Diagnosing PCOS: Symptoms, signs and what to look for

When you were young, you might’ve been prepared for some of the hormonal changes your body would experience throughout your life. It all started with puberty and then your first period. Then you can expect even more changes if you get pregnant. And lastly, the changes that often come as you get closer to menopause – goodbye periods, hello hot flashes.

But what if you start noticing changes in between these big milestones? Irregular periods, trouble getting pregnant, suddenly gaining weight without making changes to your diet or activity levels, and hair growing in places you’re not used to are just some symptoms that could be caused by polycystic ovary syndrome, or PCOS.

Keep reading to learn more about the symptoms of PCOS. We’ll also talk about risk factors, how it affects the body, how to get diagnosed and treatment options.

What is polycystic ovary syndrome?

Polycystic ovary syndrome is a medical condition caused by a hormonal imbalance in the ovaries. It happens when ovaries produce an abnormal amount of male sex hormones, or androgens. Typically, women only have a small amount of androgens, and the excess can lead to reproductive issues.

What happens when someone has PCOS

Ovulation – when an ovary releases an egg – happens once during each menstrual cycle. But your body needs to make enough female sex hormones, like progesterone and estrogen, to ovulate. So when your body doesn’t make enough of these hormones, ovulation may not happen at all or only occasionally.

When ovulation doesn’t occur, cysts (air or fluid-filled sacs) can grow on the ovaries. These cysts make androgens and are the reason women with polycystic ovary syndrome often have high androgen levels. And while some women with PCOS do develop cysts, not all women do. There could also be an abundance of abnormal follicles in the ovaries that contribute to PCOS. The hormonal imbalance is tied to several other symptoms of the condition, which we’ll talk more about below.

How common is PCOS?

The condition is more common than many people may realize. According to the Centers for Disease Control and Prevention, it affects around 6-12% of reproductive-age women in the United States – that’s around 5 million people. And while it’s believed that women are born with the condition, the symptoms usually start during puberty and may persist until or after menopause.

Symptoms of PCOS to look for

The earliest signs of polycystic ovary syndrome may seem normal or unrelated to each other. That’s because it may be easy for some people to explain away acne, weight gain or excessive hair growth in unusual areas. Occasional missed or irregular periods might not raise a red flag if it’s happened before or if you’re a little more stressed than usual.

So when looked at separately, symptoms can seem normal. But together, they may be first signs of PCOS.

Irregular menstrual cycle

One of the most common symptoms of PCOS is an irregular menstrual cycle. As we mentioned earlier, women with PCOS often have higher than normal androgen levels. These hormones, like testosterone, can interfere with their cycle and stop their body from ovulating.

The hormone imbalance can stop the egg from either maturing or being released. And without ovulation, the uterus doesn’t get the trigger it needs to shed its lining (have a period). Some people with PCOS can have regular periods and ovulate occasionally, but others may have periods every 4-5 weeks or none at all.

Ovarian problems

PCOS can lead to enlarged ovaries or ovaries that have many cysts. In your ovaries, there are thousands of follicles. In each follicle is an egg, and when the egg matures, the follicle breaks open and the egg is released for fertilization. When the follicle doesn’t release the egg, it can grow and turn into a cyst. Generally, follicular cysts don’t cause pain, but these cysts can cause the ovaries to swell, especially if there are many of them.

Stomach pain

If small cysts in the ovaries develop as part of your PCOS, it’s possible that these cysts could break open, become very large or disrupt blood flow to the ovaries, causing stomach pain.

Hirsutism

Hirsutism is a condition where women experience excessive hair growth in areas that are associated with male-pattern hair growth. For example, hair may grow on the face, back, chest (especially around the nipples), abdomen and thighs. This hair is medically described as terminal and is the type of hair you’d find on your scalp, eyebrows and eyelashes.

After puberty, it’s common for women to experience terminal hair growth in the armpits and pubic area. Although women naturally produce male hormones, the excess that comes with PCOS can cause these coarse, dark hairs to grow in areas where fine hairs are typically found.

Weight gain

Many women who have PCOS tend to put on weight easily and have difficulty getting rid of it. That’s because PCOS affects the way your body uses insulin. Insulin is responsible for controlling blood sugar, and PCOS can cause your body to develop insulin resistance. This stops your body from responding to insulin, sending a signal to your pancreas to produce even more insulin. Your body then takes the extra insulin and blood sugar and stores it in the body as fat, typically in the abdomen. This cycle is what leads to weight gain.

Insulin is also an appetite stimulant. High levels of this hormone can increase hunger and cravings, causing some people with PCOS to overeat or consume more calories than they need. It also can lead to medical problems, like insulin resistance and diabetes.

