Is PCOS Genetic? What We Know About Family Risk

PCOS, or polycystic ovarian syndrome, is the most common endocrine disorder among people who menstruate. Statistics vary, but some research suggests as many as one in five menstruators have the condition. Researchers aren’t exactly sure what causes PCOS, but genetics likely play a role.  

If you suspect you have PCOS, your healthcare provider will take a detailed history to better understand your symptoms. Though it’s important to share any family history of PCOS, to make a diagnosis, your healthcare provider will be checking to make sure you have at least two of the following: 

1. High levels of androgens (male sex hormones) or symptoms associated with high androgen levels, such as acne, increased body hair, or thinning scalp hair. 
2. Periods that are more than 35 days apart and/or fewer than eight menstrual cycles per year.
3. Ovaries that look “polycystic”  when viewed on ultrasound. 

While your ovaries might look like they contain many small cysts, the name PCOS is a bit of a misnomer. The “cysts” are actually follicles, fluid-filled sacs that contain an egg each. All properly functioning ovaries create multiple follicles per cycle, with one follicle typically growing large enough and releasing an egg during ovulation. With PCOS, these follicles stop developing properly and remain small within the ovary. The average ovary contains 10-15 of these tiny, but  visible on ultrasound, follicles at the start of each cycle. If you have PCOS, your ovaries may have more than 20 follicles each per cycle. 

Understanding your risk of PCOS is important, especially if it runs in your family. Knowing your risk is higher may not prevent you from developing the condition, but it can help you manage your care and symptoms. 

Is PCOS genetic or hereditary? Does PCOS run in families?

PCOS is what’s known as a polygenic condition. This means multiple genes likely play a role in whether or not you develop the condition.

‍Studies looking at identical and fraternal twins support this idea, suggesting that PCOS isn’t caused by a single gene or passed down simply like some other inherited conditions. According to these studies, about 72% of the risk of developing PCOS is due to genetics. 

Because there is a genetic component to PCOS, having multiple family members or an immediate family member with PCOS can increase your odds of having it. You may inherit the genes associated with PCOS or your family may pass down epigenetic changes. These are “gene switches” that can turn on and off without actually rewriting DNA code. They’re heavily influenced by environment, lifestyle, and development and can be passed down to future generations without changes to your genetic code. 

Though you get your genes from your biological parents, having a genetic condition doesn’t always mean it’s hereditary or runs in your family.  Even within the same family, people can have different genetic factors that make them more likely to develop PCOS. And studies show it often takes more than just having the genes associated with PCOS to cause the condition. 

You do have a greater chance of having PCOS if you have an immediate family member, like a mom or a sister, with the condition. A small study found that around 1 in 4 people with PCOS have a mother with the condition, and approximately 1 in 3 have a sister with it. 

You can also inherit the genes associated with PCOS from your father’s side of the family. Though you need ovaries to have PCOS, many of the genes linked to PCOS can be found in either sex. Males with a family history of  PCOS are more likely to experience PCOS-like symptoms such as hormonal issues, receding hair, and insulin resistance. 

Your ancestry might also increase your risk of developing PCOS, though more research is needed in groups typically underrepresented in research. What data we have suggests PCOS is more common among people with South Asian ancestry and Mexican Americans. 

In short, genetics play a role in PCOS, which means it can indeed be hereditary—but not always. Your genes are just part of the story. Other factors are likely at play, including your environment, hormones, and lifestyle. Plus, those factors can change the way your genes function at any point throughout your life, including during your earliest days back in the womb. Research suggests that being exposed to higher levels of androgens when developing in utero can lead to PCOS-like symptoms. 

If you have PCOS, you may pass down genes related to PCOS to your child. But remember, your child gets their genes from both parents, not just you. And having genes linked to PCOS doesn’t conclusively cause the condition. Your child’s environment, lifestyle, and unique biochemical makeup will also play a role. 

If you have PCOS, start a dialogue with your family. “I wouldn’t be surprised if some women in my family have it and just never knew,” says Lindsay Chu, MS, an embryologist with PCOS and founder of OVAhaul, “That is part of the problem with PCOS. Symptoms are often normalized or brushed off, leaving women without answers or support.” 

What does the research say about genes and PCOS? 

Researchers have studied the genomes, the genetic material, of people with and without PCOS, identifying multiple different types of gene associations. These include genes involved in: 

• Hormone production in the ovaries and adrenal glands (CYP11a, CYP17, CYP19, CYP21).  
• The effects of steroid hormones (AR, SHBG). 
•  Pituitary hormone action and regulation (LH, FSHR, AMH)
• Insulin action and secretion (CAPN10, INS, INSR, IRS-1, IRS-2).
• Obesity and type 2 diabetes (FTO). 

While the genes above are also related to other conditions or biochemical signaling, there are some gene mutations associated with PCOS (PCOS1, SRD5A1, SRD5A2) that seem to only relate to PCOS. 

While looking for similarities in the DNA among people with PCOS can give us more insights into PCOS, these types of studies, known as genome wide association studies, don’t prove that these genes cause PCOS. 

If PCOS runs in your family, you might be wondering whether you have the genes linked to PCOS. Because researchers don’t fully understand the role genetics play in developing PCOS, genetic testing isn’t part of the diagnosis process. Whole genome sequencing is expensive and often doesn’t include analysis for complex polygenic conditions like PCOS.  So your healthcare provider won’t be looking  at your DNA when diagnosing you. And that’s OK, because even if you have the genes for PCOS, that doesn’t always mean you’ll have the symptoms. 

