options available including assisted reproductive technology procedures such as controlled ovarian hyperstimulation with follicle-stimulating hormone (fsh) injections followed by in vitro fertilisation (ivf). though surgery is not commonly performed, the polycystic ovaries can be treated with a laparoscopic procedure called "ovarian drilling" (puncture of 4–10 small follicles with electrocautery, laser, or biopsy needles), which often results in either resumption of spontaneous ovulations or ovulations after adjuvant treatment with clomiphene or fsh. (ovarian wedge resection is no longer used as much due to complications such as adhesions and the presence of frequently effective medications.) there are, however, concerns about the long-term effects of ovarian drilling on ovarian function. mental health although women with pcos are far more likely to have depression than women without, the evidence for anti-depressant use in women with pcos remains inconclusive. however, the pathophysiology of depression and mental stress during pcos is linked to various changes including psychological changes such as high activity of pro-inflammatory markers and immune system during stress. pcos is associated with other mental health related conditions besides depression such as anxiety, bipolar disorder, and obsessive–compulsive disorder. hirsutism and acne further information: hirsutism when appropriate (e.g., in women of child-bearing age who require contraception), a standard contraceptive pill is frequently effective in reducing hirsutism. progestogens such as norgestrel and levonorgestrel should be avoided due to their androgenic effects. metformin combined with an oral contraceptive may be more effective than either metformin or the oral contraceptive on its own. other medications with anti-androgen effects include flutamide, and spironolactone, which can give some improvement in hirsutism. metformin can reduce hirsutism, perhaps by reducing insulin resistance, and is often used if there are other features such as insulin resistance, diabetes, or obesity that should also benefit from metformin. eflornithine (vaniqa) is a medication that is applied to the skin in cream form, and acts directly on the hair follicles to inhibit hair growth. it is usually applied to the face. 5-alpha reductase inhibitors (such as finasteride and dutasteride) may also be used; they work by blocking the conversion of testosterone to dihydrotestosterone (the latter of which responsible for most hair growth alterations and androgenic acne). although these agents have shown significant efficacy in clinical trials (for oral contraceptives, in 60–100% of individuals), the reduction in hair growth may not be enough to eliminate the social embarrassment of hirsutism, or the inconvenience of plucking or shaving. individuals vary in their response to different therapies. it is usually worth trying other medications if one does not work, but medications do not work well for all individuals. menstrual irregularity if fertility is not the primary aim, then menstruation can usually be regulated with a contraceptive pill. the purpose of regulating menstruation, in essence, is for the woman's convenience, and perhaps her sense of well-being; there is no medical requirement for regular periods, as long as they occur sufficiently often. if a regular menstrual cycle is not desired, then therapy for an irregular cycle is not necessarily required. most experts say that, if a menstrual bleed occurs at least every three months, then the endometrium (womb lining) is being shed sufficiently often to prevent an increased risk of endometrial abnormalities or cancer. if menstruation occurs less often or not at all, some form of progestogen replacement is recommended. alternative medicine a 2017 review concluded that while both myo-inositol and d-chiro-inositols may regulate menstrual cycles and improve ovulation, there is a lack of evidence regarding effects on the probability of pregnancy. a 2012 and 2017 review have found myo-inositol supplementation appears to be effective in improving several of the hormonal disturbances of pcos. myo-inositol reduces the amount of gonadotropins and the length of controlled ovarian hyperstimulation in women undergoing in vitro fertilization. a 2011 review found not enough evidence to conclude any beneficial effect from d-chiro-inositol. there is insufficient evidence to support the use of acupuncture, current studies are inconclusive and there's a need for additional randomized controlled trials. treatment pcos has no cure, as of 2023. treatment may involve lifestyle changes such as weight loss and exercise. birth control pills may help with improving the regularity of periods, excess hair growth, and acne. metformin and anti-androgens may also help. other typical acne treatments and hair removal techniques may be used. efforts to improve fertility include weight loss, metformin, and ovulation induction using clomiphene or letrozole. in vitro fertilization is used by some in whom other measures are not effective. epidemiology pcos is the most common endocrine disorder among women between the ages of 18 and 44. it affects approximately 2% to 20% of this age group depending on how it is defined. when someone is infertile due to lack of ovulation, pcos is the most common cause and could guide to patients' diagnosis. the earliest known description of what is now recognized as pcos dates from 1721 in italy. the prevalence of pcos depends on the choice of diagnostic criteria. the world health organization estimates that it affects 116 million women worldwide as of 2010 (3.4% of women). another estimate indicates that 7% of women of reproductive age are affected. another study using the rotterdam criteria found that about 18% of women had pcos, and that 70% of them were previously undiagnosed. prevalence also varies across countries due to lack of large-scale scientific studies; india, for example, has a purported rate of 1 in 5 women having pcos. there are few studies that have investigated the racial differences in cardiometabolic factors in women with pcos. there is also limited data on the racial differences in the risk of metabolic syndrome and cardiovascular disease in adolescents and young adults with pcos. the first study to comprehensively examine racial differences discovered notable racial differences in risk factors for cardiovascular disease. african american women were found to be significantly more obese, with a significantly higher prevalence of metabolic syndrome compared to white adult women with pcos. it is important for the further research of racial differences among women with pcos, to ensure that every woman that is affected by pcos has the available resources for management. ultrasonographic findings of polycystic ovaries are found in 8–25% of women non-affected by the syndrome. 14% women on oral contraceptives are found to have polycystic ovaries. ovarian cysts are also a common side effect of levonorgestrel-releasing intrauterine devices (iuds). there are few studies that have investigated the racial differences in cardiometabolic factors in women with pcos. history the condition was first described in 1935 by american gynecologists irving f. stein, sr. and michael l. leventhal, from whom its original name of stein–leventhal syndrome is taken. stein and leventhal first described pcos as an endocrine disorder in the united states, and since then, it has become recognized as one of the most common causes of oligo ovulatory infertility among women. the earliest published description of a person with what is now recognized as pcos was in 1721 in italy. cyst-related changes to the ovaries were described in 1844. etymology other names for this syndrome include polycystic ovarian syndrome, polycystic ovary disease, functional ovarian hyperandrogenism, ovarian hyperthecosis, sclerocystic ovary syndrome, and stein–leventhal syndrome. the eponymous last option is the original name; it is now used, if at all, only for the subset of women with all the symptoms of amenorrhea with infertility, hirsutism, and enlarged polycystic ovaries. most common names for this disease derive from a typical finding on medical images, called a polycystic ovary. a polycystic ovary has an abnormally large number of developing eggs visible near its surface, looking like many small cysts. society and culture in 2005, 4 million cases of pcos were reported in the us, costing $4.36 billion in healthcare costs. in 2016 out of the national institute health's research budget of $32.3 billion for that year, 0.1% was spent on pcos research. among those aged between 14 and 44, pcos is conservatively estimated to cost $4.37 billion per year. as opposed to women in the general population, women with pcos experience higher rates of depression and anxiety. international guidelines and indian guidelines suggest psychosocial factors should be considered in women with pcos, as well as screenings for depression and anxiety. globally, this aspect has been increasingly focused on because it reflects the true impact of pcos on the lives of patients. research shows that pcos adversely impacts a patient's quality of life. public figures a number of celebrities and public figures have spoken about their experiences with pcos, including: victoria beckham maci bookout frankie bridge harnaam kaur jaime king chrisette michele lea michele keke palmer sasha pieterse daisy ridley romee strijd lee tilghman