14 Signs of PCOS You Need to Know

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that impacts many women. While it's challenging for health services to know the exact number, it's estimated to affect 8-13% of women of reproductive age. Despite its widespread presence and significant impact on women's lives, PCOS is often under-recognized as a global public health issue. 

This syndrome is characterized by a hormonal imbalance that can lead to diverse symptoms. You might experience the signs of PCOS, which include irregular menstrual cycles, weight gain, excessive hair growth, acne, or even thinning hair on your scalp. Because many of these signs can be subtle or develop gradually, they sometimes go unnoticed or are misdiagnosed for years.

The lack of awareness and understanding around PCOS can, unfortunately, lead to a cycle of delayed diagnosis and less effective treatments. However, an early diagnosis of PCOS can empower you. It allows you to take proactive steps to manage your condition, potentially reduce your risk of serious long-term health challenges, improve your fertility outlook, and enhance your overall quality of life.

What Exactly Is PCOS?

Understanding PCOS means grasping a common hormonal condition that can influence your menstrual cycles, fertility, and general health from puberty through menopause. While its name suggests "cysts on the ovaries," the core issue is a hormonal imbalance. Women with PCOS often have higher-than-normal levels of androgens, which are typically considered "male" hormones. 

In PCOS, these elevated androgen levels are a primary reason for disrupted ovulation. While women naturally have some androgens, higher amounts can interfere with the menstrual cycle and contribute to insulin resistance. The three main features often seen in PCOS are:

• Absent or irregular ovulation leading to absent or irregular periods, 

• Higher levels of androgens in your body (which can be seen in symptoms or blood tests)

• The presence of polycystic ovaries on an ultrasound.

The precise cause of PCOS  is still being researched, but it's strongly associated with these hormonal imbalances, particularly androgen levels and insulin resistance. The condition also has a hereditary component, often running in families. It's a complex condition that extends beyond the physical appearance of cysts on the ovaries.

PCOS is surprisingly common, affecting a notable percentage of women within the reproductive age range. Because symptoms can appear gradually and vary so much, many women remain unaware they have the condition. However, becoming informed about PCOS and seeking early detection can make a profound difference.

Most Common Signs of PCOS

The signs of PCOS can vary significantly from one woman to another. Some may experience many symptoms, while others have only a few. Here are some of the most commonly experienced signs:

1. Irregular or Missed Periods

This is often a key indicator of PCOS. With PCOS your menstrual periods do not seem to follow certain patterns. For example, you may have fewer than eight periods a year, or more than 35 days between periods. Oftentimes, your menstrual bleeding will be abnormally heavy. All of the following menstrual irregularities could be caused by PCOS:

• Amenorrhea (absence of menstruation)

• Oligomenorrhea (frequently missed, irregular periods)

• Menorrhagia (Heavy menstrual bleeding)

• Anovulatory periods (Bleeding but no ovulation)

The hormonal imbalance of PCOS interferes with normal ovulation and one of the major symptoms of PCOS is cycle irregularities so if you aren’t tracking your cycle, there are many benefits to doing so. Using Mira’s fertility kit can help you know exactly when you ovulate and therefore track and predict your cycle (even if your baseline LH is high). 

Regardless of what your goals are, daily hormone monitoring with the Mira Hormone Monitor can track up to four key fertility hormones in urine with lab-grade accuracy. Your numeric results are tracked in real-time in the Mira App, enabling you to see your unique hormone patterns over time. Not only is this detailed information helpful for life planning, but it can give key insights into managing your hormone imbalance and the results can even be shared with your healthcare team. 

2. Excess Hair Growth (Hirsutism)

Hirsutism is the appearance of coarse, dark hair in areas typically associated with male hair growth, such as the face, chest, back, and belly. This is a direct result of higher androgen levels. It's important to know that the severity of hirsutism can differ among ethnic groups and has a genetic component.

3. Severe Acne and Oily Skin

The hormonal imbalances in PCOS, especially elevated androgen levels, can overstimulate the sebaceous glands, leading to excessive oil production and often severe acne. This acne usually doesn’t respond to typical treatments.

4. Scalp Hair Thinning or Male-Pattern Baldness

While some hair thinning is a natural part of aging, women with PCOS may experience more significant hair loss on their heads, sometimes resembling male pattern baldness with a receding hairline. This symptom can become more pronounced as women age.

