Polycystic Ovary Syndrome (PCOS) is a medical condition that affects every woman differently. There is an array of symptoms, and while some women may experience all of these symptoms severely, others may not experience any noticeable symptoms. On the other hand, women may experience several symptoms varying from mild to severe. [1] The following article will highlight the most common symptoms associated with PCOS, how you can determine whether you have PCOS, and how to get professionally diagnosed by a practitioner.

Irregular Periods Or Absent Periods (Oligomenorrhea)

One of the most common PCOS symptoms is irregular periods or not getting periods at all. This is known as oligomenorrhea and it’s estimated to occur in 75%-85% of women with PCOS, and less than 18% of women without PCOS. [2] A woman experiences Oligomenorrhea when their menstrual cycle is greater than 35 days apart or when they only have four to nine menstrual cycles in a year. [3] However, there are exceptions to some women experiencing irregular periods or not getting their period at all, for instance during [3]:

• Menarche – the first menstrual cycle in females, where anovulatory cycles (when the egg doesn’t release from a woman’s ovary) may occur and cause light or irregular flow that eventually becomes regular. The light or irregular flow can be confused with oligomenorrhea initially. [3], [4]
• Postpartum – After giving birth, a new mom’s first period can come anywhere between two to twelve weeks, however, six to twelve weeks is when most women experience their first period. Similarly, this can be confused with oligomenorrhea initially. [5]
• Perimenopausal period – Irregular bleeding is a sign and symptom of Perimenopause and is often confused with oligomenorrhea. [3]

These periods in a woman’s life typically cause fluctuating hormone levels, which may affect their menstrual cycles but are usually expected.

However, women with PCOS may experience an increase in androgens (a group of sex hormones that men and women both produce, but men produce more of), especially testosterone which can affect their menstrual cycle and prevent ovulation. [6], [7] An increase of androgens causes a hormonal imbalance, impacting the follicle (a small fluid-filled sac located in the ovary, with an immature egg) from being able to mature or get released as it’s normally supposed to. [8], [7] And, instead of being released, the follicle stays in the ovaries. [7] Additionally, when a woman doesn’t ovulate and experiences the normal hormonal events that lead up to menstruation, the uterus does not have the stimulation required to shed its lining - in other words, a woman’s period may be delayed, or absent entirely. [7]

Many Small Cysts On The Ovaries (Polycystic Ovaries)

Usually accidentally found through physical examination or imaging, ovarian cysts are multiple small fluid-filled sacs that can form on the surface or the inside of one or both ovaries. [9], [10] Ovaries are organs located deep within the pelvis. A woman’s ovaries play an important role in her menstrual cycle (periods), conception (pregnancy), and producing the hormones estrogen and progesterone. [11] In a normal instance, eggs develop inside the ovaries, within a sac or follicle and the egg is then released from its sac into one of the fallopian tubes during ovulation and the sac dissolves. [12] However, with polycystic ovaries, the eggs mature in the ovaries but are never released. And, as each menstrual cycle passes, the cysts are at risk of growing larger and developing into multiple cysts. [12]

Ovarian cysts are quite common for a woman to develop, as 20% of women will develop at least one ovarian cyst in their lifetime. [9] Most cysts are benign and do not require surgical intervention, however, while uncommon, ovarian cysts can be malignant, or cancerous. [12], [9]

Increase of Androgens

The pituitary gland (attached to the brain) is responsible for sending signals to the body, to produce the right amount of estrogen, progesterone, and testosterone (different hormones). [13] However, PCOS disrupts the signals, causing estrogen and progesterone levels to drop and testosterone levels to increase [13], or in other words - triggering a hormonal imbalance. Testosterone is the most common androgen, and both females and males produce a certain amount of healthy testosterone levels (males more than females), normally. [6] The disrupted signals causing an increase in testosterone levels impact the ovulation phase of the menstrual cycle and can lead to several other symptoms such as:

Acne or Oily Skin

PCOS acne caused by a hormonal imbalance typically shows up on the areas more sensitive to the effects of hormones, such as the lower half of a woman’s face - around the jawline, chin, lower cheeks, and upper neck. [14], [15] Body acne, such as the chest and back can be affected too. Women can experience several kinds of acne, including [15]:

• closed comedones (whiteheads)
• open comedones (blackheads)
• pustules (small, inflamed, and pus-filled pimples)

Excessive Hair Growth On The Face Or Body (Hirsutism)

Some women may experience thick, dark hair on the face (mustache and beard), neck, chest, stomach, lower back, buttocks, and thighs, which is known as hirsutism. As androgen levels increase, it may cause excessive male-pattern hair growth in unwanted areas for women. [16]

Hirsutism is quite common, as it affects nearly 10% of women in the United States. The disorder often causes emotional stress and mental anguish for women as the hairs tend to appear in unwanted areas. [17]

Female-Pattern Baldness And Hair Loss On Scalp (Androgenic Alopecia)

When women experience female-pattern baldness and hair loss on the scalp it’s known as androgenic alopecia. It works similarly for both women and men - approximately 10% of testosterone is converted into an androgen called dihydrotestosterone (also known as DHT). [18] DHT is released into the bloodstream and links to receptors on hair follicles on the scalp, causing them to shrink. [18] This can cause the hair to either fall or thin significantly. Since women with PCOS have increased levels of testosterone, they’re at risk of facing androgenic alopecia because their bodies are also turning testosterone into DHT.

The way women experience hair loss is different from men. Women can experience hair loss in one of two ways [18]:

• Hair thinning starts mid-scalp and gradually continues in a circular pattern
• Or, hair thinning starts at the hairline and gradually spreads towards the center and back of the scalp in a triangular pattern - so the thinning will be wider at the front and narrower in the back.

It’s uncommon for women to experience complete baldness, instead, they’re more likely to experience excessive hair thinning and shorter hair. [18] However, extreme hair thinning can expose large areas of the scalp. [18]

How Can I Get Professionally Diagnosed With PCOS?

To professionally get diagnosed with PCOS, a woman must have at least two of the three following symptoms [19]:

• Irregular periods or no periods at all -Increased androgen levels (potentially showing up as other symptoms such as acne, excess facial and body hair (hirsutism), or female-pattern baldness (androgenic alopecia)) -Many small cysts on the surface or inside the ovaries

Additionally, the tests your doctor will most likely request you do include [19]:

• Blood test - to check androgen levels, including testosterone, and insulin levels, since both tend to increase for women with PCOS.
• Pelvic Ultrasound - to check the uterus and ovaries to see if any ovarian cysts are present. The test uses sound waves to create images of the uterus and ovaries on a computer monitor. However, ovarian cysts may not appear on the ultrasound for women on birth control pills.