Polycystic Ovarian Syndrome is a hormone imbalance that happens due to an excess productionof androgen hormones in your ovaries. Your ovaries produce and release eggs. PCOS often leads to irregular periods, and irregular ovulation. Your ultrasound can show “polycystic ovaries”, enlarged ovaries with immature follicles in the surface of the ovaries that look like a pearl string. It can be difficult to get pregnant with PCOS, that is often when PCOS is diagnosed. Up to 15% of women and a higher rate of people assigned female at birth have PCOS. Signs of PCOS are irregular periods, abnormal hair growth, acne, obesity, dark areas on your skin (neck, armpits, groin, breasts), this is called Acanthosis Nigricans, ovarian cysts, skin tags, male pattern balding, infertility.We don’t know what causes PCOS; it is multifactorial; genes play a role, so do higher levels of androgens, insulin resistance (a higher level of insulin which leads to a higher androgen production which affects ovulation). Insulin helps you process glucose (carbohydrates and having insulin resistance leads to higher glucose levels in the blood and possibly can lead to diabetes. People with PCOS also have chronic inflammation (elevated white blood cell count or C-reactiveprotein).Other complications related to pregnancy include a higher risk of preeclampsia, gestational diabetes, preterm labor, cesarean section.How do we diagnose PCOS; with a history, physical exam, lab tests and pelvic ultrasound.Treatment of PCOS; hormonal options, medications that make insulin work better (Metformin), medications that block androgens (Spironolactone), lifestyle changes.Treatment of irregular periods to help someone get pregnant are medications that help induce ovulation as clomiphene and letrozole or an injection of gonadotropins, or IVF.PCOS is a chronic condition and can increase your risks for diabetes, hypertension, heart disease, endometrial cancer, sleep apnea, depression and anxiety.