Polycystic Ovarian Syndrome (or PCOS) affects 6-12% of all people with ovaries in the US (up to 5 million people) (CDC, 2020). The first symptom you’ll usually notice are abnormal or missed periods; however, some people don’t notice their PCOS until they are attempting to become pregnant.
Here, we’ll take a brief look at some of the most common symptoms of PCOS.
Let’s start with the name PCOS--polycystic ovarian syndrome; it’s actually a bit controversial! The name essentially means “a syndrome that includes multiple cysts on the ovaries”, and while that’s often true in patients with PCOS, many other diagnoses also come with ovarian cysts, including endometriosis, other hormonal conditions, and pregnancy.
Ovarian cysts can be cancerous, but this is not common. Most ovarian cysts are harmless. A ruptured cysts can cause sudden, severe pain and heavy bleeding; you should see a doctor if this occurs to ensure there are no complications from your ruptured cysts.
Those with ovarian cysts should also seek medical attention if they have pain together with vomiting and a fever; if they experience faintness, weakness, or dizziness; or if they have sudden rapid breathing (OWH}.
Excess Androgens in PCOS
A better way to look at PCOS is as an imbalance of estrogen and androgens. Typically, those assigned female at birth will have more estrogen, while those assigned male at birth will have more androgens (including testosterone) (U.S. National Cancer Institute).
The increased androgens in PCOS (known as hyperandrogenism) causes many of the physical side effects of PCOS, such as:
- Hirsutism (dark, coarse hair on the face and neck which can look like a moustache or beard)
- Hormonal acne, especially on the chin
- Problems menstruating, including irregular menstruation or amenorrhea (no menstrual periods for three or more months)
Hormonal conditions like PCOS can interfere with many of the other hormonal systems of the body, which can lead to a number of comorbid issues. These problems are so common that most doctors will screen for them when you get a PCOS diagnosis. Comorbid conditions include:
- Thyroid dysregulation, especially hypothyroidism (Singla, Gupta, Khemani, & Aggarwal, 2015)
- Insulin resistance, which can often be an indicator of diabetes (CDC, 2020)
- Mental health issues including depression (Himelein & Thatcher, 2006)
- Body image problems including gender dysphoria (Kowalczyk et al, 2012)
Curious whether you have PCOS? You may be diagnosed if you have any 2 of the following 3 symptoms (Rotterdam, 2004):
- Excess androgens (whether by test or physical description including facial hair and hormonal acne)
- Irregular, infrequent, or no menstrual periods
- Cysts on the ovaries (usually detected via ultrasound)
If this sounds like you, talk to your doctor about a potential diagnosis, and make sure you are screened for other co-occurring conditions like insulin resistance and thyroid problems.
There is no cure for PCOS, but there are medications and lifestyle changes that may help improve your symptoms and your quality of life.
- Centers for Disease Control and Prevention [CDC] (2020). PCOS (polycystic ovary syndrome) and diabetes. https://www.cdc.gov/diabetes/basics/pcos.html
- U.S. National Cancer Institute. (n.d.). Gonads. SEER Training. https://training.seer.cancer.gov/anatomy/endocrine/glands/gonads.html
- U.S. Office on Women’s Health [OWH] (n.d.). Ovarian cysts. https://www.womenshealth.gov/a-z-topics/ovarian-cysts
- Singla, R., Gupta, Y., Khemani, M., & Aggarwal, S. (2015). Thyroid disorders and polycystic ovary syndrome: An emerging relationship. Indian journal of endocrinology and metabolism, 19(1), 25–29. https://doi.org/10.4103/2230-8210.146860
- Himelein, M. J., & Thatcher, S. S. (2006). Polycystic ovary syndrome and mental health: a review. Obstetrical & gynecological survey, 61(11), 723-732. https://doi.org/10.1097/01.ogx.0000243772.33357.84
- Kowalczyk, R., Skrzypulec, V., Lew-Starowicz, Z., Nowosielski, K., Grabski, B., & Merk, W. (2012). Psychological gender of patients with polycystic ovary syndrome. Acta obstetricia et gynecologica Scandinavica, 91(6), 710–714. https://doi.org/10.1111/j.1600-0412.2012.01408.x
- Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group [Rotterdam] (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and sterility, 81(1), 19–25. https://doi.org/10.1016/j.fertnstert.2003.10.004