Polycystic ovary syndrome, commonly known as PCOS, is the most prevalent hormonal disorder among women of reproductive age, affecting an estimated 8 to 13 percent of women worldwide. Despite being so common, it is frequently misdiagnosed or goes undetected for years. Many women live with symptoms they dismiss as “just how they are,” not realizing that what they are experiencing has a name, an explanation, and treatment options.
Understanding what PCOS looks like can lead to earlier diagnosis and better health outcomes. Here is what every woman should know.
What Is PCOS?
PCOS is a hormonal and metabolic disorder characterized by an imbalance between reproductive hormones. It involves elevated androgens (often called “male hormones,” though they are present in all women), disrupted ovulation, and in many cases, insulin resistance. The name refers to the appearance of small fluid-filled follicles on the ovaries that can be seen on ultrasound, though the absence of these does not rule out the condition.
According to the internationally accepted Rotterdam criteria, a diagnosis of PCOS requires at least two of the following three features: irregular or absent ovulation, clinical or biochemical signs of elevated androgens, and polycystic ovarian appearance on ultrasound or an elevated anti-Mullerian hormone (AMH) level.
Menstrual Irregularities
One of the most recognizable signs of PCOS is an unpredictable menstrual cycle. Periods may come fewer than eight times per year, be spaced more than 35 days apart, or disappear altogether for months at a time. Some women experience the opposite, with heavier than usual bleeding when periods do arrive. Irregular periods in PCOS reflect irregular or absent ovulation, which is central to the condition.
Signs of Elevated Androgens
Many women with PCOS have higher-than-normal levels of androgens such as testosterone. This shows up in visible, often distressing ways:
- Hirsutism: Unwanted hair growth on the face, chin, chest, back, or abdomen
- Acne: Persistent acne, particularly along the jawline, chin, and lower face, that does not respond well to standard skincare
- Scalp hair thinning: Hair loss or thinning on the scalp, similar to male-pattern baldness
These symptoms can be emotionally difficult and are sometimes treated in isolation without addressing the underlying hormonal cause. If you have been struggling with any of these, a hormonal evaluation may be warranted.
Weight Gain and Difficulty Losing Weight
Insulin resistance affects between 50 and 75 percent of women with PCOS. When the body does not use insulin efficiently, it compensates by producing more. Those higher insulin levels then trigger the ovaries to produce even more androgens, worsening the cycle. Insulin resistance also makes it much easier to gain weight and significantly harder to lose it, even with diet and exercise changes. Weight tends to concentrate around the midsection.
Skin Changes
PCOS-related insulin resistance can also cause a skin condition called acanthosis nigricans, which appears as dark, velvety patches of skin, typically in the folds of the neck, armpits, or groin. Skin tags are also more common. These changes are a visible marker of metabolic disruption.
Mood and Mental Health Symptoms
The 2023 International Evidence-Based Guideline for PCOS strongly recommends screening all women with PCOS for anxiety and depression. Studies consistently show significantly elevated rates of both conditions in women with PCOS, and these symptoms are not just a response to dealing with the condition. Hormonal and metabolic imbalances directly affect mood, energy, and emotional resilience.
Fertility Challenges
Because PCOS disrupts regular ovulation, it is the most common cause of ovulatory infertility. Women who are trying to conceive may notice that irregular periods make it difficult to identify a fertile window, or they may have been trying for a year or more without success. The good news is that PCOS-related infertility is highly treatable, and many women with PCOS go on to have healthy pregnancies.
When to Seek Evaluation
You do not need every symptom on this list to have PCOS. The condition presents differently in every woman. If you are experiencing irregular periods alongside any of the above symptoms, or if you have a family history of PCOS or type 2 diabetes, it is worth getting evaluated.
At Ivana MD, we provide comprehensive PCOS evaluations for women throughout Sugar Land, Missouri City, Stafford, Richmond, League City, and the greater Houston and Fort Bend County area. Early diagnosis leads to better management, better long-term health, and greater peace of mind. If any of these symptoms sound familiar, please do not wait to reach out.
