Signs of PCOS You Need to Know

Polycystic ovary syndrome (PCOS) is one of the leading causes of infertility and as many as one in ten people with uteruses may have the condition. The condition can show up in many ways, from irregular periods to trouble conceiving, but at its core it is a hormonal condition that happens during your reproductive years. In this post we’ll go over the many signs of PCOS, including irregular periods, hair growth, acne, and infertility, among others. We’ll also dive into the causes, diagnosis and treatments for this condition to manage symptoms and improve health. 

What Is PCOS?

PCOS or polycystic ovary syndrome (also known as polycystic ovarian syndrome) is an endocrine condition characterized by an imbalance in reproductive hormones. Namely, the imbalance between estrogen, progesterone, and testosterone can wreak havoc on your menstrual cycle, while elevated testosterone levels lead to other symptoms like acne or unwanted hair growth. This hormonal imbalance can disrupt ovulation leading the ovaries to develop many small fluid-filled sacs (cysts). Not everyone with PCOS will develop ovarian cysts, and you can have PCOS without cystic ovaries. 

Polycystic ovary syndrome affects nearly 1 in 10 women of reproductive age and is among the leading causes of infertility. It is notoriously hard to diagnose and many people go years with PCOS symptoms before getting a PCOS diagnosis. Although PCOS overwhelmingly affects the ovaries, it can impact many other systems in the body including your digestive system, skeletal system, cardiovascular system, as well as your mental health. 

Hormonal Imbalance of PCOS 

Androgens 

Androgens are often referred to as “male” sex hormones and although men do produce them at higher levels, they are also produced in female bodies, just at lower levels. Androgens are responsible for sexual arousal and libido and are synthesized in the ovaries and adrenal glands. Those with PCOS often have elevated androgen levels which can leave them vulnerable to developing symptoms like hair loss, unwanted hair growth, and weight gain.

Progesterone 

Progesterone is a reproductive hormone released by the corpus luteum in the ovary after ovulation. It plays a crucial role in the menstrual cycle and the early stages of pregnancy. PCOS is often associated with lower than average progesterone levels. When progesterone levels don’t naturally rise and fall as they should during your menstrual cycle you may experience irregular periods as well as difficulty conceiving. 

Insulin

Insulin is the hormone that helps our cells absorb glucose (blood sugar) to get energy. With PCOS, the body doesn’t respond to insulin the way it should. As a result, we may have a higher glucose level and more insulin produced in our bodies. This situation can then lead to chronic Type 2 Diabetes. Having too much insulin can also cause the body to make more androgens. 

Development of PCOS (pathophysiology) 

It’s not clear what causes PCOS and it likely involves a mix of factors from genetic to environmental. It primarily affects the ovaries and as a result, ovulation. The hormonal imbalance associated with PCOS can create problems in the ovaries, which means the egg may not develop as it should or may not be released during ovulation like it should. 

Typically, follicles develop to release an egg within the menstrual cycle, but abnormal hormone levels in PCOS prevent these follicles from developing or maturing properly. These follicles (small fluid-filled sacs that contain immature eggs) accumulate and appear as cysts on ovaries. Elevated androgen levels (also known as hyperandrogenism) prevent the normal release of an egg (i.e. ovulation). Due to these hormonal imbalances, those with PCOS often have irregular cycles and their ovulation is unlikely to be typical. 

Symptoms of PCOS 

According to the PCOS Awareness Association, here are the most common symptoms that people experience. 

1. Irregular Periods

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 Home 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)

You may find excess hair growth in the following areas: face, arms, back, chest, thumbs, toes, abdomen, upper thighs. Disbalance of androgens is to blame. But remember: facial and body hair could be a sign of PCOS, as well as it could be just your natural unique body feature.

3. Hair Thinning or Male-pattern Baldness (Hair Loss)

This might sound contradictory to the previous symptoms, but PCOS can cause thinning hair, hair loss, and male-pattern baldness. The severity of the hair loss can vary, depending on the individual, and usually elevated androgen levels are to blame. Higher levels of androgens disrupt the hair growth cycle leading to increased shedding, hair thinning, and PCOS hair loss. 

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

4. Skin Changes

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. 

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 with PCOS. 

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

5. Weight Gain and Difficulty Losing Weight

Weight gain and difficulty losing weight, no matter what diet you’ve tried, is one of the most frustrating symptoms of PCOS. About half of those with PCOS have excess weight or obesity, and experience trouble losing weight, especially around the waist. In fact, the term PCOS belly is a common name for the fat that tends to form around the midsection of PCOS patients. 

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. Fatigue

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. 

7. Infertility

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. 

8. Mood Swings

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. 

