PCOS symptoms: What are the early signs of PCOS?

Overview: What does PCOS feel/look like?

Polycystic ovary syndrome is one of the most common hormonal disorders among women during their childbearing years. Women with PCOS have too much male hormone in the body, so women may experience excessive hair growth, severe acne, weight gain, and even male-pattern hair loss. Ovulation may not occur, so women with PCOS will notice they have fewer periods than other women. 

The defining characteristic of PCOS is multiple small cysts on the ovaries. These small cysts are follicles, the fluid-filled sacs enclosing an egg that normally develop and release the egg during ovulation each month. In women with excess testosterone, follicles sometimes fail to release an egg, so the follicle remains in the ovary. Over time, the ovaries will contain a dozen or more leftover follicles. They cause no symptoms, so the only way to identify polycystic ovaries is through an ultrasound exam. 

PCOS is also associated with several other medical conditions, including infertility, obesity, glucose intolerance, Type 2 diabetes, obstructive sleep apnea, and fatty liver. According to the Centers for Disease Control and Prevention (CDC), over 50% of women with PCOS will be diagnosed with Type 2 diabetes before they turn 40. While these conditions are not symptoms of PCOS, their symptoms are a significant part of the experience of PCOS.

What are the early signs of PCOS?

The early signs of PCOS can vary; some women may show no symptoms. These early signs include unwanted body hair typical of a man (such as excess facial hair), severe acne, absent or irregular periods, or an inability to conceive.

Other PCOS symptoms

Many PCOS symptoms are caused by excess testosterone. Symptoms include unwanted male characteristics such as:

• Body hair growth typical of a man, such as excess facial hair

• Severe acne

• Male-pattern baldness

• Skin tags

A second common feature of PCOS is a decrease in ovulation, resulting in having fewer periods than normal each year or having no periods at all.

A third common feature involves multiple ovarian cysts. There are no symptoms, so polycystic ovary (PCO) is only discoverable with an ultrasound exam.

PCOS is associated with multiple health problems, including metabolic syndrome, insulin resistance, Type 2 diabetes, depression, anxiety, and a higher risk of heart disease. While these conditions are not symptoms of PCOS, they are diagnostic clues that PCOS may be the underlying cause.

RELATED: Insulin resistance symptoms: what are the early signs of insulin resistance?

PCOS vs. PCO symptoms 

Polycystic ovary syndrome (PCOS) is a hormone disorder involving high levels of androgens (the most common being testosterone). Among the problems it creates are polycystic ovaries; there are 12 or more follicles in what is often an enlarged ovary. However, polycystic ovaries (PCO) are very common. Thirty-two percent of women with normal hormone function have polycystic ovaries that meet the definition of PCOS. For these women, polycystic ovaries are nothing to worry about. They don’t cause symptoms, nor are they associated with other medical conditions. 

When to see a doctor for PCOS symptoms

Not all women with PCOS experience all or even some of the symptoms of PCOS. Many will first seek medical help for a specific reason, such as a missed period, severe acne, or fertility issues. Even if none of these is an issue, women should also see a healthcare professional if they have excess hair growth, menstrual cycle changes, unexplained weight gain, or symptoms of metabolic disorder or diabetes such as weight gain or darkened skin in the armpits. 

Most women with PCOS will be initially diagnosed by their primary care physician, gynecologist, or fertility doctor. A PCOS diagnosis is very tricky. A woman must meet at least two of the following three criteria: excess androgen (testosterone) in the blood, decreased ovulation, and polycystic ovaries. Diagnosis will require a blood test to measure sex hormone levels, particularly free testosterone levels, as well as insulin levels. A physical exam will look for signs of excess testosterone, like thinning hair or unwanted hair growth. The clinician will also perform a pelvic exam. To identify polycystic ovaries, the clinician will use a transvaginal ultrasound. 

Other serious hormonal conditions are similar to PCOS, including thyroid disease, high prolactin levels, and adrenal gland problems. The clinician will run several blood tests to rule out these other conditions before diagnosing PCOS. 

