Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal conditions affecting people with ovaries during their reproductive years. Despite how widespread it is, PCOS is often misunderstood, and many people are left feeling confused about their symptoms or unsure about what to do next. This guide is here to break things down—what PCOS is, how it’s diagnosed, and how to manage it.

What Exactly Is PCOS?

PCOS happens when your hormones don’t quite work as they should, and it throws off your ovulation—the process where your ovaries release an egg each month, leading to menstruation. Without regular ovulation, the menstrual cycle becomes irregular or unpredictable. 

One of the key features of PCOS is higher-than-normal levels of androgens, also known as “male hormones.” These hormones can disrupt your menstrual cycle and lead to symptoms like acne, excess hair growth, or even hair thinning.

You might have heard the term “polycystic” and thought it meant cysts on your ovaries. But that’s not exactly what’s happening. In PCOS, the “cysts” seen on an ultrasound are actually tiny, undeveloped follicles—small sacs that contain immature eggs. These follicles are harmless on their own, but their presence can be a sign of hormonal imbalance.

What Are the Common Symptoms of PCOS?

PCOS can look very different from person to person. Some people only have mild symptoms, while others experience more challenges. Here are the most common ones:

1. Irregular Periods

If your periods are all over the place—coming late, lasting longer than usual, or even skipping months—it could be due to PCOS. This happens because the hormonal imbalances disrupt ovulation, which affects your cycle.

This may manifest as:

• Delayed or infrequent menstruation.
• Prolonged cycles lasting over 35 days.
• Abnormal menstrual bleeding, which can be unusually heavy or light.

2. High Androgens

When androgens are elevated, you might notice:

• Acne: Persistent breakouts on your face, back, or chest.
• Excess body or facial hair (hirsutism): Dark, coarse hair in areas like your chin, upper lip, or abdomen.
• Thinning hair: Hair loss on your scalp, similar to male-pattern baldness.

3. Trouble Getting Pregnant

PCOS can make ovulation unpredictable—or stop it altogether—which can make it harder to conceive. An imbalanced hormonal environment can also cause a decline in egg quality. The good news? With the right help, many people with PCOS successfully become pregnant.

4. Weight Challenges

Weight gain, especially around your belly, is common with PCOS. Losing weight can also feel harder than usual due to how PCOS affects your metabolism.

5. Insulin Resistance

Many people with PCOS have insulin resistance, which means your body struggles to use insulin properly. This can increase your risk of developing type 2 diabetes.

6. Skin and Energy Changes

• Darkened patches of skin (called acanthosis nigricans), often on your neck, armpits, or groin.
• Feeling unusually tired or having mood swings.

Why Does Regular Bleeding Matter?

If you go months without a period, your uterine lining (the layer of tissue inside your womb) doesn’t shed like it’s supposed to. Over time, this can cause it to grow too thick—a condition called endometrial hyperplasia. If this isn’t addressed, it can lead to irregular spotting, heavy bleeding, or, in rare cases, more serious issues like endometrial cancer.

Medications like progesterone or hormonal birth control can help ensure your uterine lining is shed regularly. If you’ve skipped several periods, it’s worth talking to your doctor to prevent potential complications.

How Is PCOS Diagnosed?

Diagnosing PCOS isn’t always straightforward, as there’s no single test. Doctors usually look at a combination of factors, including:

• Your Medical History: Your doctor will ask about your periods, weight changes, and symptoms like acne or hair growth.
• Blood Tests: These measure hormone levels to check for imbalances.
• A Physical Exam: Checking for outward signs of high androgen levels, such as excess facial hair or scalp hair thinning.
• Ultrasound: An ultrasound might show multiple small follicles on your ovaries, which can indicate PCOS.

Since irregular periods or weight gain can have other causes (like thyroid issues), your doctor might do additional tests to rule those out.

How Is PCOS Treated?

While there isn’t a one-size-fits-all cure for PCOS, there are plenty of ways to manage it effectively. Treatment depends on your symptoms and goals, whether that’s improving your cycles, reducing acne, or trying to get pregnant.

1. Medications

• Hormonal Birth Control: Helps regulate periods, reduce acne, and protect your uterine lining.
• Metformin: Improves insulin resistance and can sometimes help with ovulation.
• Fertility Treatments: If you’re trying to conceive, medications like letrozole or clomiphene can help stimulate ovulation.

2. Supplements

Supplements can be helpful, but they work best when tailored to your specific deficiencies and form of PCOS. Speak to your doctor to figure out what’s right for you. Common options include:

• Inositol: Supports insulin sensitivity and may improve ovulation.
• Vitamin D: Often low in people with PCOS, this vitamin supports hormone balance.
• Omega-3s and CoQ10: Help reduce inflammation and improve egg quality.

3. Lifestyle Changes

• Nutrition: Focus on a balanced diet with whole foods to help regulate blood sugar and support hormones.
• Physical Activity: Exercise can improve how your body uses insulin and promote overall well-being.
• Stress Management: Practices like yoga or mindfulness can help ease stress, which may make symptoms worse.

4. Cosmetic Options

If excessive hair growth or acne bothers you, treatments like laser hair removal, topical creams or oral medications can make a big difference.

PCOS and Fertility

If you’re trying to get pregnant, PCOS can feel like a major hurdle—but it’s often manageable. Here’s what can help:

• Lifestyle & Dietary Changes: Dietary changes and targeted supplements can improve ovulation naturally, leading to pregnancy naturally. 
• PCOS-Sensitive Ovulation Tracking: Tracking ovulation can be harder for women with irregular periods caused by PCOS. LH urine test kits often aren’t reliable because of prolonged or unexpected LH surges. Instead, monitoring multiple hormone changes and tracking cervical mucus can give clearer insights into when ovulation might occur. 
• Medications: Fertility medications like letrozole or clomiphene can help your body ovulate. Your doctor will guide you through the process and discuss any risks, like the chance of having twins.
• Advanced Options: If needed, treatments like in-vitro fertilization (IVF) are available.

When Should You See a Doctor?

It’s a good idea to see a doctor if you:

• Have irregular or absent periods, especially if you have fewer than three periods in a year.
• Experience excessive hair growth, persistent acne, or weight gain.
• Have trouble getting pregnant, especially when combined with any of the above symptoms.

Early diagnosis can help manage symptoms effectively and reduce the risk of complications like diabetes, especially during pregnancy, or endometrial hyperplasia.

Living with PCOS

PCOS can feel overwhelming, but it’s important to remember you’re not alone—and there are plenty of ways to manage it. With small, consistent steps like improving your nutrition, managing stress, and working with your doctor, you can take control of your symptoms and feel better.

If you’re dealing with symptoms or seeking clarity about your reproductive health, a PCOS-specific screening can help. A thorough hormonal evaluation offers insights into your body’s patterns and provides clear, actionable steps to manage your health effectively.