For a more in-depth look at this PCOS symptom, check out our full post on PCOS Hair Loss.

5. Weight Gain and Belly Fat

Many women with PCOS experience weight gain, particularly around the abdomen. This is frequently linked to insulin resistance, a common characteristic. When your body is less efficient at using insulin, it can lead to higher blood sugar levels and increased fat storage, especially around your middle. If you notice this "PCOS belly" or extra fat, positive lifestyle changes, like a balanced diet and regular exercise, can often help.

The overall imbalance of hormones from PCOS can affect your metabolism hunger levels, and how your body stores fat. Although it can be challenging to manage your weight, the National Health Service (NHS) in England estimates that just a 5% decrease in body weight can lead to significant improvements in PCOS-related symptoms. 

Read our full article on PCOS Weight Gain for a more detailed look at this symptom. 

6. Difficulty Getting Pregnant

Irregular ovulation, one of the most common PCOS symptoms, can make it challenging to conceive. PCOS is one of the leading causes of infertility. This is obviously the result of irregular or anovulatory periods (when ovaries do not release eggs). Numbers speak for themselves: polycystic ovary syndrome represents 80% of anovulatory infertility cases. PCOS can interfere with your ability to get pregnant naturally but it is still possible. 

See our guide on how to get pregnant with PCOS.

Other Possible PCOS Symptoms in More Detail

In addition to the most common signs, other possible signs of PCOS include:

7. Darkened skin patches (acanthosis nigricans)

These are dark, velvety skin regions often found in the armpits, groin, and neck creases. Although not harmful, the development of dark patches of skin, usually concentrated around the neck, groin, and armpits, is known as acanthosis nigricans. It’s often a sign of an underlying condition like a hormonal imbalance or insulin resistance - both of which are likely linked with PCOS. 

8. Skin tags

Women with PCOS may experience small, benign growths of skin known as skin tags, which can develop in various areas of the body. PCOS can affect your skin in the form of hormonal acne, oily skin, dark patches, skin tags, or any combination of these symptoms. Given that the root cause of PCOS is hyperandrogenism (too many androgens), PCOS-related acne is most likely to develop in the cheeks, jawline, chin, and upper neck. These areas are most sensitive to hormonal fluctuations and PCOS acne often presents similarly to hormonal acne. This may not be the same for everyone but hormonal acne is persistent and does not respond well to the usual treatments. 

Check out our full article on PCOS Acne to learn more about how it develops, the most common symptoms, and potential treatments. 

9. Fatigue or low energy

Persistent tiredness is a common complaint among women with PCOS. Although not a direct cause, many people with PCOS experience an increase in fatigue and low energy. The weight gain, hormonal imbalance, and heavy periods associated with a PCOS diagnosis make fatigue more likely. Research supports this with studies linking heavy menstrual bleeding to increased fatigue and decreased overall quality of life.

10. Pelvic pain

Unusual pain may happen during menstruation or without it. Polycystic ovaries may be the culprit or the pain may come from other conditions (like endometriosis or uterine fibroids). Not to mention the increase in inflammation associated with PCOS can lead to body pain and heightened sensitivity. 

11. Mood swings, anxiety, depression

Hormonal fluctuations can contribute to mood changes and mental health challenges. When you have PCOS you are three times more likely to suffer mental health issues, including mood swings, depression, and anxiety. Hormonal imbalances are the biggest factor, but dealing with PCOS can be challenging with symptoms impacting your everyday life. Treatment and lifestyle changes can have a huge impact in managing this side of a PCOS diagnosis.

12. Sleep problems 

PCOS is linked with an increased risk of sleep apnea, a condition where breathing repeatedly stops and starts during sleep. According to the latest research, having PCOS puts you at an increased risk for sleep disturbances. Which coincides with the fact that those with PCOS often report insomnia and poor sleep. Another condition associated with PCOS is sleep apnea when a person stops breathing for short periods of time during sleep.

13. Headaches

Women with PCOS appear to have higher rates of headaches, including migraines.

14. High blood pressure

Even women with PCOS who are at a normal weight may be at a higher risk of developing hypertension (high blood pressure).

