Let’s Start With the Basics
If you’ve been told you might have PCOS — or you’ve been Googling your symptoms late at night — you’re not alone. Polycystic ovary syndrome, or PCOS, is the most common hormonal condition affecting women of reproductive age worldwide. According to international evidence-based guidelines published in 2023, PCOS affects between 10 and 13 percent of women of reproductive age. That means millions of women are navigating irregular periods, frustrating skin changes, and confusing lab results, often without a clear answer for years.
At our gynecology practice serving Missouri City and Sugar Land, Texas, we see patients with PCOS every week. Some come in already suspecting the diagnosis. Others are caught completely off guard. Either way, the first step is understanding what PCOS actually is — because a lot of the information out there is either outdated or just plain wrong.
So, What Exactly Is PCOS?
PCOS stands for polycystic ovary syndrome. Despite the name, you don’t actually need to have cysts on your ovaries to be diagnosed with it. The name comes from an early description of the condition that’s stuck around even as our understanding has evolved significantly.
At its core, PCOS is a hormonal disorder characterized by a combination of three possible features: elevated androgen levels (the hormones often thought of as ‘male’ hormones, though women have them too), irregular or absent ovulation, and either polycystic-appearing ovaries on ultrasound or elevated anti-Müllerian hormone (AMH) levels. According to the 2023 International Evidence-Based Guideline for the Assessment and Management of PCOS — the gold standard used by providers worldwide — a diagnosis requires at least two of these three features, after ruling out other conditions.
The ‘polycystic’ appearance refers to the presence of multiple small follicles on the ovaries, which look like a string of pearls on ultrasound. But here’s the key thing: having this finding alone doesn’t mean you have PCOS. Context matters, and that’s why working with an experienced gynecologist who understands the diagnostic criteria is so important.
Why Does PCOS Happen?
Honestly? We don’t fully understand all the causes yet, and that’s one of the reasons PCOS research is so active right now. What we do know is that PCOS has a strong genetic component — it tends to run in families. If your mother, sister, or aunt has PCOS, your risk is higher.
The hormonal imbalance at the center of PCOS typically involves excess androgens (like testosterone), which interfere with normal ovulation. Many women with PCOS also have some degree of insulin resistance — meaning their cells don’t respond normally to insulin — which leads the pancreas to overproduce insulin. That excess insulin, in turn, can stimulate the ovaries to make even more androgens. It’s a cycle that can be frustrating to manage, but it’s also one that can be meaningfully improved with the right interventions.
It’s important to note that PCOS is not caused by anything you did or didn’t do. You can’t ‘give yourself’ PCOS by eating poorly or being sedentary, though lifestyle factors can definitely affect how severe symptoms become.
What Are the Most Common Symptoms?
PCOS is notoriously variable — two women with the condition can have completely different symptom profiles. That’s one of the reasons it often takes years to diagnose. Common symptoms include irregular or infrequent menstrual periods (fewer than 8 periods per year is a common clinical marker), heavy periods when they do occur, acne (particularly along the jawline and chin), excess facial or body hair (called hirsutism), hair thinning or loss on the scalp, difficulty getting pregnant, unexplained weight gain especially around the abdomen, dark patches of skin in body folds (acanthosis nigricans), and mood changes including anxiety and depression.
Not everyone with PCOS will have all of these. Some women have very regular periods but still have elevated androgens and polycystic ovaries. Others have significant menstrual irregularity as their primary complaint. The presentation really varies, and that’s a big part of why personalized care from a knowledgeable gynecologist matters so much.
Is PCOS Just a Reproductive Problem?
This is one of the most important things to understand about PCOS: it is not just a reproductive condition. The 2023 international guidelines are very clear that PCOS has impacts across the lifespan, including metabolic health, cardiovascular risk, and psychological wellbeing.
Women with PCOS have a higher risk of developing type 2 diabetes, high blood pressure, high cholesterol, and cardiovascular disease. They also have a significantly elevated risk of depression and anxiety — which often goes unaddressed. Endometrial health is another concern; because infrequent ovulation means infrequent periods, the uterine lining can build up over time, increasing the risk of endometrial hyperplasia if not managed.
These long-term considerations are part of why getting diagnosed and working with a healthcare provider isn’t optional. This is about your long-term health, not just your periods.
Why So Many Women Go Undiagnosed
Studies consistently show that women with PCOS experience significant delays in diagnosis — often years. This happens for a few reasons. First, PCOS symptoms overlap with other conditions, and not every provider thinks to consider it. Second, many women are told their irregular periods are ‘just stress’ or ‘normal variation.’ Third, the symptoms (acne, weight changes, mood issues) are sometimes dismissed as lifestyle issues rather than recognized as part of a pattern.
Internationally, women report dissatisfaction with how they’re heard during the diagnostic process. This is something we take seriously at our practice. When a patient comes in with multiple symptoms that could fit PCOS, we investigate thoroughly — including the right hormonal bloodwork and imaging when appropriate.
When Should You See a Gynecologist?
If you’re experiencing irregular periods, significant acne especially in your 20s or 30s, unexplained hair growth or hair loss, or trouble getting pregnant, it’s worth scheduling an evaluation. You don’t need to have every symptom, and you certainly don’t need to feel confident in a diagnosis to make an appointment.
Women in Sugar Land, Missouri City, and the surrounding Fort Bend County area have access to compassionate, evidence-based gynecological care right here in their community. You don’t need to travel to the Texas Medical Center to get a thorough PCOS evaluation. Our team is here to listen, investigate, and work with you on a plan that fits your life.
The Bottom Line
PCOS is common, often underdiagnosed, and genuinely manageable with the right care. Whether you’re struggling with irregular cycles, worrying about your long-term health, or trying to conceive, getting a proper evaluation is the most important first step. Reach out to a gynecologist in Sugar Land or Missouri City today — your health is worth the conversation.
