Written by Nancy Fitzgerald
If you’ve had no luck conceiving, are experiencing strange bald spots and breakouts, or are having irregular periods, you just might have polycystic ovarian syndrome (PCOS). [1,2]
It’s a hormone imbalance that affects some 5 million American women—as many as 12 percent of those in their childbearing years.  And even if you’re not looking to get pregnant, PCOS can affect your health in other serious ways too. [1,2]
That’s why it’s important to know the signs—and talk to your health care provider about them.
“When young women are having unusual menstrual cycles and other symptoms, one of the first things I think about is PCOS,” says Rachel Adams, M.D., a gynecologist with Mercy Medical Center in Baltimore. [3,4] “They may be feeling anxious, so I let them know that it’s really common—and that there are really effective treatments. There are lots of good reasons to be hopeful.” 
Here’s everything you need to know about PCOS.
What Is PCOS?
PCOS is a hormonal disorder among women that’s caused by larger-than-normal ovaries with cysts. It’s driven by two major factors: your hormones and heredity. However, some external lifestyle factors can also play a role. Here’s an in-depth description of the three:
Reason #1: Hormones
In addition to making supplies of female hormones like estrogen and progesterone, women also produce small amounts of androgens—or male hormones, such as testosterone. Women with PCOS may have too much testosterone, which can cause excessive hair growth on the face, chest, and back, acne, and male-pattern baldness.
The boost in levels of testosterone is partially a result of increased levels of insulin, which are produced to flood the system and overcome insulin resistance that occurs with PCOS. [3,5]
“That causes some complex issues,” explains Dr. Adams. “Insulin resistance increases the risk of developing diabetes and cardiovascular disease.” 
In addition to testosterone changes, she notes that as your body continues to produce estrogen, it’s actually feeding the lining of your uterus and making it thicker, which could increase the risk of uterine cancer if not treated appropriately.
“Your hormones play this beautiful symphony timed to tell your body to release an egg and shed the uterine lining. If it’s not timed properly, there’s a failure to communicate, leading to multiple issues.” 
Reason #2: Heredity
Twin studies have shown that you’re more likely to have PCOS if you have a first-degree relative—a mother or sister—who has it too. That’s why your doctor will spend time carefully exploring your medical history if you bring up any PCOS symptoms.  “Testing can provide important information,” says Ashish Chaudhari, M.D., a gynecologist at Dartmouth-Hitchcock Medical Center in Concord, N.H. [7,8]
Reason #3: Your Weight
Though it’s not entirely clear if one spurs on the other, one thing’s for sure: There is a strong connection between obesity and PCOS. As many as 80 percent of women with PCOS are overweight.
And it turns out your weight and hormones may be connected too. “The thinking is that women who are obese have more fat cells, which the insulin resistance and testosterone levels, thereby worsening the severity of PCOS,” explains Adams. 
5 Signs You Might Have PCOS
PCOS is a complicated condition with a variety of causes, and it plays out in a variety of ways. “The three most important symptoms we look for are irregular cycles, excessive hair growth, and ovarian cysts,” explains Dr. Adams. “If we find two out of those three, we diagnose PCOS.” 
Here’s a look at the signs:
PCOS Sign #1: Your Periods Are Irregular
Everyone’s cycle is a little different, but if yours is way off—say, your period comes every 45 days, or if you don’t have a period for five or six months—that’s one of the main warning signs of PCOS. Alternatively, your period may come more frequently or you may experience heavy bleeding. [1,2,3,7]
PCOS Sign #2: You’re Having Trouble Conceiving
PCOS is one of the most common causes of infertility. That’s because the condition prevents you from releasing an egg every month. So if you’ve been trying unsuccessfully to conceive for a year, PCOS is a strong possibility.