9. 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. 

10. Sleep Problems

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.

11. Polycystic Ovaries

If you have PCOS, your ovaries might be enlarged and contain follicles that have not ovulated. These follicles are tiny, benign and painless cysts that may resemble a string of pearls during an ultrasound. As a result, the ovaries might fail to function regularly.

Not everyone with PCOS will have polycystic ovaries as the name suggests. It’s just one of many symptoms and is not necessarily present – some people will develop cysts on their ovaries but not everyone will and it is only one aspect of the condition. 

Causes and Risk Factors of PCOS

What Causes PCOS?

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 buildup 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. 

Risk Factors of PCOS

PCOS affects about 10 million people in the world and can happen at any age after puberty to any race or ethnicity. The following factors put you at a higher risk for PCOS:

• Family history – Although not fully understood, there is a genetic component to PCOS. If you have a family history of PCOS or other endocrine disorders, it’s more likely you could have it too.
• Lifestyle factors – Being overweight, eating a poor diet, or having a sedentary lifestyle can all play a part to increase your risk of PCOS. They are not a direct cause, but can worsen your symptoms, especially if you have a genetic risk of the condition. 
• Lack of awareness – “Small” issues like oily skin, extra hair growth, or acne may be overlooked and not considered symptoms of a serious health condition. They often go unmentioned to your doctor and as a result are unnoticed and many just think it’s their “normal”. This can delay a PCOS diagnosis until you have a more serious issue, like trouble getting pregnant. 

Diagnosis of PCOS

A PCOS diagnosis can be difficult to obtain since there is no single test for PCOS, and it is a diagnosis of exclusion. This means that before a PCOS diagnosis can be made, other conditions with similar symptoms must be ruled out. 

To be diagnosed with PCOS your doctor will talk to you about your medical history and do a physical exam and a variety of standard tests. 

Based on the Rotterdam criteria, a PCOS diagnosis may be made if you have at least two of the following criteria: 

• Irregular periods
• Signs that you have high levels of androgens (excess hair growth, acne, thinning of scalp hair, etc.) and/or high androgens in your blood
• Multiple cysts on one or both ovaries (seen via ultrasound)

Tests and Examinations for PCOS 

Along with your medical history, there are a number of exams and tests your doctor may perform to help diagnose PCOS. 

Physical Exam

Your doctor will measure your blood pressure, body mass index (BMI), and waist size. They will also look at your skin for extra hair on your face, chest or back, acne, or skin discoloration. Your doctor may look for any hair loss or signs of other health conditions (such as an enlarged thyroid gland).

Pelvic Exam

Your doctor may do a pelvic exam for signs of extra male hormones (for example, an enlarged clitoris) and check to see if your ovaries are enlarged or swollen.

Pelvic Ultrasound (Sonogram)

This test uses sound waves to examine your ovaries for cysts and check the endometrium (lining of the uterus).

Blood Tests

Blood tests check your androgen hormone levels. Your doctor will also check other hormones (sometimes PCOS may be mistaken for thyroid disease). Your doctor may also test your cholesterol levels and test you for diabetes.

If you are struggling with PCOS symptoms you may be able to gain a better perspective on your hormones through a single at-home lab test like Mira’s Panorama Fertility Lab Test. This convenient kit tests 5 hormones that affect your ovulation, cycle regularity, and ability to get pregnant and can help identify hormonal signals that can lead to PCOS. You’ll get 5 individual and personalized hormone reports with actionable steps to understand what your numbers mean for your ovarian reserve, thyroid function, menstrual cycle, hormonal balance, and fertility health. You can even show these reports to your healthcare provider to help with any treatment. 

Complications of PCOS

The impacts of PCOS go far beyond our reproductive system. PCOS can influence many factors in your overall health including fertility challenges, metabolic issues, pregnancy complications, and mental health concerns. Understanding how this condition impacts your overall health can help you take charge of your health and manage the condition effectively. 

• Infertility – PCOS is one of the leading causes of infertility and many only learn they have the condition when trying to conceive (TTC).

• Metabolic Issues – Metabolic complications include insulin resistance, obesity, obstructive sleep apnea, and non-alcoholic fatty liver disease.

• Pregnancy Complications – Being pregnant with PCOS puts you at an increased risk of miscarriage, gestational diabetes, and preeclampsia.

• Nonalcoholic Steatohepatitis – PCOS and nonalcoholic steatohepatitis (also known as nonalcoholic fatty liver disease) share many of the same risk factors and there is a strong link between the two. 

• Cardiovascular Risks – Metabolic complications include an increased risk for heart disease through several factors including obesity, high cholesterol, and hypertension.

