Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects women of reproductive age. The exact cause of PCOS is unknown, but it may occur as a result of excess insulin - insulin regulates blood glucose levels. An excessive amount may increase androgen production, causing ovulation difficulties; abnormally high levels of androgen; and genetics. The symptoms of PCOS include abnormal periods - infrequent, irregular or prolonged menstrual cycles; excess androgen - a male hormone that can cause excess facial and body hair (hirsutism), severe acne and male-pattern baldness; polycystic ovaries - ovaries may develop numerous small collections of fluid-filled sacs (called follicles), each containing an immature egg that isn’t mature enough to trigger ovulation. These symptoms worsen if a person is obese. PCOS is associated with infertility, gestational diabetes, pregnancy-induced high blood pressure, miscarriage or premature birth, endometrial cancer, metabolic syndrome, abnormal uterine bleeding, sleep apnea, type 2 diabetes, depression, anxiety and eating disorders. Diagnosis involves a discussion of medical history, menstrual cycle and weight changes; a physical exam to check for excess hair growth, insulin resistance and acne; a pelvic exam to check for masses and other abnormalities; blood tests to measure hormone, blood glucose, and levels and fasting cholesterol levels; an ultrasound to checks the appearance of the ovaries and the thickness of the lining of the uterus. Treatment of PCOS involves lifestyle changes such as weight loss, regular physical activity, and avoiding low-fat or high-carbohydrate diets. Medications are also available, such as combination birth control pills or a skin patch or vaginal ring that contains a combination of estrogen and progestin; progestin therapy to regulate periods and protect against endometrial cancer; drugs such as Clomiphene and Metformin to increase ability to ovulate; drugs such as Aldactone and Vaniqa to reduce excessive hair growth. Surgery is generally a last resort to improve fertility - involves drilling tiny holes in the ovaries with a laser or thin heated needle to restore normal ovulation.