Signs and Symptoms of PCOS

Polycystic ovary syndrome (PCOS) is a hormonal condition that causes enlarged ovaries and cysts (small growths). With PCOS, a person has more androgens—or, hormones that are responsible for producing male sex features—in their body.1

The increased levels of androgens in people with PCOS can cause a variety of symptoms, such as irregular periods, increased body hair, skin changes, and weight gain. You can also have just one symptom, a range of symptoms, or all of them. In some cases, you might not experience any symptoms at all, making the condition difficult to diagnose.

It may not always be clear that you have PCOS. Some people will only find out about their condition when they are having problems getting pregnant or when they seek medical care for weight management or skin concerns. Though the condition can happen during your 20s or 30s, PCOS might also develop as early as your teenage years.2

Antral Follicles on the Ovaries

The name polycystic ovary syndrome can be confusing. That's because PCOS doesn't actually cause ovarian cysts. Instead, these tiny growths on your ovaries are known as antral follicles. These follicles are very small and can be undetectable. However, once these follicles grow, they can be 2 to 10 millimeters big.3

As you age, the natural number of antral follicles that you have on your ovaries decreases. However, if you have a high amount of antral follicles, this can indicate that you have PCOS. Keep in mind: these follicles are not usually something that you can notice or feel. Your healthcare provider will need to use an ultrasound to confirm the number of antral follicles you have.

Menstrual Changes

One of the hallmark symptoms of PCOS is a change in your periods. Menstrual changes can happen when you're not ovulating regularly—which is a process that occurs when the ovaries release an egg. When you do not ovulate, the lining of the uterus may become thicker and shed irregularly. As a result, this irregular shedding can contribute to changes in your periods.4

These changes include:5

• Unpredictable periods
• Periods that occur more frequently
• Missing periods altogether (a condition known as amenorrhea)6
• Having a very heavy or a very light flow

How Many Days Should Pass Between Periods?

Hair Changes

PCOS can also change how your hair grows on your body. While some people may experience too much hair growth, others may lose hair in certain places.

• Excess hair growth: Hirsutism is a condition that occurs when hair that's dark and coarse grows on your body. This condition can co-occur with (or, happen at the same time as) PCOS. In fact, around 70% of people with PCOS experience hirsutism. If you have this symptom, you may notice that thick hair is growing on your chest, nipples, stomach, and face.1
• Hair loss: An increase in your androgen levels can cause symptoms like male-pattern baldness or thinning hair. Shedding some hair is normal for most people. But, it may be a sign of concern if you have bald patches, a receding hairline, or losing several strands or locks of your hair over time.5
  

Weight Gain

Problems related to weight are another sign of PCOS. If you notice that you're gaining several pounds (10 or more pounds over the span of a few months) without making changes to your diet or exercise, it might be possible that your weight gain is a result of PCOS. In fact, nearly half of all people with PCOS have obesity.7

You might also notice that you're having difficulty losing weight, despite making healthy lifestyle changes. While this can be a sign of other health conditions, you may want to start tracking your eating and exercise habits and share them with your healthcare provider if you're considered about your weight.4

Insulin Resistance

Obesity is often the result of insulin resistance—another common sign of PCOS. Insulin is a hormone that is made in your pancreas that helps cells in your muscles, fat, and liver take in glucose (sugar) from your blood and turn it into energy. Insulin resistance can happen when those cells have a hard time responding to insulin, leading to a spike in your blood sugar.8

Skin Changes

It's not uncommon for people with PCOS to experience changes in their skin. Generally, there are two primary skin concerns related to PCOS, which include:

• Acne: Having a high level of androgens can cause acne that is severe or painful, appears later in life, frequently occurs, and is resistant to treatment. If you have acne, you might notice that you're developing pimples on your face, chest, or back. In one study, researchers found that 85% of people who had higher levels of androgens or a diagnosis for PCOS experienced acne.910
• Acanthosis nigricans: Acanthosis nigricans is a skin condition that leads to thick, dark patches or tags on your skin. The condition occurs as a result of insulin resistance. You might notice patches or skin tags in places where your body creases such as the armpits, groin, neck, and breasts.17
  

Infertility

One study found that 60.2% of participants with PCOS reported experiencing infertility—or difficulties with conceiving a child. PCOS is a primary cause of infertility and people may not know that they have the condition until they are trying to conceive.11

Infertility can occur due to an imbalance of sex hormones. Having high levels of androgen can affect how regularly you're ovulating, making it difficult for your eggs to mature and conceive a baby. Unfortunately, those with PCOS also have a higher rate of miscarriages.10

Symptoms in Adolescents

While PCOS commonly affects those in their 20s and 30s, you might develop the condition during your teenage years. In fact, anywhere from 6% to 18% of adolescents can have PCOS. Adolescents tend to experience symptoms that mimic PCOS symptoms in adults—such as acne, irregular periods, ovarian cysts, and hirsutism.12

However, the condition can be harder to diagnose in adolescence because symptoms like irregular periods tend to be normal among people who are just beginning menstruation.13 Because of the symptom overlap, research is ongoing to understand more about adolescents with PCOS and if other symptoms in younger populations can occur.

When To See a Healthcare Provider

If you have any symptoms of PCOS or think you might be at risk for the condition, it's a good idea to see a healthcare provider sooner rather than later. Your provider can help you get started on a diagnostic process and rule out other medical conditions.14

Additionally, seeing a healthcare provider is important because of how PCOS can affect the body in different ways. PCOS may put you at a higher risk for complications such as endometrial cancer, infertility, diabetes, and problems associated with obesity.1

A Quick Review

PCOS is a hormonal condition that occurs when you have high androgen levels, causing a variety of symptoms such as excessive hair growth or hair loss, menstrual changes, skin problems, insulin resistance, infertility, and weight gain. PCOS commonly affects adults who were assigned female at birth, but adolescents develop the condition as well.