PCOS: Symptoms, Causes, and What You Can Do

Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions in women of reproductive age, affecting roughly 6-12% of women. Despite this, the average time from symptom onset to diagnosis is often several years.

Part of why diagnosis is delayed is that PCOS looks different in different women. Here's what to know.

What Is PCOS?

PCOS is a hormonal and metabolic disorder characterized by three potential features — you need at least two of three to receive a PCOS diagnosis:

1. Irregular or absent menstrual cycles (anovulation — cycles without ovulation)
2. Clinical or lab evidence of excess androgens (elevated testosterone, or physical signs like excess facial/body hair or acne)
3. Polycystic appearance of the ovaries on ultrasound (multiple small follicles arranged around the edge of enlarged ovaries)

The name "polycystic" is a bit of a misnomer — the "cysts" are actually immature follicles, not true cysts, and their presence on ultrasound alone doesn't mean you have PCOS.

Common Signs and Symptoms

Irregular periods

Cycles that come every 35+ days, or fewer than 8 periods per year, or unpredictable timing. This reflects disrupted ovulation.

Excess hair growth (hirsutism)

Coarse hair growth in typically male-pattern areas — upper lip, chin, sideburns, chest, abdomen, inner thighs. Driven by elevated androgens.

Acne

Hormonal acne — often along the jawline, chin, and cheeks — that persists or worsens into adulthood. Responsive to anti-androgen treatments.

Scalp hair thinning

The flip side of hirsutism: androgenic alopecia (hair thinning on the scalp) can occur alongside excess body hair.

Weight gain or difficulty losing weight

PCOS is closely associated with insulin resistance, which affects fat storage and metabolism. Many women with PCOS find that maintaining a healthy weight is harder than expected for their level of eating and activity.

Fertility challenges

Because ovulation is irregular or absent, conceiving can be harder. PCOS is one of the most common causes of ovulatory infertility.

Skin changes

Skin tags and darkening of skin in folds (called acanthosis nigricans, a sign of insulin resistance) can occur.

What Causes PCOS?

The exact cause isn't fully understood, but it involves:

• Insulin resistance — present in the majority of women with PCOS. Elevated insulin stimulates the ovaries to produce more androgens.
• Excess androgen production — by the ovaries and sometimes the adrenal glands
• Disrupted hormonal signaling — affecting the normal cyclical rise and fall of LH and FSH that drives regular ovulation
• Genetics — PCOS runs in families; if a first-degree relative has it, your risk is significantly elevated

How PCOS Is Managed

PCOS is a long-term hormonal condition, but it's very manageable. Treatment is individualized based on your primary concerns.

Lifestyle changes (most foundational)

Because insulin resistance is so central, addressing it through diet and exercise often improves multiple aspects of PCOS simultaneously. Reducing refined carbohydrates and added sugars, increasing protein and fiber, and regular physical activity (especially strength training) can improve insulin sensitivity, regulate cycles, reduce androgen levels, and support fertility.

Weight loss in women with PCOS who have excess weight can produce significant hormonal improvements — even 5-10% weight reduction can restore ovulation in some women.

For irregular periods:

Combined oral contraceptives containing anti-androgenic progestins (like norgestimate or drospirenone) regulate cycles and reduce androgen effects. Progesterone alone can be used periodically to induce a period.

For excess hair and acne:

Anti-androgen medications like spironolactone reduce the effect of androgens on hair follicles and sebaceous glands. Combined with a contraceptive (spironolactone requires contraception), this is often very effective for hirsutism and acne.

For insulin resistance and metabolic health:

Metformin (a diabetes medication) is used off-label in PCOS to improve insulin sensitivity. It can also help regulate cycles and support weight management.

For fertility:

Medications to induce ovulation (letrozole, clomiphene) are first-line approaches when conception is the goal.

Getting Diagnosed

If you have irregular cycles, signs of excess androgens, or are having difficulty conceiving, a physician can evaluate for PCOS with a combination of clinical history, a hormone panel, and potentially a pelvic ultrasound.

Ready to talk to a real doctor? Get started with Coral Health today.