PCOS Symptoms and Treatment: Causes, Diagnosis, Risks & Management

PCOS symptoms and treatment can look different from one person to another. Polycystic ovary syndrome (PCOS) is a hormonal and metabolic condition that can affect menstrual cycles, ovulation, androgen levels, skin and hair, fertility, and aspects of long-term metabolic health.

PCOS does not look the same in every person. Some people mainly experience irregular periods, while others may notice acne, unwanted facial or body hair, scalp hair thinning, difficulty becoming pregnant, or metabolic concerns. Some people have several of these features, while others have relatively few noticeable symptoms.

The World Health Organization estimates that PCOS affects around 10–13% of women of reproductive age worldwide, and up to 70% of affected women may not know they have the condition.

PCOS can be difficult to identify because several other conditions can cause similar symptoms. There is no single blood test that, by itself, confirms PCOS.

This guide explains the commonly recognized symptoms, how PCOS is diagnosed, potential long-term health considerations, and general treatment approaches healthcare professionals may use. It is intended for education and should not be used to diagnose or treat yourself.

Key Takeaways

• PCOS is a complex condition involving reproductive hormones, ovulation, and metabolic health, and its features vary from person to person.
• Common features include irregular or absent periods, clinical or biochemical hyperandrogenism, acne, unwanted hair growth, scalp hair thinning, and difficulty becoming pregnant.
• Having polycystic-appearing ovaries on an ultrasound does not automatically mean someone has PCOS.
• In adults, diagnosis generally involves two of three features: ovulatory dysfunction, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology (PCOM) identified by ultrasound or, when appropriate, anti-Müllerian hormone (AMH), after other causes have been considered and excluded.
• PCOS is associated with several metabolic, reproductive, and psychological health considerations, but not everyone with PCOS develops every possible complication.
• A healthy lifestyle can support overall health regardless of whether weight loss is a goal.
• Treatment depends on symptoms, health concerns, reproductive plans, medical history, and personal preferences.
• Someone trying to conceive may need a different management approach from someone primarily seeking help with menstrual irregularity, acne, unwanted hair, or metabolic concerns.

What Is PCOS?

Polycystic ovary syndrome is a complex endocrine condition that can influence ovulation, reproductive hormones, and metabolic health.

Despite its name, PCOS is not simply a condition in which the ovaries contain cysts.

The term “polycystic” relates to a particular ovarian appearance that may be seen on ultrasound. This is called polycystic ovarian morphology (PCOM). An ultrasound may show an increased number of ovarian follicles and/or increased ovarian volume, depending on the imaging method and diagnostic criteria being used. These are follicles rather than the type of ovarian cysts that the name “polycystic” might suggest.

Importantly, having this ovarian appearance does not automatically mean a person has PCOS. Some people have PCOM without having the syndrome, while some people with PCOS do not have polycystic ovarian morphology.

For adults, the commonly used diagnostic framework considers three main features:

1. Ovulatory dysfunction, often reflected by irregular menstrual cycles.
2. Clinical or biochemical hyperandrogenism, meaning signs of increased androgen activity or elevated androgen levels on testing.
3. Polycystic ovarian morphology (PCOM) identified through ultrasound or, in appropriate adults, AMH as an alternative way of assessing ovarian morphology.

Generally, two of these three features are sufficient for an adult PCOS diagnosis after other possible causes have been considered and excluded. If an adult has both irregular menstrual cycles and clear evidence of hyperandrogenism, an ultrasound or AMH measurement is generally not necessary to establish the diagnosis.

PCOS can affect more than reproductive health. Assessment may also consider metabolic health, psychological wellbeing, quality of life, and reproductive goals.

What Causes PCOS?

There is no single known cause of PCOS. It appears to involve a combination of genetic factors, hormonal regulation, metabolic processes, and other biological influences.

Genetics and Family History

PCOS can occur in families. Having a close relative with PCOS or certain related metabolic or reproductive features may increase the likelihood of developing the condition.

However, family history alone does not determine whether someone will develop PCOS.

Androgen Activity

Androgens are hormones that are present in everyone, although they are generally found at higher levels in males.

Some people with PCOS have increased androgen levels or increased androgen activity. This can contribute to features such as unwanted coarse hair growth, acne, or scalp hair thinning.

Insulin Resistance and Metabolic Factors

Insulin resistance is a common and important feature associated with PCOS, although it is not the sole cause of the condition.

When the body’s cells respond less effectively to insulin, the body may compensate by producing more insulin. Higher insulin levels can interact with ovarian and adrenal hormone production and may contribute to increased androgen activity in some people.

Insulin resistance can occur in people with PCOS across different body sizes.

Weight and PCOS

The relationship between body weight and PCOS is complicated.