‍Infographic: “4 Things to Know About PCOS and Genetics” 

1. PCOS is a polygenic condition, meaning multiple genes likely cause it. 
2. Genes play a role in whether you develop PCOS as do environmental factors, hormones, and lifestyle. 
3. You can inherit the genes associated with PCOS from either or both of your parents.
4. Having a mother or sister with PCOS can increase your risk. And having close male relatives with PCOS-like symptoms can also indicate a family history of PCOS. 

Are you born with PCOS, or do you develop it later?

PCOS is generally not considered a condition you're born with, although you can be born with genetic traits that increase your risk of developing it later in life. PCOS likely develops due to a combination of genetic and environmental factors. Those who do develop PCOS tend to start experiencing symptoms around the time of puberty. 

Because symptoms can vary in severity, you may not think much of them until you’re older or having difficulties getting pregnant. This was the case for Chu,  who wasn’t diagnosed with PCOS until a pregnancy loss in her early 20s. 

“Up to that point, I didn’t have the classic weight gain or acne many people associate with PCOS. My main symptom was irregular cycles, but I knew something deeper was going on,” she says. “After the miscarriage, I pushed for testing. Bloodwork showed high androgens, my cycles were irregular, and an ultrasound revealed cysts on my ovaries, the trifecta of PCOS.”

Though Chu’s symptoms appeared in her early 20s, some of her most challenging symptoms, including stubborn acne, weight fluctuations, and more noticeable hormonal changes, didn’t show up until after she was diagnosed. 

“That was when I truly began to understand how dynamic PCOS is,” Chu says. “It is not a fixed set of symptoms; it is a condition that changes over time, shaped by stress, environment, and metabolic health.”

What to do if PCOS runs in your family

If PCOS runs in your family, or you suspect it might, you’ll want to start tracking your reproductive and metabolic health early. Tracking your cycles can help you identify patterns and figure out what’s normal for you. Early signs of PCOS can include infrequent periods, persistent acne that may not respond to treatment, scalp hair loss, increased facial and body hair, carrying more of your weight in your abdomen, and  difficulty losing weight.

It’s important to share your concerns, and your family history, with your health care provider. If your healthcare provider suspects PCOS they may order the following tests: 

• Hormone blood tests: People with PCOS tend to have higher than average levels of antimullerian hormone (AMH), higher testosterone levels, elevated luteinizing hormone (LH), and a higher LH to follicle stimulating hormone (FSH) ratio. 
• Metabolic blood tests: These tests will look for insulin resistance, high cholesterol,  inflammation, and vitamin deficiencies. 
• Ultrasound: An abdominal or transvaginal scan that will look at your ovaries to see if they have more follicles than expected. 

Chu recommends getting baseline labs in your 20s or earlier if you start noticing symptoms. This way you’ll have a clear picture of your hormones, glucose control, and inflammation markers.

Preventing PCOS isn’t always possible. You can’t control what hormones and environmental factors you’re exposed to in utero or childhood. As you age, you can prioritize healthy habits, such as eating well, exercising, and getting enough sleep, which may reduce your risk factors of PCOS or your symptoms, if you already have PCOS. 

“From my own journey and the patients I work with, I have seen that PCOS responds best to targeted, intentional changes,” Chu says. “Sleep, nutrition, movement, and stress management are non-negotiables, but they should be tailored to your biology. That might mean changing your carb timing to match glucose response, using supplements that support your specific gene pathways, or adjusting workouts to align with your hormonal patterns.” 

Frequently Asked Questions (FAQs)

Which parent passes down PCOS?

PCOS is related to multiple different genes, which can be inherited from either your mother or your father. Only people with ovaries can develop PCOS, which means your biological father can’t have the condition. However, male relatives can have PCOS-like symptoms like a prematurely receding hairline, hormone issues, and insulin resistance. 

Is PCOS genetic or environmental? 

PCOS has a strong genetic component, but that’s only part of the story. It’s possible to have the genes associated with PCOS, but not the condition itself. That’s because PCOS is likely caused by a mix of genetic and environmental factors.  

How do I know if I’m at risk for PCOS?

There is no definitive way to know if you’re at risk for PCOS. If you have a first-degree relative, like a mother or a sister, with the condition, your risk will be higher. Having a personal or family history of obesity, insulin resistance, or type 2 diabetes can also increase your risk. Other risk factors include your lifestyle or diet, environmental pollutants, bacterial imbalances in your digestive system, and hormonal imbalances. 

Can I prevent PCOS if it runs in my family?

There is no definitive way to prevent PCOS. Making healthy lifestyle choices like eating a varied and balanced diet, exercising, getting enough sleep, and avoiding environmental pollutants may reduce your risk. 

While PCOS may have a genetic component, you’re not destined to get PCOS -- even if it runs in your family. PCOS likely occurs due to a mixture of genetics and environmental factors -- two things that can be beyond your control. But if you do have PCOS, making healthy choices, whenever possible, can help reduce your symptoms. 

Allara Health can help you get a diagnosis if you think you have PCOS. Allara provides customizable PCOS treatment that merges nutrition, lifestyle, medication and supplements with expert support to help you feel your best. 

Key Takeaways

• PCOS is common but complex. PCOS is the most common hormonal disorder among people who menstruate, but no one test can make a diagnosis.  
• PCOS has a strong genetic link—but it's not that simple. Multiple genes contribute to your risk, but having the genes doesn’t mean you’ll develop the condition.
• Environment and lifestyle can play a major role in whether you develop PCOS. Pollutants, hormone levels in the womb, stress, diet, and lifestyle choices can all influence whether or how symptoms appear.
• Your family history matters. You’re more likely to have PCOS If your mother or sister has PCOS. But even male relatives can have PCOS-like traits, such as early hair loss or insulin resistance.