is a substance found only in animal products. Eating too much cholesterol is not healthy for your heart. Some cholesterol is formed naturally inside your body.
  • Sodium:Sodium is the amount of salt in the serving of food. People with high blood pressure are often told to follow a low sodium diet. Processed foods, even though that might not taste salty, are often high in sodium.
  • Total Carbohydrate: Carbohydrates give your muscles and brain energy. Certain types of carbohydrates are sometimes listed on the label.
  • Dietary Fiber: Helps with digestion and keeps you full between meals.
  • Sugars: Are important for instant energy, but eating too much added sugar can be unhealthy. Soon the Nutrition Facts label will list naturally-occurring sugar (such as the lactose in milk) separately from added sugar (such as the chocolate in chocolate milk).
  • Protein: This nutrient is used to build muscle and fight infections.
  • Vitamins and Minerals (A, C, Calcium, Iron): This amount is the percent  (%) Daily Value for vitamin A, vitamin C, calcium, and iron you are getting from a serving of this product. Other vitamins and minerals may be included in this section.

Other nutrients, such as polyunsaturated or monounsaturated fat and other vitamins and minerals, can also be put on the Nutrition Facts label if the company that makes the food wants them listed.

Ingredients are often listed either underneath or nearby the Nutrition Facts label on a product. The ingredients are listed by weight, meaning that the first ingredient listed is the one that is found in the highest quantity in that product. When you’re checking to see if a product is made from whole grains, you want to make sure that the word “whole” or the type of whole grain (such as oats or quinoa) is listed as the first ingredient. Sometimes for marketing purposes a company will list that a product “contains whole grains” but when you look at the ingredient list it is actually not the first ingredient.

What should I look for on the Nutrition Facts label?

The first thing you should look at is the serving size. The amount of each nutrient on the label is what’s found in one serving of that food, not in the whole container. If you don’t know what one serving size is, you won’t know the amount of each nutrient you’re actually getting. For example, a large bag of microwave popcorn has three servings in it. It’s okay to eat more than one serving at a time, but it’s important to know that if you eat the whole bag, you’d be getting three times what’s listed on the label. Eating when you’re hungry and stopping when your full is an important part of healthy eating for PCOS, so keep that in mind.

Do I need to read every Nutrition Facts label?

No. You don’t need to keep track of every nutrient you are eating. Just take a look at Nutrition Facts labels once in a while to help you make healthy choices and choose foods that will give your body the nutrition it needs. For example, if you don’t drink much milk, you should read Nutrition Facts labels to help you find other foods and drinks that are high in calcium. You can also use the Nutrition Facts label to compare two different foods. For example, if you are deciding between two different kinds of bread, reading the Nutrition Facts labels can help you make the healthier choice by choosing the bread that has the highest amount of fiber and least amount of added sugar.

The Nutrition Facts label lists a 2000-calorie diet. Should I be eating 2000 calories?

It’s possible that a 2000-calorie diet may be right for you, but many adolescents need more than 2000 calories as they grow in height, build bones, build muscles, and stay active, and some may need slightly less. The 2000–calorie diet is just an estimate and is used to help calculate the Percent (%) Daily Value listed on the Nutrition Facts label.

Is it important for me to exercise?

Yes! It’s really important that girls and young women with PCOS are physically active, because exercise brings down insulin levels, can help with weight management, is important for cardiovascular health, and can help improve mood. Exercise can be especially helpful in lowering insulin directly after a meal. So, if possible, go for a walk or find an enjoyable way to move your body after you eat a meal. Any increase in activity helps, so find some movement, sport, or exercise that you enjoy. If you aren’t doing a lot of exercise now, start slowly, and build up to your fitness goal. If you only exercise once in a while, try to exercise more regularly. Work towards increasing your physical activity to at least 5 days a week for 60 minutes per day.

PCOS: Sample Menus and Recipes

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Here you’ll find sample menus that will help give you some ideas for healthy meals and snacks. Keep in mind that depending on your own metabolism and activity level, your energy (calorie) needs may be higher or lower than this plan. Try to include a protein, a whole grain carbohydrate, and a healthy fat in each meal and snack. Refer to the PCOS-Friendly food suggestions list for ideas. We also have a blank menu (“My Menu“) that you can download, photocopy, and fill in with daily menus that you enjoy. In addition to filling out the menus, it’s a good idea for you to meet with a registered dietitian to get more specific and customized meal planning advice.

Menu 1 Menu 2 Menu 3


Here are some healthy and delicious recipes for you to include in your PCOS-friendly eating plan.