• Mental Health – PCOS can take a toll on your mental health from dealing with symptoms (both visible and invisible) to managing the various health complications. 

• Endometrial Cancer – Having PCOS puts you at an increased risk for endometrial cancer. The exact reasons are not fully known, and more research is needed to confirm the link. 

• Obesity – You may experience metabolic issues that put you at an increased risk for insulin resistance and weight gain. Having PCOS means you may also find it harder to lose weight due to the underlying hormonal imbalance. 

How Is PCOS Treated?

PCOS treatment is not a one size fits all approach and depends on what your main symptoms are and also on your fertility goals. 

For Those Trying to Conceive 

Whether you are actively TTC or plan to become pregnant in the future, the number one recommendation for PCOS treatment is to maintain a healthy weight. Obesity and weight gain are a major concern of PCOS and can lead to insulin resistance PCOS. The root of the problem is hormonal imbalance and can lead to problems with ovulation. Even reducing weight by 5-10% can reduce insulin resistance by about 50%, restore ovulation, and regulate menstrual cycles. 

PCOS may cause irregular ovulation or a lack of ovulation altogether, which can make getting pregnant a challenge. There are fertility medications that can help with ovulation if diet and exercise aren’t enough. These medications include letrozole, clomid, and gonadotropins. Each works in a specific way to induce ovulation so you can try to conceive but not without risk. 

The risks of ovulation-inducing medications include having a multiple pregnancy (i.e. twins or triplets), ectopic pregnancy, miscarriage and premature delivery, and ovarian hyperstimulation syndrome (OHSS). Although OHSS is rare, it is a serious reaction to injecting fertility drugs and involves swollen and painful ovaries, mild abdominal pain, bloating, nausea, vomiting, and diarrhea. OHSS usually goes away without treatment but can develop into a more severe form as well. 

Although PCOS is a leading cause of infertility, many women with PCOS can and do get pregnant. Learn more about PCOS-related pregnancy problems and how to deal with them here.

For Those Not Trying to Conceive 

If you are not actively trying to get pregnant, and don’t plan to in the near future, there are a number of medications you can take to manage your symptoms. Your doctor can recommend the best options to manage your concerns. 

Birth Control Pills

Your doctor may prescribe birth control pills to regulate your cycle, reduce androgens, acne, and excessive facial and body hair. Combination birth control pills that contain both estrogen and progestin work by reducing androgen production and regulating estrogen. Oral contraceptives like these will help to balance your overall hormones which can help with certain symptoms like irregular bleeding, acne, and unwanted hair growth. 

Diabetes Medications 

Medications designed to help regulate your blood sugar and insulin levels are often prescribed to help manage your weight with PCOS and restore ovulation. Liraglutide and Metformin are commonly used alongside the appropriate lifestyle changes to help you maintain a healthy weight. 

Medications for Specific Symptoms

There are a number of other medications that your doctor may prescribe depending on specific symptoms. Letrozole (Femara) is a breast cancer treatment meant to treat PCOS symptoms like lack of ovulation by stimulating the ovaries. Eflornithine (Vaniqa) is a cream prescribed for hair growth as it can slow the growth of facial hair. Spironolactone (Aldactone) can be used to treat acne and hair loss but can cause birth defects, so effective contraception needs to be taken as well. 

Self-Management of PCOS

Hormone tracking 

It can be hard to track and understand your cycle when you have PCOS. Many apps and free tools only work with a “regular” cycle and don’t account for the unpredictability that can come with a PCOS diagnosis. The Mira App is a free tool that uses the power of AI to provide advanced, personalized cycle predictions for each user. It’s ad-free and free to download, and can be used with or without our fertility monitor. 

There are a number of different ways to track your cycle but hormone tracking is more accurate and effective. Traditionally, the only way to measure your exact hormone levels was through blood testing at a doctor’s office, but you can track your actual hormone concentrations with the help of a digital fertility analyzer. The Mira fertility monitor tracks hormone levels and gives you actual LH levels throughout your cycle. Together with the companion app that uses smart learning to track your cycle over time, you’re able to track personalized information on par with what you would get at a doctor’s office. You can get precise daily hormone level readings, similar to those from a lab, and monitor your hormonal map over time through dynamic charts on your smartphone. You can clearly pinpoint ovulation patterns, see hormone levels, and even track and record your cycle symptoms. 

Lifestyle Modifications

It’s important to make sure that you are eating a balanced diet, getting enough exercise, prioritizing sleep, and managing your stress since these can all have a direct impact on our hormonal balance. Our hormones are easily affected by what we eat and drink, how much sleep we get, and how stressed out we are. PCOS treatment often involves lifestyle modifications to address hormonal imbalances first before medication or other treatments are considered. 