Skin issues

PCOS can lead to symptoms that affect your skin, such as:

Acne and oily skin. When androgen levels in the body are high, this increases oil (or sebum) production in the skin. Sebum is usually a good thing. It keeps the skin from drying out, but too much can plug your pores and lead to acne flare-ups.
Dark or thick skin patches. The high insulin levels associated with PCOS can lead to a condition called acanthosis nigricans. This happens when the top layers of the skin get darker, thicker and appear velvety. These patches are usually found on the back of the neck and sometimes under the arms, breasts and in the groin.
Skin tags. Skin tags are a less common symptom of PCOS, but they do occur for some. They are small, noncancerous growths that usually grow in the same areas as dark skin patches.

Thinning hair

High levels of androgens, like testosterone, affect hair growth. Androgenic alopecia is a symptom of PCOS that causes women to experience hair loss. It’s often characterized by hair loss around the temples and frontal areas of the scalp. Instead of baldness, female pattern hair loss typically leads to thinner, shorter hair.

Infertility

PCOS is one of the most common causes of female infertility. If you’re under 35 years old, infertility means not being able to get pregnant after one year of trying. If you’re 35 or older, this time is shortened to six months. As we mentioned earlier, when excess androgens interfere with your menstrual cycle, it prevents your body from regular ovulation. If your body doesn’t go through normal ovulation, it becomes harder to get pregnant. But it’s important to know that pregnancy is still possible.

Causes of PCOS aren’t yet known

While we know that PCOS stems from a hormonal imbalance, doctors and researchers have yet to uncover what causes the imbalance. But there are a few factors that might play a role:

PCOS may be linked to genetics. Your chance of having PCOS increases if you have a family history of the condition.
Another factor that may cause it is insulin resistance. High levels of insulin can lead to your body producing excess androgens, creating the hormone imbalance seen in people with PCOS, as well as many of the symptoms listed above.
When your body experiences an injury or infection, it responds to protect itself. Your white blood cells launch a “response” called low-grade inflammation, which produces a steady flow of inflammation throughout your body, a chronic condition in people with PCOS. This can cause polycystic ovaries to produce androgens and the cycle of symptoms continues.
Having an excess of body fat can affect how well your ovaries work, but even losing just 5% of your total weight can improve ovarian function.

How PCOS affects the body

While PCOS has many specific symptoms, it can lead to other chronic health conditions. Women with PCOS are more likely to experience or develop:

Reproductive problems – As we mentioned earlier, PCOS and infertility are connected. However, the condition is also linked to reproductive complications like gestational diabetes during pregnancy, increased blood pressure during pregnancy or delivery, and uterine cancer.
Type 2 diabetes – PCOS can lead to insulin resistance, causing problems with the way your body regulates its blood sugar. Because the body produces too much insulin, this can lead to diabetes.
Heart disease – High insulin and blood sugar levels can damage the heart and blood vessels which over time leads to heart disease, including atherosclerosis (hardening of the arteries), coronary artery disease, high blood pressure, high cholesterol, heart attack and stroke.

How PCOS is diagnosed

A primary care doctor or a women’s health specialist like an OB-GYN – a medical doctor or clinician who specializes in female reproductive health – can diagnose PCOS. The process usually begins with a conversation. Your doctor will start with your symptoms and medical history before moving on to a physical exam, which will likely include a pelvic exam.

Doctors often look for three symptoms for diagnosis: irregular periods, excess androgens and polycystic ovaries. Two out of three of these symptoms are typically needed for a positive diagnosis. And because a physical exam can’t confirm the presence of abnormal androgen levels or polycystic ovaries, doctors may use additional tests, such as ultrasounds and blood tests.

Ultrasound

Your doctor may use an ultrasound to confirm a PCOS diagnosis. This test uses soundwaves and echoes to take pictures of your reproductive organs, or in this case, your ovaries. With an ultrasound, your doctor can look at the size of your ovaries and see if there is a high number of small follicles in your ovaries (polycystic ovaries).

Blood tests

Doctors use blood tests to check for high levels of hormones. This can tell them if your body is producing higher than normal androgens. They can also use a blood test to check your blood glucose levels as well as your cholesterol, both of which can be signs of PCOS. Blood tests also rule out other conditions that can mimic some of the features of PCOS.

Does PCOS go away on its own?

PCOS is a chronic condition that has no cure, and it can show up as any assortment of symptoms. Fortunately, there are many PCOS treatment options available to manage symptoms and help people reach their pregnancy goals.

PCOS affects each person in different ways, but your doctor can help you find a treatment plan that works best for your needs. Similar to other reproductive conditions like endometriosis, treatment of polycystic ovarian syndrome often depends on your pregnancy plans.

Conservative treatment may include birth control pills or ovulation medications, as well as changes in your diet, diabetes medication, and oral or topical medications for symptom management. More advanced treatment options, like ovulation medication and surgery, are also considered if you are having difficulty getting pregnant.

Talk with a doctor about PCOS symptoms

PCOS can come with a wide range of symptoms. If you’re experiencing irregular menstrual cycles, excessive hair growth, acne or inexplicable weight gain, schedule an appointment with your primary care doctor. Whether or not you have the condition, your doctor can help you take steps to feeling better.