PCOS Sign #3: You’re Experiencing an Excess of Hair
You may experience hair growth on your face, neck, or forearms with PCOS. “That’s called hirsutism,” Dr. Adams explains. “If a patient tells me she’s having to use waxing or laser treatments every couple of days, along with irregular menses, that cues me into thinking it might be PCOS.” [2,3]
On the flip side: Some women with PCOS may experience alopecia—male-pattern hair loss at the temples. The culprit in both cases is likely too much testosterone. [3,7,10]
PCOS Sign #4: You’re Having Adult Acne
You may have struggled with acne as a teen, but if you’re still getting breakouts well into your 20s or beyond—and treatments don’t seem to be working—that could be a sign of PCOS. Once again, excess testosterone may be to blame. [1,2,3,7]
PCOS Sign #5: You’re Gaining Weight
If you’ve recently gained weight, your body mass index (BMI) has increased, or you can’t seem to lose weight despite efforts to live a healthier lifestyle, you could have PCOS. Again, while it’s unclear whether the weight contributed to PCOS or vice versa, a sudden uptick in pounds is important to bring up with your doctor. [1,2,3,7]
How to Get Help for PCOS
There’s no cure for PCOS, but there are many effective treatment paths. And that’s important: Left untreated, PCOS is often linked to other health issues, including heart disease and cancer of the lining of the uterus (endometrial cancer). It’s even associated with sleep apnea, anxiety, and depression. [2,7]
Plus, women with PCOS are four times more likely than others to develop type 2 diabetes.  So, if you have any PCOS symptoms, your first step is a complete checkup. Here’s what you might expect at your doctor’s office:
- A thorough medical history
- A physical exam, checking your weight, blood pressure, and BMI; perhaps a gynecological exam
- Hormonal health tests which will look at levels of different key indicators. These can be done by your doctor, or you can keep track of some of your primary female hormones with at-home testing
- An A1C or glucose tolerance test to check for insulin levels and possible diabetes
- An ultrasound exam to check for the presence of cysts on your ovaries
Once you’ve got a diagnosis, it’s time for you and your provider to discuss treatment options. “There’s no easy fix,” says Dr. Chaudhari. “But if you can address PCOS, you’ll have better overall health, reduce your risk of diabetes and heart disease, and you’ll improve your chances of becoming pregnant if you want to have a baby. The most important thing is to remember that you have control—if you’re worried, be sure to seek out help.” 
Here are the types of treatments your doctor might recommend to manage PCOS:
Weight loss. According to the American College of Obstetricians and Gynecologists, as many as four out of five women with PCOS are obese, which means dropping some weight can often help ease symptoms. [3,12]
“Losing 5 to 10 percent of your body weight can help get your cycles working again,” says Chaudhari. “And staying active is important too—that can accelerate weight loss. People who follow a healthy diet and a moderate activity regimen tend to do very well.” 
Hormone, fertility, and diabetes medications. “If we can get your hormones back in line, everything else tends to follow suit,” explains Dr. Chaudhari. “One of the most common treatments is birth control pills. That way, you receive a specified dose of estrogen and progesterone. If you have those hormones in your bloodstream in the right proportions, then hormone production from the ovaries stops.” 
Medications to treat excess hair and acne. Dr. Adams says that medicines like spironolactone or flutamide, which bind to male hormones, are often helpful. Birth control pills can address these problems as well. [7,11]
Centers for Disease Control and Prevention
PCOS (Polycystic Ovary Syndrome) and Diabetes
U.S. Department of Health and Human Services
Office on Women’s Health
Polycystic ovary syndrome
Rachel Adams, M.D.
Controlling Your Blood Sugar Can Improve Your PCOS and Hormone Imbalance
Vink JM, Sadrzadeh S, Lambalk CB, Boomsma DI.
Heritability of polycystic ovary syndrome in a Dutch twin-family study.
Journal of Clinical Endocrinology and Metabolism 2006 Jun;91(6):2100-4
Ashish C. Chaudhari, MD
Ashish C. Chaudhari, MD
Obesity and Polycystic Ovary Syndrome
Obesity Management 2007 Apr;3(2):69-73
Dermatology & Plastic Surgery Institute Outcomes
Adolescent Girls With Androgenic Alopecia Should be Screened for Polycystic Ovary Syndrome, Other Comorbidities
Williams T, Mortada R, Porter S.
Diagnosis and Treatment of Polycystic Ovary Syndrome
American Family Physician 2016 Jul 15;94(2):106-13
American College of Obstetricians and Gynecologists
Polycystic Ovary Syndrome (PCOS) FAQ’s