Diagnosis does not end there. Because PCOS is associated with other serious health problems, the clinician may run other tests, including:

• Blood tests and an oral glucose tolerance test (OGTT) to identify glucose intolerance or Type 2 diabetes 

• A blood test to measure hormones during ovulation to identify fertility problems

• A blood test to measure liver function in overweight women to catch fatty liver

• A blood test to measure cholesterol and fat levels

• An ultrasound to look for endometrial cancer

• A symptom screening for obstructive sleep apnea

• A symptom screening for depression

RELATED: What your fertility labs mean

Complications of PCOS

A number of medical conditions and complications are associated with PCOS, including:

• Obesity

• Metabolic syndrome

• Prediabetes

• Type 2 diabetes 

• Problems getting pregnant 

• Infertility

• Gestational diabetes

• High blood pressure

• High cholesterol

• Endometrial cancer

• Non-alcoholic fatty liver

• Sleep apnea

• Depression

• Anxiety

• Increased risk of atherosclerosis, heart disease, heart attack, or stroke

How to treat PCOS symptoms

PCOS is a chronic and even lifelong condition. Treatment is required to prevent complications, but the treatment will depend on whether a woman is trying to get pregnant or not. Some of the symptoms may take several months of treatment to improve. A primary care physician, gynecologist, fertility specialist, or doctor who specializes in the body’s hormone system (endocrinologist) may oversee treatment at various stages.

For women not trying to conceive, the first-line treatment is hormonal birth control, usually a hormone-releasing vaginal ring, but some women may take birth control pills. For women trying to conceive, the first-line treatment will be fertility drugs such as clomiphene or Femara (letrozole).

Lifestyle changes are an important component of treatment, particularly dietary changes and exercise to promote weight loss or control blood sugar levels.

Other treatments include:

• Metformin (to control both PCOS and glucose intolerance)

• Other antidiabetic medications

• Antiandrogens (drugs that block testosterone) such as spironolactone or finasteride to reverse male characteristics

• Topical acne medications 

• Phototherapy for excess hair growth or acne

RELATED: 5 effective PCOS treatments

Living with PCOS

PCOS is a chronic condition, but the symptoms can be controlled and the risk of complications is reduced through treatment. Lifestyle modifications are a major part of treatment, so women can help control symptoms by doing the following:

• Take all medications as instructed

• Keep all appointments with healthcare providers

• Keep a symptom and side effects diary and share this with the care team

• Lose weight and maintain a healthy weight

• Adopt a lower-carbohydrate diet with foods rich in nutrients, lean meat, and high fiber

• Avoid sugary foods

• Avoid processed foods with refined carbohydrates

• Exercise

RELATED: The best diet for PCOS

FAQs about PCOS symptoms

What does a PCOS belly look like?

PCOS increases the testosterone in a woman’s bloodstream. This causes women to develop unwanted male characteristics such as excess facial hair or skin tags. In addition, women with PCOS tend to deposit fat on their bodies like men do, usually on the belly. So PCOS belly looks like a tight round belly, what is normally called a “pot” belly when a man has one.

Is coffee bad for PCOS?

While there is plenty of advice about coffee and PCOS, there’s no definite evidence that it’s bad or good for women with PCOS. Studies have shown that coffee and caffeine may improve symptoms of PCOS (which is good), increase estrogen levels (which may be good), increase stress hormones in the body (which is bad), and may have no effect on fertility (which is neither good nor bad). As with anything, people should drink coffee and caffeine in moderation. Otherwise, ask a healthcare professional for medical advice about drinking coffee while managing PCOS symptoms. 

Does PCOS get worse with age?

The hormone levels of PCOS do not change significantly with age. However, untreated PCOS over time can result in complications such as weight gain, metabolic syndrome, and Type 2 diabetes. These associated conditions often worsen PCOS.

What’s next? Additional resources for people with PCOS symptoms

Test and diagnostics

• Diagnosis and treatment of polycystic ovarian syndrome, American Family Physician

• Polycystic ovarian syndrome, StatPearls

• Polycystic ovary syndrome: commonly asked questions and answers, American Family Physician

Treatments

• 5 effective PCOS treatments, SingleCare

• Diagnosis and treatment of polycystic ovarian syndrome, American Family Physician

• Polycystic ovarian syndrome, StatPearls

Scientific studies and clinical trials

• Pathophysiology of polycystic ovary syndrome revisited: current understanding and perspectives regarding future research, Reproductive Medicine and Biology

• The polycystic ovary post-Rotterdam: a common age-dependent finding in ovulatory women without metabolic significance, The Journal of Clinical Endocrinology & Metabolism

More information on related health conditions

• Depression treatments and medications, SingleCare

• Hypertension treatments and medications, SingleCare

• Insulin resistance symptoms: what are the early signs of insulin resistance?, SingleCare

• Sleep apnea treatments and medications, SingleCare

• Type 2 diabetes treatments and medications, SingleCare