PCOS Care and Treatment
Polycystic ovary syndrome can affect your periods, skin, weight, mood and plans for pregnancy. We help you understand what is happening, confirm the diagnosis with labs and imaging close to home, and build a plan that fits your goals.
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Understanding PCOS
Polycystic ovary syndrome, or PCOS, is a common hormonal condition that affects people with ovaries, often starting in the teen years or early adulthood. It is usually diagnosed when someone has at least two of three features: irregular or missed periods, signs of higher androgen levels (hormones such as testosterone), and ovaries that look polycystic on ultrasound, once other causes have been ruled out. The name can be misleading. The small follicles seen on ultrasound are not harmful cysts, and some people with PCOS never have them. PCOS looks different from person to person, which is one reason it can go unrecognized for years.
The exact cause of PCOS is not fully understood. It tends to run in families, and insulin resistance, where the body needs more insulin to keep blood sugar steady, plays a role for many people. Higher insulin levels can push the ovaries to make more androgens, which can disrupt ovulation and lead to acne and extra hair growth. PCOS happens at any body size, though weight gain can make symptoms stronger. Over time, PCOS is linked with prediabetes and type 2 diabetes, high cholesterol, sleep apnea, anxiety and depression. When periods are very infrequent, the lining of the uterus can build up, which is why regular shedding of the lining matters.
Care matters because PCOS is very treatable, and the right plan depends on your goals, whether that is regular cycles, clearer skin, steadier blood sugar or a future pregnancy. Diagnosis starts with a telehealth visit to talk through your cycles, symptoms, health history and family history. Your provider may order labs at a local lab, such as a pregnancy test, thyroid and prolactin levels, testosterone, and blood sugar and cholesterol checks. A pelvic ultrasound is often ordered to a local imaging center when it would help, though it is usually not used to diagnose PCOS in teens, because ovaries naturally look this way in the years after periods begin. When a hands-on exam is needed, we will help you arrange it.
Signs & Symptoms of PCOS
- Irregular or infrequent periods. Cycles that are often longer than 35 days, unpredictable, or fewer than about eight periods a year are a common sign.
- Missed periods. Some people go months without a period, even when they are not pregnant.
- Extra hair growth. Coarse, dark hair on the face, chest, belly or back can reflect higher androgen levels.
- Persistent acne. Acne that continues past the teen years or flares along the jaw and chin can be linked with PCOS.
- Thinning scalp hair. Some people notice hair thinning at the crown or a widening part.
- Weight changes. Weight gain, especially around the middle, or difficulty losing weight is common.
- Darkened skin patches. Velvety, darker skin on the neck, underarms or groin can be a sign of insulin resistance.
- Trouble getting pregnant. Irregular ovulation can make it harder to conceive, and PCOS is a common, treatable cause.
What to Expect
- A telehealth visit to review your cycles, symptoms, health history and family history
- Labs ordered to a local lab, and a pelvic ultrasound at a local imaging center when it would help
- A plan built around your goals, such as regular cycles, clearer skin, steadier blood sugar or pregnancy
- Clear explanations of birth control options, metformin and other treatments, including their benefits and side effects
- Follow-up to check your progress, with referral to a specialist when fertility care or other support is needed
How We Care for PCOS
Assessment
We start with a video visit to talk through your periods, skin and hair changes, weight, mood and sleep, and any plans for pregnancy. Labs at a local lab help confirm the diagnosis and rule out thyroid problems, high prolactin and other look-alike conditions. A pelvic ultrasound may be ordered to a local imaging center, and we check blood sugar and cholesterol because PCOS affects long-term health.
Treatment Plan
Together we choose steps that match your goals. Combined hormonal birth control, such as the pill, patch or ring, can regulate cycles, and progestin options can protect the uterine lining. Metformin may help when insulin resistance or prediabetes is present. We also talk through nutrition, activity and sleep, and treatments for acne and unwanted hair growth.
Ongoing Care
We review how your cycles, skin and energy are responding and adjust the plan as needed. Periodic labs track blood sugar and cholesterol over time. If you are hoping to become pregnant, we talk through timing and preconception health and refer you to a gynecologist or fertility specialist when that care is needed.
Benefits
A Plan Built Around Your Goals
Your treatment reflects what matters most to you right now, whether that is regular cycles, clearer skin, steadier blood sugar or a future pregnancy.
Women's Health Is a Focus
Brooke Tuttle, FNP-C, is a board-certified family nurse practitioner who spent 11 years as a registered nurse in labor and delivery, postpartum and well-baby nursery care before becoming a nurse practitioner, and has practiced family medicine since 2017.
Care From Home
Visits happen by video for patients located in Utah, with labs and imaging ordered to locations near you.
