10 signs and symptoms of PCOS

Polycystic ovary syndrome (PCOS) is a complicated hormonal condition that affects women of childbearing age. Some women will have several severe symptoms, but others may only have minor symptoms (or even none at all).  

Symptoms can improve or worsen depending on your lifestyle and how well controlled your PCOS is. 

In this blog, we discuss some of the most common signs and symptoms of PCOS in depth, all of which link back to the two main disease processes in PCOS — insulin resistance and hyperandrogenism (raised levels of male hormones). To find out more about these causes, read our what every woman should know about PCOS section. 

The signs and symptoms in this blog include: 

• Irregular or absent periods 
• Difficulty losing weight or being overweight  
• Fatigue 
• Hirsutism and thinning of hair on the scalp 
• Acne or oily skin 
• Insulin resistance 
• Infertility 
• Acanthosis nigricans (dry, dark patches of skin) 
• Mood changes, low self-esteem, and mental health issues 
• Cysts  

1. Irregular or absent periods

One of the first indications that something is amiss is if your periods become irregular (or stop completely). If this happens, see your doctor - particularly if your periods have stopped, or if you are only bleeding very irregularly.  

Irregular or absent periods do not necessarily mean you have PCOS, and it would be important for your doctor to look at other potential causes, such as a thyroid condition.  

Your periods can become irregular or absent with PCOS due to either: 

• A hormone imbalance 
• Polycystic ovaries  

You can also take control of your health and test yourself for reassurance with one of our PCOS blood tests.  

2. Difficulty losing weight or being overweight

Most women with PCOS (38% - 88%) are either overweight or obese [1]. And being overweight or finding it difficult to lose weight can cause challenges for women both physically and emotionally. 

Both the symptoms experienced, and the increased risk of other health conditions, are affected by having a high body mass index (BMI). Unfortunately, the very nature of the condition makes it difficult to lose weight and adds to the emotional burden a woman with PCOS experiences.  

However, both lifestyle changes and symptom management can have significant benefits with weight loss. Read our PCOS-friendly diet to help with symptom management.  

3. Fatigue

Fatigue is one of the most common complaints of women with PCOS [2].   

Symptoms of fatigue include: 

• Feeling tired during the day 
• Struggling to concentrate 
• Mood swings  
• Headaches 

Fatigue can be due to hormones but also a sleep disturbance, such as obstructive sleep apnoea (OSA). And women with PCOS are twice as likely to develop OSA than women without the condition [3]. 

You can read more about OSA in our blog on what health conditions PCOS can put you at higher risk of.  

4. Hirsutism and thinning of hair on the scalp

Women with PCOS can have two distinct types of hair patterns:  

1. Hirsutism  
2. Thinning of the hair on the scalp 

Hirsutism is body or facial hair that develops in several (possibly unwanted) places, such as the: 

• Face 
• Neck 
• Chest 
• Abdomen 
• Lower back 
• Bottom  
• Thighs  

Women may also notice that they start to lose hair on the head, commonly known as male pattern baldness.  

Hirsutism in women can range from mild to severe. You can assess the degree to which you are affected by hirsutism on the Ferriman-Gallway Score.  

Not all women with PCOS will have hirsutism or notice their hair thinning, but it’s not a favoured symptom. Both these symptoms can be caused by an excess of hormones called androgens.  

An androgen is a male sex hormone (such as testosterone) and 60-100% of women with PCOS will have raised androgen levels. 

All women naturally have a small amount of testosterone in their bloodstream, however, in PCOS this level is higher than usual and as a result, causes the development of hair (or shedding of hair) where women wouldn't normally expect it. 

5. Acne or oily skin

Raised androgen levels aren’t just responsible for unwanted hair – they can also cause acne and oily skin.  

Oily skin can affect the: 

• Face 
• Back  
• Neck 

Having oily skin can cause acne, both of which can be emotionally distressing conditions to live with. But the good news is, that a combination of lifestyle changes, dietary improvements, supplements, and medication can help. To help with symptom management, we have put together five ways to manage your PCOS symptoms.  

6. Insulin resistance

As many as 70% of women with PCOS have insulin resistance [4].  

Insulin resistance means that the cells in the body are resistant to the effect of normal insulin levels. To compensate, the pancreas produces more insulin to keep blood sugar normal. This raised level of insulin may be one of the reasons why PCOS develops. 

You can find out more about insulin resistance in our what every woman should know about PCOS blog.  