How PCOS Is Diagnosed

There isn't one single test to definitively diagnose PCOS, and it's estimated that up to 70% of affected women remain undiagnosed worldwide. Healthcare providers typically use a set of guidelines called the Rotterdam criteria, which require the presence of at least two out of the following three criteria:

1. Irregular menstrual periods: Caused by anovulation (no ovulation) or oligo-ovulation (infrequent ovulation).

2. Evidence of elevated androgen levels: This can be observed through physical signs, such as excessive hair growth, acne, or male-pattern baldness, or confirmed by blood tests that show high androgen levels.

3. Polycystic ovaries identified on an ultrasound: It's important to remember that not all women with PCOS will have visible cysts on their ovaries.

Here’s a look at how these criteria are often checked:

Other tests and evaluations used in the diagnosis of PCOS include:

• Pelvic ultrasound: To examine the ovaries for the presence of multiple small follicles that give them a "polycystic" appearance.

• Blood tests: To measure hormone levels (including androgens, insulin, prolactin, TSH, thyroid hormones, and lipids) and to rule out other conditions that might have similar symptoms.

• Medical history and physical exam: When making a diagnosis, your doctor will also consider your personal and family medical history, including any history of irregular periods, ovulation issues, or a family history of PCOS or type 2 diabetes.

If you are diagnosed with PCOS, it's essential to have regular check-ups with a medical professional to monitor for any metabolic and reproductive issues that may arise. Additionally, it's vital to acknowledge that women with PCOS commonly experience depression and anxiety, and support for mental well-being is a key part of comprehensive care.

Tools like the Mira Hormone Monitor, Wands, and the Mira App are designed to help you track changes in your hormone levels from urine, which can be crucial for understanding your unique hormonal patterns. By analyzing hormones such as the progesterone metabolite in urine (PdG), FSH, estradiol metabolite in urine (E3G), and luteinizing hormone (LH), you can gain a clearer understanding of your reproductive health. It's beneficial for women with PCOS because they often have higher baseline LH levels, which can sometimes lead to false positives on regular ovulation predictor kits (OPKs). In contrast, Mira measures the actual concentration of these hormones, potentially offering more accurate insights for individuals with PCOS and irregular cycles.

Disclaimer: The Mira Hormone Monitor, Wands, Mira App, and BBT tracking tools are designed to help you understand your fertility awareness and track your cycle. They are not intended to diagnose, treat, cure, or prevent any disease, track pregnancy, or be used for contraception. The information you receive through these tools should not replace professional medical advice, diagnosis, or treatment. Individual results and cycle patterns can vary, and it's always best to consult with qualified healthcare providers for any concerns about your fertility, conception, and reproductive health.

What Causes These Symptoms?

It’s important to note that there is no singular cause of PCOS and the exact cause of this disorder is not yet known. Several factors may play a role including the following:

Insulin resistance

When the body has a difficult time converting sugars from foods into energy, the result is insulin and sugar build up in the bloodstream. When insulin levels are high, the body ramps up production of certain male hormones (androgens). Higher androgen levels then go on to disrupt ovarian functions, including ovulation. 

Low-grade inflammation 

Research has shown that those with PCOS may have a type of long-term, low-grade inflammation that contributes to the production of androgens. Chronic inflammation contributes to hyperandrogenism and the excess androgen levels trigger an immune response in the body, contributing to many of the symptoms of PCOS.

Genetics 

Various research sources show that a strong family history of PCOS or other metabolic issues can increase your chance of a PCOS diagnosis. This is due to the presence of specific genes that influence hormone regulation and insulin metabolism in the body. 

Excess androgens 

The excess production of male hormones, hyperandrogenism, is a hallmark of PCOS and causes a host of issues. Aside from causing symptoms like unwanted hair growth, acne, and even weight gain, high androgen levels impact ovulation and create problems in the ovaries. The hormonal imbalance associated with PCOS can mean either the egg doesn’t develop as it should or isn’t released during ovulation like it should be often leading to irregular cycles and irregular or absent ovulation. 