Your Treatment Journey
First Visit (Week 1)
We talk through your symptoms, cycles, history and goals by video. Your provider orders labs at a local lab and, when helpful, a pelvic ultrasound at a local imaging center.
Weeks 2 to 4
We review your results together and confirm whether PCOS or another cause best explains your symptoms. You start the parts of your plan that fit your goals.
Months 2 to 6
Cycle changes often show within a few months, while acne and unwanted hair growth usually take longer, often 6 months or more. We adjust doses or options based on how you feel.
Long-Term Care
PCOS is managed over time. Regular check-ins, periodic blood sugar and cholesterol labs, and updates to your plan as your goals change, including before a pregnancy, help protect your long-term health.
Warning Signs That Need Prompt Care
Very heavy bleeding. Soaking through a pad or tampon every hour for several hours needs urgent care.
No period for 3 months or more. If you are not pregnant, a long gap between periods should be evaluated so the uterine lining can be protected.
Sudden severe pelvic pain. Intense pain on one side, especially with nausea or vomiting, can signal a twisted ovary or a ruptured cyst.
Pregnancy with pain or bleeding. A positive pregnancy test with one-sided pain, bleeding or dizziness needs prompt evaluation.
Signs of high blood sugar. Extreme thirst, frequent urination, blurred vision or unexplained weight loss should be checked promptly.
Rapid new hair growth or a deepening voice. Fast changes like these are not typical of PCOS and need prompt evaluation for other causes.
Low mood or hopelessness. If you are struggling, reach out. If you have thoughts of harming yourself, call or text 988, the Suicide and Crisis Lifeline.
If you have severe pain, heavy bleeding with dizziness or fainting, or thoughts of harming yourself, call 911 or go to the nearest emergency room.
When to Reach Out
If any of these signs sound familiar, reach out through our contact page. PCOS is common and treatable, and getting answers is the first step.
Evidence-Based Treatment
International evidence-based guidelines for PCOS put healthy eating, regular activity and good sleep at the foundation of care, at any body size. Combined hormonal birth control is a common first choice to regulate cycles and reduce acne and unwanted hair growth, and progestin options can protect the uterine lining for people who cannot use estrogen. Metformin may be added for insulin resistance, prediabetes or weight concerns, and it can be combined with birth control. Spironolactone may help with hair growth and acne, but it must be paired with reliable contraception because it is not safe in pregnancy. For people trying to conceive, letrozole is a common first medicine to help ovulation, and that care is often shared with a gynecologist or fertility specialist. Guidelines also recommend regular screening for diabetes, high cholesterol, mood changes and sleep apnea.
Common Questions About Polycystic Ovary Syndrome (PCOS)
Can PCOS be diagnosed and treated by telehealth?
Much of it, yes. Diagnosis relies on your history, labs and sometimes an ultrasound, so we can talk through your symptoms by video, order labs at a local lab and send a pelvic ultrasound order to a local imaging center. Visits are for patients located in Utah. If a pelvic exam or other hands-on care is needed, we will help you arrange an in-person visit nearby.
Does PCOS mean I cannot get pregnant?
No. Many people with PCOS become pregnant, sometimes on their own and sometimes with help. Irregular ovulation can make it take longer, and treatment can improve the chances. If you are planning a pregnancy, we can talk through preconception health, folic acid and timing, and refer you to a gynecologist or fertility specialist when that care is needed.
Do I have to take birth control for PCOS?
Not necessarily. Birth control is a common option because it regulates cycles and can help acne and hair growth, but it is not the only choice. Other options include progestin to protect the uterine lining, metformin, lifestyle changes and targeted skin treatments. Your provider will talk through the benefits and risks of each so you can choose what fits.
Will losing weight help my PCOS?
For people carrying extra weight, losing even 5 to 10 percent of body weight can improve cycles, ovulation and blood sugar. PCOS can make weight harder to manage, and weight loss is not required for treatment. People of every size can benefit from a plan, and we focus on changes that are realistic and sustainable.
Does insurance cover PCOS care?
Sagebrooke Family Medicine is an insurance-based practice, and we are in the process of joining insurance plans. What you pay depends on your plan, including any copay, deductible or coinsurance. Contact the practice to check whether your plan is accepted, and check with your insurer about coverage for medications, labs and ultrasound.
Can teens have PCOS?
Yes. PCOS often begins in the teen years, but it can be hard to diagnose early because periods are naturally irregular in the first few years after they start. For teens, diagnosis usually relies on cycle patterns and signs of higher androgens rather than ultrasound, and your provider may watch the pattern over time before confirming it. For a teen, a parent or guardian joins the video visit.
Get Answers About PCOS
If your cycles, skin or weight have you wondering about PCOS, reach out through our contact page to ask about a telehealth visit for patients located in Utah.
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