What Are the First Signs of PCOS?

Missed periods, infertility, weight gain and acne are all signs of polycystic ovarian syndrome resulting from hormone imbalance in women.

Polycystic ovarian syndrome (PCOS) is a condition caused by an imbalance of reproductive hormones that results in problems in the ovaries. Monthly ovulation does not occur and levels of male hormones (androgens) in women are elevated. 

PCOS is a common cause of infertility and cysts in the ovaries.

Some of the first signs a woman may notice that could indicate she may have polycystic ovarian syndrome (PCOS) include: 

• Missed menstrual periods/irregular periods
• Difficulty conceiving
• Weight gain
• Acne or oily skin

Symptoms of polycystic ovarian syndrome (PCOS) usually start around puberty, but some women may not develop symptoms until late adolescence or early adulthood, and can include:

• Irregular menstrual cycle
• Missed periods 
• Less frequent periods (fewer than eight periods in a year)
• No menstrual periods
• Heavy or prolonged periods
• Unpredictable periods
• Weight gain, obesity, or difficulty losing weight
  • Up to 80% of women with PCOS are obese
• Excess hair growth (hirsutism)
  • Affects up to 70% of women with PCOS
  • Occurs on the face, chin, neck, sideburn area, chest, abdomen, upper arm, inner thighs, or other parts of the body where men usually grow hair
• Thinning hair or hair loss on the scalp; male-pattern baldness
• Severe acne or acne that does not respond to usual treatments
• Oily skin
• Darkening of skin (acanthosis nigricans)
  • Especially along neck creases, in the groin, and underneath breasts
• Skin tags
• Multiple small fluid-filled sacs in the ovaries
• Infertility 
• Increased risk of heart disease and heart attack
• Sleep apnea
• Breathing stops (apnea) during sleep
  • May occur in up to 50% of women with PCOS
  • May result in fatigue and daytime sleepiness
  • Untreated sleep apnea can increase the risk of insulin resistance, obesity, diabetes, and cardiovascular problems, such as high blood pressure, heart attack, abnormal heart rhythms, or stroke
• Depression 
• Anxiety 
• Sexual dysfunction 
• Eating disorders, including bulimia and binge eating

The cause of polycystic ovarian syndrome (PCOS) is unknown but it is believed that several factors may play a role, such as:

• Insulin abnormalities
  • Insulin resistance
  • Hyperinsulinemia
  • Glucose intolerance (also called “prediabetes”)
  • Type 2 diabetes
• Reproductive system abnormalities
  • Abnormal levels of the pituitary hormone luteinizing hormone (LH) 
  • High levels of male hormones (androgens) 
• Irregular menstrual cycle

Polycystic ovarian syndrome (PCOS) is diagnosed with a patient history and physical examination and tests such as:

• Body mass index (BMI) measurement and waist size
• Pelvic exam
• Pelvic ultrasound (sonogram)
• Blood tests
  • Androgen hormone levels
  • Cholesterol levels 
  • Blood glucose 
  • Pregnancy
  • Prolactin level
  • Thyroid-stimulating hormone (TSH)
  • Follicle-stimulating hormone (FSH) 
• Sleep studies for sleep apnea screening

Once other conditions are ruled out, a diagnosis of PCOS may be made when at least two of the following symptoms occur: 

• Irregular periods
• Signs of high levels of androgens such as:
  • Excess male-pattern hair growth (hirsutism)
  • Acne
  • Thinning of scalp hair
• High blood levels of androgens
• Multiple cysts on one or both ovaries

There is no cure for polycystic ovarian syndrome (PCOS), and treatment is aimed at managing symptoms. Many women will need a combination of treatments, including:

• Hormonal birth control, including the pill, patch, shot, vaginal ring, and hormone intrauterine device (IUD)
  • Helps make the menstrual cycle more regular
  • Lowers the risk of endometrial cancer
  • Can improve acne and reduce excess hair growth
• Anti-androgen medications such as spironolactone 
  • Can help with excess hair growth, acne, and scalp hair loss
  • Not approved by the Food and Drug Administration (FDA) to treat PCOS
  • May cause problems during pregnancy
• Metformin (Glucophage)
  • Can help lower insulin and androgen levels
  • Not approved by the Food and Drug Administration (FDA) to treat PCOS
• Prescription skin treatments or oral antibiotics for acne
  • Eflornithine HCl cream to slow hair growth in unwanted places
• Infertility medications
  • Clomiphene
  • Letrozole: usually used to treat breast cancer but can be effective in women with PCOS who want to conceive
  • Gonadotropin therapy (follicle-stimulating hormone [FSH] injections)

Treatments women can do on their own to help PCOS symptoms include: 

• Weight loss
  • One of the most effective approaches for managing insulin abnormalities, irregular menstrual periods, infertility, and other symptoms of PCOS
• Regular exercise
• Hair removal treatments
  • Creams/depilatories
  • Laser hair removal
  • Electrolysis
  • Hair replacement and wigs for scalp hair loss

Complications of polycystic ovarian syndrome (PCOS) include: 

• Increased risk of heart disease and heart attack
• Sleep apnea
  • Untreated sleep apnea can increase the risk of insulin resistance, obesity, diabetes, and cardiovascular problems, such as high blood pressure, heart attack, abnormal heart rhythms, or stroke
• Irregular or absent menstrual periods can increase a woman's risk of endometrial overgrowth (called endometrial hyperplasia) or endometrial cancer
• Depression 
• Anxiety 
• Sexual dysfunction 
• Eating disorders, including bulimia and binge eating
• Problems during pregnancy 
  • Miscarriage
  • Gestational diabetes
  • Preeclampsia
  • Cesarean section (C-section)
  • Higher risk of having a heavy baby (macrosomia) and of the baby spending more time in a neonatal intensive care unit (NICU)