Ants on a Log Black & Blue Berry Smoothie Chicken Stir-Fry Easy Hummus Fruit Salad Grilled Salmon with Basil Scrambled Egg & Tomato Sandwich Tofu Bean Salad Tomato & Mozzarella Pockets Tuna Melt Vegetable Lentil Soup

PCOS: PCOS-Friendly Foods, Snacks, and Grocery Shopping Tips

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You may have noticed that some meals leave you satisfied while others leave you with a growling stomach only an hour later. One way to help you feel more satisfied from meals is to have a mix of different types of nutrients at each meal. A meal with a source of protein, a whole grain carbohydrate and a fat in addition to fruits and vegetables will help you to stay full for longer. For women with PCOS, fueling up on well-planned meals and snacks throughout the day may help to keep you from overeating or making less healthy choices due to extreme hunger or low blood sugar.

Below are foods that are sources of protein, carbohydrates, and fat. Remember to try to choose whole grain sources of carbohydrates versus sources of carbohydrates that are “refined” (made mostly from white flour and/or sugar). This is important because whole grains, which are higher in fiber, will not impact your blood sugar levels as much as refined sources of carbohydrate.

When choosing proteins try to avoid those that are breaded and/or fried such as fried chicken, fish sticks, or chicken nuggets. Beware that some sauces contain a lot of sugar so make sure to look at the Nutrition Facts label or make your own sauce rather than buying pre-made or from a restaurant.

Take a look at the Sample PCOS-Friendly Menus to get some ideas, and then plan your own menu using the foods from the lists below. After you’ve planned your menu, make a shopping list of the foods you will need to help you eat balanced meals and snacks.

PCOS-Friendly food lists:


  • Apples
  • Pears
  • Oranges
  • Berries
  • Bananas
  • Cantaloupe
  • Grapes
  • Kiwi
  • Honeydew melon
  • Peach
  • Plums


  • Broccoli
  • Brussel sprouts
  • Cauliflower
  • Tomato
  • Leafy greens such as spinach, kale, and collards
  • Asparagus
  • Carrots
  • Celery
  • Cucumber
  • Eggplant
  • Green beans
  • Mushroom
  • Onion
  • Peppers
  • Snap peas
  • Zucchini


  • Beans
  • Lean beef
  • Yogurt (plain is best, or try to find an option with less than 15 total grams of sugar per serving)
  • Cheese
  • Chicken
  • Eggs
  • Egg Substitute
  • Fish
  • Hummus
  • Milk (low–fat)
  • Nuts
  • Nut butters (such as peanut butter or almond butter)
  • Pork
  • Shellfish
  • Tofu
  • Veggie Burgers (try to find an option with more than 10 grams of protein)


  • Bread (whole wheat)
  • Brown Rice
  • Whole Grain Cereal (try to find an option with more than 5 grams of fiber per serving)
  • Corn
  • English Muffin (whole wheat)
  • Pasta (whole wheat)
  • Sweet Potato
  • Tortilla (corn or whole wheat)
  • Oats
  • Quinoa

Fat for food preparation/dressings:

  • Avocado
  • Guacamole
  • Canola or Vegetable Oil
  • Corn oil
  • Olive Oil

What snacks should I choose?

Foods from the fruit and vegetable group are healthy snacks because they are high in fiber and packed with nutrients. Try to pick high–fiber foods and pair them with protein foods. For example, try an apple or celery with peanut butter, whole wheat crackers and cheese, whole wheat pita or carrots and hummus, or yogurt and nuts.

Easy snack ideas

Grocery Shopping

Before you go grocery shopping, make a list of all of the types of foods and drinks you’ll need such as: vegetables, fruits, proteins such as meat, dairy and legumes, and whole grain sources of carbohydrates. If you have a variety of these foods, you’ll be able to plan healthy meals and snacks. By paying attention to the labels on food products, you’ll be able to choose foods that you like, and are healthy for young women with PCOS. You can use the list of foods above to help start your list.

How do I use the Nutrition Facts label when grocery shopping?

Nutrition Facts labels are located on most food products, and list the nutrients that are found in one serving. Reading the labels can help you figure out which of your favorite foods are the most nutritious choices, and can also help you decide which foods to buy when you are grocery shopping.

Reading Nutrition Facts labels can help you to be more intentional about your food choices. For more information on reading the label, visit this guide.

PCOS: Quiz

PCOS iconsYoung women with PCOS usually have certain symptoms. The following quiz was created to help you figure out if you might have PCOS. This quiz is designed as an educational tool and is not a substitute for medical advice by your health care provider.

If you answer “yes” to 3 or more of these questions, you should make an appointment with your health care provider. Your health care provider will be able to tell if you have PCOS or whether your symptoms are caused by another condition.

  1. My periods come about every 2-3 months or less often.
  2. I get my period every 2-3 weeks.
  3. My acne is pretty bad.
  4. I have darker patches of skin on the back of my neck, under my arms, or in my groin area.
  5. The hair on my head feels like it’s getting thin.
  6. I have dark hair above my lip,
  7. No matter what I try, I have a hard time getting down to a normal weight.
  8. I have a relative with PCOS.
  9. I have diabetes.
  10. Diabetes runs in my family.