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

Treatments for Hair Growth

Hirsutism (excessive hair growth) affects about 70% of women with PCOS and can take a psychological toll. Shaving, bleaching, waxing, and plucking may not be enough to ward off the excessive growth, so there are other options to consider. Laser hair removal uses heat from a laser to heat the hair follicles and destroy them, preventing growth. Whereas electrolysis is a technique that uses a tiny needle and electrical zap to destroy the hair root and prevent growth.

Skincare for Acne Management 

PCOS acne is different from adolescent-type acne and may need different skincare treatments. Topical treatments like retinoids help normalize skin cell turnover and prevent clogged pores. While benzoyl peroxide and salicylic acid target bacterial growth and inflammation. 

Supplements 

Research has shown that several vitamins and supplements may help those with PCOS manage the condition. PCOS supplements like Mira’s can help balance hormones, enhance insulin sensitivity, reduce inflammation, and promote overall well-being. Most work to manage insulin resistance, metabolism, and hormone balance but can have a range of other health benefits. 

See this post for a deep dive on some of the most common and effective PCOS supplements and how they help combat certain symptoms.

Living with PCOS

PCOS is a complex hormonal condition that doesn’t just affect your fertility. PCOS can also impact your metabolism, heart health, and skin, not to mention the impacts on your psychological health. 

Coping with Symptoms 

As we’ve covered, coping with the symptoms of PCOS depends on how the condition is affecting you. Together with your healthcare provider, you will likely determine the best strategy for managing hair growth, acne, weight gain, or any other PCOS symptoms. 

The impacts of PCOS aren’t just physical and managing your mental health is just as important. PCOS comes with an increased risk of depression, anxiety and other psychiatric disorders not to mention issues with body image and self esteem. It’s important to find emotional support and practice stress management while dealing with these challenges.

Meditation can be a valuable tool for stress management and help with PCOS treatment. There are a number of popular apps and tracks for meditation that can guide you. Mira’s own Fertility Meditation Playlist combines mantras, visualizations, breathing techniques, and yoga to enhance fertility and reduce stress. 

Empowering Actions 

PCOS is a serious health condition with no known cure, but that doesn’t mean you can’t manage this challenge through your actions. Early diagnosis and management is key to reduce the risk of associated health conditions and improve both the physical and psychological toll PCOS can take. 

Since cycle irregularity is a hallmark of PCOS tracking your cycle for symptoms is one of the best places to start. You can use one of the many apps or tools available to help predict your period and note any related symptoms. 

We recommend the Mira Fertility & Cycle Tracker since it works so well for users with irregular cycles or PCOS. With an algorithm trained on real hormonal values and optimized using over 4 million hormone data points it’s unlike other apps that rely on averages. You can use our app with or without Mira’s at-home hormone monitor, but it’s important to note that the app can be used effectively without any purchases. Not only does it allow you to enter symptoms and other vital information, you can empower yourself with fertility education through the app’s extensive library of articles, webinars, and free ebooks.

Managing PCOS may mean frequent medical appointments, especially while you are in the diagnosis stage. Your doctor may ask a number of questions about your symptoms so it’s important to be prepared. Keeping a diary or log of symptoms you experience can help guide the conversation. If you have any key questions to ask, make a note of them as well so you are prepared for your appointment. Talking to your doctor about PCOS can be challenging, but as with any chronic condition, arming yourself with knowledge can help ease the hurdle. 

If you don’t have a PCOS diagnosis yet, but are still struggling with symptoms like hard acne, heavy bleeding, and excessive hair growth you may be able to gain a better perspective on your hormones through a single at-home lab test like Mira’s Panorama Fertility Lab Test. This convenient kit tests 5 hormones that affect your ovulation, cycle regularity, and ability to get pregnant and can help identify hormonal signals that can lead to PCOS. You get 5 individual and personalized hormone reports with actionable steps to understand what those numbers mean for your fertility health.

If you are still struggling with PCOS and how to manage it all, consider consulting a professional who can help. Mira’s own Hormone Health Coaches can help! Unlike a doctor, Hormone Health Coaches offer a practical and integrative approach on all things fertility – including how to manage a hormonal imbalance like PCOS. All of our coaches have field experience in fertility and can help assess your symptoms, analyze hormone tests, and provide practical lifestyle guidance on managing PCOS. They can also signpost you to further support depending on your individual situation and goals. 

Final Thoughts 

There’s no universal cure for PCOS, but its many symptoms can be treated and/or relieved. It’s very important to take care of yourself and check with your doctor if you have any doubts.