Introduction
Symptoms of Polycystic Ovarian Syndrome (PCOS) is one of the most prevalent hormonal disorders affecting women of reproductive age. Yet, despite its widespread impact, PCOS often goes undiagnosed or misdiagnosed due to its wide range of symptoms that vary from woman to woman.
Many women discover they have PCOS only after struggling with infertility or menstrual irregularities. But in truth, PCOS presents itself through many subtle and sometimes confusing signs long before a diagnosis is made.
Following are the symptoms of PCOS
Irregular or Missed Periods :-
One of the most common symptoms of PCOS is irregular menstrual cycles. Many women with PCOS experience infrequent periods (oligomenorrhea) or, in some cases, complete absence of periods (amenorrhea).
This happens because hormonal imbalances—particularly high levels of androgens and insulin—disrupt the normal ovulatory cycle. Without regular ovulation, the uterus doesn’t receive the signals it needs to shed its lining, leading to missed or delayed periods.
Common Signs:
- Fewer than 9 periods a year
- Long cycles (more than 35 days apart)
- Heavy or very light bleeding when periods do occur
Excess Facial and Body Hair (Hirsutism) :-
Hirsutism refers to the excessive growth of coarse, dark hair in areas where men typically grow hair, such as the face, chest, back, or abdomen.
In PCOS, the ovaries (and sometimes adrenal glands) produce excess androgens (male hormones like testosterone), which stimulate unwanted hair growth.
Common Signs:
- Hair growth on the upper lip, chin, chest, back, or stomach
- Thick, dark hair in areas that are usually soft or hairless in women
Hirsutism can be emotionally distressing, and it’s one of the most visible symptoms of PCOS.
Acne and Oily Skin :-
Acne, especially around the jawline, chin, and cheeks, is another common sign of high androgen levels. These hormones increase the production of sebum, an oily substance in the skin, which can clog pores and cause breakouts.
Women with PCOS may experience persistent, cystic acne even in adulthood, often resistant to regular skin treatments.
Common Signs:
- Painful, deep pimples or cysts
- Acne on jawline, back, or chest
- Excessively oily skin that doesn’t respond to cleansers
Scalp Hair Thinning or Hair Loss :-
While PCOS causes excess hair in some places, it can also cause scalp hair to thin or fall out, a condition similar to male-pattern baldness. This is due to androgens shrinking hair follicles on the scalp.
Over time, the hair becomes finer and eventually stops growing.
Common Signs:
- Widening hair part
- Thinning at the crown of the head
- Increased hair fall while combing or washing
Weight Gain or Difficulty Losing Weight
Most women with PCOS struggle with weight gain, especially around the abdomen. This is primarily linked to insulin resistance, which is common in PCOS.
When the body doesn’t respond properly to insulin, it stores more fat, particularly visceral fat (deep belly fat), which worsens inflammation and hormonal imbalance.
Common Signs:
- Rapid or unexplained weight gain
- Trouble losing weight despite dieting or exercising
- Fat accumulation mostly in the abdominal area
Even women who are lean may have “hidden” insulin resistance, making this a key but not exclusive symptom.
Dark Patches of Skin (Acanthosis Nigricans) :-
Dark, velvety patches of skin particularly on the neck, underarms, or groin are a visible sign of high insulin levels. The skin thickens and darkens as a reaction to insulin resistance.
Common Signs:
- Brown or black patches on the back of the neck
- Skin tags or thickened skin in folds and creases
- Often accompanied by itchiness or rough texture
This symptom is especially common in overweight individuals with PCOS.
Infertility or Trouble Getting Pregnant :-
One of the leading causes of female infertility is PCOS. Because the hormonal imbalance affects ovulation, women with this it may not release an egg every month (anovulation), making conception difficult.
Even if periods seem regular, ovulation may still not be occurring, which makes it harder to track fertile windows.
Common Signs:
- Trying to conceive for over a year without success
- Irregular ovulation or lack of ovulation
- Dependence on fertility medications or assisted reproductive techniques
Mood Changes, Anxiety, and Depression :-
PCOS doesn’t just affect the body as it can impact mental health too. Hormonal imbalances, body image issues, and infertility can contribute to mood swings, anxiety, and depression.
In addition, insulin resistance may also influence brain chemistry, further impacting mood.
Common Signs:
- Feeling overwhelmed, low, or hopeless
- Increased irritability or mood swings
- Trouble concentrating or feeling mentally foggy
Seeking mental health support is essential and should be part of PCOS management.
Fatigue and Low Energy Levels
Chronic tiredness, sluggishness, or feeling drained even after adequate sleep may be linked to insulin resistance and hormone fluctuations in PCOS.
The body isn’t using glucose efficiently for energy, leading to persistent fatigue. Poor sleep quality due to hormonal imbalance can also play a role.
Common Signs:
- Needing naps during the day
- Waking up tired despite a full night’s rest
- Feeling tired after meals (especially high-carb ones)
Fatigue can often be mistaken for laziness or overwork—but it’s a real and treatable symptom.
Sleep Issues and Sleep Apnea :-
Many women with PCOS—especially those who are overweight experience obstructive sleep apnea, a condition where breathing repeatedly stops during sleep.
Sleep apnea leads to poor oxygenation, restless sleep, and chronic daytime fatigue. It also worsens insulin resistance and increases the risk of high blood pressure and heart disease.
Common Signs:
- Loud snoring
- Waking up gasping for air
- Daytime drowsiness or headaches in the morning
Sleep studies and CPAP therapy can help in managing this often-ignored aspect of PCOS.
Polycystic Ovaries (As Seen on Ultrasound) :-
The term “polycystic ovaries” refers to the appearance of the ovaries on ultrasound—enlarged and containing many small, immature follicles (cysts).
While it’s a defining feature of PCOS, not all women with PCOS have visible cysts, and some women with cysts don’t have at all.
Common Signs:
- Enlarged ovaries with a “string of pearls” appearance
- More than 12 follicles in each ovary
- Confirmed by pelvic ultrasound
This diagnostic clue must be considered alongside clinical symptoms and blood tests.
Conclusion
PCOS is a syndrome, meaning it includes a combination of symptoms that may vary in severity. You don’t need to have all the symptoms to be diagnosed. Even having 2 or 3 key signs, like irregular periods and acne, could warrant further testing.
The earlier PCOS is identified, the better it can be managed. From lifestyle changes to medical therapy, there are many effective ways to balance hormones, regulate cycles, and improve fertility.