7. Infertility

Quite often, PCOS is managed through contraception as it balances the hormones out [5]. So, a lot of women, may not find out they have PCOS until they stop contraception and try and start a family.  

If you are under 35 years of age and have been trying to conceive for 12 months or longer or are over 35 and have been trying for six months or more, then this may mean you are experiencing the first signs of infertility. In these cases, you should speak to a medical professional for advice.  

If you are not ovulating regularly due to PCOS, then it will take you longer to conceive. If you are not ovulating at all, it will not be possible to become pregnant without treatment.  

Most women with PCOS do ovulate, but it can be as infrequently as only a few times a year [6]. A combination of lifestyle changes and treatments from your doctor can help you to ovulate more regularly and optimise your ability to conceive.  

8. Acanthosis nigricans (dry, dark patches of skin)

Acanthosis nigricans is the name given to dry, dark patches of skin that usually appear on the neck, groin, or under your arm. And is more common in people with darker skin.  

Acanthosis can help identify whether someone with PCOS has an increased risk for type 2 diabetes mellitus [7]. Acanthosis can be down to an increased BMI and irregular insulin levels.  

Treatment for acanthosis nigricans is through a combination of lifestyle changes and medication to balance your hormones and insulin levels. 

9. Mood changes, low self-esteem, and mental health issues

The symptoms of PCOS can affect your mood and self-esteem, especially if you suffer from some of the more visible symptoms such as weight gain, hirsutism, and acne. However, research shows that PCOS can also lead to severe mental health issues, including anxiety, depression, and eating disorders. 

PCOS is a debilitating condition, both physically and emotionally. If you feel that your mood is affected, take the time to discuss this with your doctor, as you do not need to suffer in silence.  

You can read more about where to get support in our what every woman needs to know about PCOS blog.  

10. Polycystic ovaries

Contrary to its name, women with PCOS do not have cysts, and they also do not have to have polycystic ovaries to be diagnosed with PCOS.  

Polycystic ovaries means when your ovaries become enlarged and contain fluid-filled sacs (follicles) that surround the eggs [8]. These follicles are harmless and can be anywhere up to 8mm (approximately 0.3 inches) in size.  

In PCOS, these follicles may be unable to release an egg, meaning ovulation does not take place, affecting infertility.  

Not to worry though, as there are ways to manage and treat certain aspects of PCOS and possible infertility. And you can find more information on our blog:  how can PCOS affect my fertility?

What do I do if I’m experiencing symptoms of PCOS?

If you are experiencing any symptoms of PCOS, we recommend speaking to your doctor.  

You can also take an at-home blood test, such as our Polycystic Ovary Syndrome Blood Test, for peace of mind.  

We have also put together some more information about PCOS in our guide, including how to manage your symptoms and everything you need to know about PCOS.

References 

1. Barber, T., Hanson, P., Weickert, M. and Franks, S., 2019. Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies. Clinical Medicine Insights: Reproductive Health, 13, p.117955811987404. 
2. Health, P., 2022. PCOS and Fatigue - Why Are You Feeling So Tired? - PERLA Health. [online] PERLA Health. Available at: <https://perlahealth.com/pcos-and-fatigue-why-are-you-feeling-so-tired-2/> [Accessed 14 June 2022]. 
3. Kumarendran, B., Sumilo, D., O’Reilly, M., Toulis, K., Gokhale, K., Wijeyaratne, C., Coomarasamy, A., Arlt, W., Tahrani, A. and Nirantharakumar, K., 2019. Increased risk of obstructive sleep apnoea in women with polycystic ovary syndrome: a population-based cohort study. European Journal of Endocrinology, 180(4), pp.265-272. 
4. Marshall, J. and Dunaif, A., 2012. Should all women with PCOS be treated for insulin resistance?. Fertility and Sterility, 97(1), pp.18-22. 
5. nhs.uk. 2022. Polycystic ovary syndrome - Treatment. [online] Available at: <https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/> [Accessed 14 June 2022]. 
6. 2022. [online] Available at: <https://www.tommys.org/pregnancy-information/planning-a-pregnancy/fertility-and-causes-of-infertility/pcos-and-fertility-everything-you-need-know> [Accessed 14 June 2022]. 
7. G, S., 2013. Acanthosis Nigricansin PCOS Patients and Its Relation with Type 2 Diabetes Mellitus and Body Mass at a Tertiary Care Hospital in Southern India. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH,. 
8. nhs.uk. 2022. Polycystic ovary syndrome. [online] Available at: <https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/> [Accessed 15 June 2022].