PCOS symptoms and signs: what to look for and how it's diagnosed
What is PCOS?
PCOS is a hormonal condition that affects how your ovaries work. Despite the name, you don't have to have cysts to have PCOS: the 'cysts' seen on scans are actually lots of small, partly developed follicles (fluid-filled sacs that contain eggs) that haven't released an egg.
The exact cause isn't fully understood, but it often runs in families and is linked to higher levels of androgens (hormones such as testosterone, which everyone has in some amount) and to insulin resistance, where your body doesn't respond to insulin as well as it should.
Common symptoms of PCOS
PCOS looks different in everyone. Some people have many symptoms, others only one or two. The most common signs are:
- Irregular or missed periods — cycles that are often longer than 35 days, very unpredictable, or absent
- Excess hair growth on the face, chest, back or tummy (called hirsutism)
- Acne or oily skin, especially if it continues beyond your teens
- Thinning hair or hair loss from the head
- Weight gain or finding it hard to lose weight
- Difficulty getting pregnant, because ovulation happens irregularly or not at all
Some people also notice darker, velvety patches of skin in body folds such as the neck or armpits, which can be a sign of insulin resistance. Many people with PCOS say the condition affects their mood and self-esteem too — that's real, and worth mentioning to your doctor.
How is PCOS diagnosed?
There isn't a single test for PCOS. Doctors usually diagnose it if you have at least two of these three features:
- irregular periods or signs that you aren't ovulating regularly
- signs of high androgens, either symptoms like excess hair or acne, or raised levels on a blood test
- polycystic-looking ovaries on an ultrasound scan
Your doctor will also want to rule out other conditions that can look similar, such as thyroid problems or high prolactin, usually with blood tests. In teenagers, scans are generally not used to diagnose PCOS, because ovaries naturally have many follicles in the years after periods begin.
It helps to bring a record of your cycles and symptoms to your appointment, along with a note of any family history of PCOS or type 2 diabetes.
Why getting diagnosed matters
PCOS isn't only about periods and skin. It's linked to a higher risk of some longer-term health problems, including type 2 diabetes, high cholesterol, high blood pressure and sleep apnoea. If you have very few periods over a long time, the lining of the womb can build up, which can increase the risk of womb (endometrial) cancer — this is one reason doctors may suggest treatment to make sure you have regular bleeds.
A diagnosis means you can get the right checks over time, such as blood sugar and blood pressure tests, and support that fits your goals.
How PCOS is treated and managed
There's no cure, but treatment can make a big difference. What's right for you depends on your symptoms and whether you want to get pregnant:
- Lifestyle — regular movement and a balanced diet can improve symptoms and insulin resistance. For people who are overweight, even modest weight loss can help regulate periods, but PCOS can make weight harder to manage, so be kind to yourself.
- Hormonal contraception can regulate bleeding and help with acne and hair growth.
- Other medicines may be offered for insulin resistance, excess hair or acne.
- Fertility treatment, including medicines that help you ovulate, can help if you're trying to conceive.
- Hair removal and skincare options can help with how you feel day to day.
Your doctor can talk you through the benefits and side effects of each option.
When to see a doctor
Make an appointment if you have irregular or absent periods, excess hair growth, persistent acne, hair thinning, or you've been trying to get pregnant without success. You don't need to have every symptom.
See a doctor promptly if you have very heavy or prolonged bleeding, bleeding after sex, or symptoms that come on suddenly or quickly get worse — for example, rapid new hair growth or a deepening voice — as these need checking for other causes.
Frequently asked questions
Can you have PCOS with regular periods?
Yes, it's possible. Because PCOS is diagnosed using two out of three features, you could have regular periods but still have signs of high androgens and polycystic-looking ovaries. A doctor can assess your symptoms and run tests.
Can you get pregnant with PCOS?
Many people with PCOS get pregnant, sometimes naturally and sometimes with treatment to help them ovulate. PCOS is one of the most common causes of irregular ovulation, so if you're trying to conceive it's worth speaking to a doctor early.
Does PCOS cause weight gain?
PCOS is linked to weight gain and can make losing weight harder, partly because of insulin resistance. But people of any size can have PCOS, and not everyone with PCOS gains weight.
Does PCOS go away?
PCOS is a long-term condition, but symptoms often change over time and can be managed well. Some symptoms, such as irregular periods, may change around menopause, but the associated health risks like type 2 diabetes still matter, so ongoing check-ups are important.
What blood tests check for PCOS?
Doctors commonly check hormone levels such as testosterone, and may test thyroid function and prolactin to rule out other causes. They may also check blood sugar and cholesterol because of the long-term risks linked to PCOS.
Talk about it with other women
Questions, experiences, what worked for you — in Periods & Cycles. You can post anonymously.
Ask a questionSources & further reading
- NHS — Polycystic ovary syndrome
- Office on Women's Health — Women's health information
- Mayo Clinic — Health information
This guide is general information written to help you understand your options. It is not a substitute for advice from a doctor, lawyer or financial adviser who knows your situation — if you have worrying symptoms, please see a health professional.