When to See a Doctor

Early diagnosis and management of PCOS are essential for managing symptoms and potentially preventing long-term health complications. You should consider seeing a doctor if you experience any of the following:

• Unexplained weight gain or new or excessive hair growth

• Severe acne that doesn't improve with standard treatments

• Trouble getting pregnant

• Persistent irregular periods

These menstrual irregularities can be a significant indicator of underlying hormonal imbalances, particularly in the context of PCOS. For women with PCOS who are trying to conceive, specialized programs like the Hormone Health Clinic for Fertility can offer a coaching-based approach to address hormonal imbalances and improve fertility. 

At the Mira Hormone Health Clinic for Fertility, you can find one-on-one management services for all stages of women's reproductive lives. Our experts provide personalized advice on lifestyle adjustments, empowering you to manage your symptoms effectively and optimize your health. We aim to help clients make informed decisions to improve their well-being and enhance fertility prospects by considering all aspects of their health and lifestyle.

Using the Mira App to track your period, symptoms, and hormonal patterns related to PCOS is also helpful. The Mira App, by measuring actual hormone concentrations, can be particularly beneficial for women with PCOS who have irregular cycles. It uses AI to learn your hormone patterns over time, potentially providing more accurate insights for ovulation tracking. Additionally, Basal Body Temperature (BBT) charting can be a valuable tool to help confirm if ovulation has occurred, especially in cycles where an apparent LH surge might not be easily detected.

What Are the Long-Term Effects of PCOS?

If left unmanaged, PCOS can increase your risk for various long-term health conditions, such as:

• Type 2 diabetes: Insulin resistance dramatically raises the risk of a person getting type 2 diabetes.

• Cardiovascular risks: Women with PCOS are at an increased risk of developing heart disease and stroke.

• Sleep apnea: PCOS is associated with a higher likelihood of experiencing sleep apnea.

• Endometrial cancer: Certain irregular period patterns and hormonal imbalance may lead to cancer of the uterine lining.

• Mental health concerns: Hormonal fluctuations and the daily challenges of living with PCOS can contribute to mental health issues like anxiety and depression.

Can PCOS Be Treated?

While there is currently no cure for PCOS, the condition can be effectively managed. Management often involves a combination of lifestyle adjustments, hormonal birth control, medications like metformin, and fertility treatments. The best approach will depend on your specific symptoms and personal health goals.

Treatment strategies focus on addressing individual symptoms and can vary depending on whether you are trying to conceive:

• Lifestyle changes: Eating a balanced diet, maintaining a healthy weight, and engaging in regular physical activity are often the first-line PCOS treatments. These changes can significantly improve insulin sensitivity and overall well-being.

See our guide to balancing hormones naturally for more information on how it can help with your PCOS diagnosis. 

• Ovulation-inducing medications: If you are trying to conceive, these medications can help stimulate regular ovulation.

• Birth control: Hormone-based birth control (pills, patches, or rings) can be used to regulate menstrual cycles and help manage symptoms like acne and hirsutism.

• Anti-androgen medications: These medications can help block the effects of androgens, alleviating symptoms such as hirsutism and acne.

• Insulin-sensitizers: Medications like metformin can improve your body's response to insulin and help control blood sugar levels.

• Supplements: Certain supplements may help manage symptoms of PCOS. It's crucial to discuss any supplements with your doctor before taking them. For instance, Mira PCOS supplements are designed to provide essential vitamins and nutrients that support hormonal regulation, making them a helpful addition to a well-rounded approach to managing PCOS.

There are many choices for managing PCOS; finding the right combination for you is a personal journey. Always consult a healthcare professional before starting any new treatment, as their effectiveness and safety can vary.

Summary: Recognizing the Signs Early Matters

PCOS is a common hormonal condition that can significantly impact a woman’s health and well-being. Prompt recognition of its signs and symptoms, even if they seem mild or develop gradually, is crucial for seeking timely diagnosis and effective management. If you suspect you may have PCOS, it's essential to consult with a doctor to discuss your concerns and explore appropriate treatment options. Taking charge of your health through awareness and proactive steps can make a profound difference in your life with PCOS.

Frequently Asked Questions

What are the early signs of PCOS?

Early signs of PCOS can often include irregular periods, new or excessive hair growth, persistent acne, and challenges with weight gain. If you notice any of these symptoms, especially if they are new or concerning, it's a good idea to speak with a healthcare professional.