Higher body weight can be associated with greater metabolic risk in some people with PCOS, but PCOS is not simply caused by being overweight. People in smaller bodies can also have PCOS and experience metabolic or reproductive concerns.

For this reason, PCOS management should not automatically focus on weight loss. A broader approach can consider nutrition, physical activity, sleep, metabolic health, symptoms, quality of life, and the person’s individual goals.

Common Symptoms of PCOS

PCOS symptoms can vary considerably. Having one symptom does not necessarily mean that someone has PCOS.

1. Irregular Periods

Menstrual irregularity is one of the most common features associated with PCOS.

Periods may be:

• Less frequent than expected
• Separated by unusually long cycles
• Absent for periods of time
• Unpredictable
• Sometimes accompanied by changes in bleeding patterns

For adults who are more than three years beyond their first menstrual period, cycles occurring less often than every 21 days, more than 35 days apart, or fewer than eight times per year can indicate irregular cycles that warrant assessment.

Menstrual irregularity can have many possible causes, so it does not automatically indicate PCOS.

2. Signs of Increased Androgen Activity

Increased androgen activity can contribute to:

• Coarser or darker facial or body hair
• Acne
• Oily skin
• Scalp hair thinning

Not everyone with PCOS develops all of these features.

3. Unwanted Hair Growth

Hirsutism refers to excessive terminal hair growth in areas where hair growth is more typically influenced by androgens.

It may occur on areas such as:

• Chin
• Upper lip
• Chest
• Abdomen
• Back

The amount and distribution of body hair vary naturally between individuals and populations, so healthcare professionals consider the overall clinical picture rather than relying on hair growth alone.

4. Acne

Acne can occur with PCOS, particularly when androgen activity is increased.

However, acne by itself is not enough to diagnose PCOS, because acne is common for many reasons.

Persistent or severe acne combined with menstrual changes or other androgen-related features may be worth discussing with a healthcare professional.

5. Scalp Hair Thinning

Some people with PCOS experience scalp hair thinning related to androgen activity.

However, hair loss can also have many other causes, including nutritional issues, thyroid disorders, stress, medications, and other hormonal or dermatological conditions.

6. Difficulty Becoming Pregnant

PCOS can affect ovulation, which may make pregnancy more difficult for some people.

However, having PCOS does not mean that pregnancy is impossible.

Some people with PCOS become pregnant without fertility treatment, while others may need help to identify and manage ovulation problems or other fertility factors.

7. Metabolic Health Features

PCOS can be associated with metabolic concerns such as:

• Insulin resistance
• Abnormal glucose regulation
• Changes in cholesterol or triglyceride levels
• Higher blood pressure
• Weight changes

These are health considerations rather than symptoms that everyone with PCOS will experience.

Acanthosis Nigricans and PCOS

Acanthosis nigricans is a skin change that can cause darker, thicker, or velvety-looking skin, particularly in body folds such as the neck, armpits, or groin.

It can be associated with insulin resistance and may occur in people with PCOS.

However, acanthosis nigricans does not automatically mean that someone has PCOS or insulin resistance. Other conditions can also cause this skin change.

How Is PCOS Diagnosed?

There is no single test that confirms PCOS.

Healthcare professionals usually consider a combination of menstrual history, symptoms, physical findings, laboratory results, and, when appropriate, ovarian imaging.

The purpose of the evaluation is not only to identify features associated with PCOS but also to consider other conditions that can produce similar symptoms.

Medical History

A clinician may ask about:

• Age when periods began
• Menstrual cycle frequency and pattern
• Acne
• Facial or body hair growth
• Scalp hair changes
• Changes in body weight
• Pregnancy and fertility history
• Current medications and supplements
• Family history
• Other medical conditions
• Relevant symptoms

Tracking menstrual cycles before an appointment can provide useful information.

Physical Examination

Depending on the situation, an examination may include:

• Blood pressure
• Weight and other body measurements
• Skin examination
• Acne assessment
• Assessment of facial or body hair
• Scalp examination

The exact assessment depends on the person’s symptoms and medical history.

Blood Tests

Blood tests may be used to assess androgen levels and investigate other possible explanations for symptoms.

Depending on the situation, healthcare professionals may also assess:

• Glucose regulation
• Cholesterol and triglycerides
• Thyroid function
• Prolactin
• Other hormones or tests when clinically appropriate

Routine insulin resistance testing using clinically available insulin assays is not recommended as a stand-alone diagnostic test for PCOS.

Ultrasound and Polycystic Ovarian Morphology

A pelvic ultrasound may be used to evaluate the ovaries and uterus.

When ovarian morphology is relevant to the diagnosis, clinicians may look for features consistent with polycystic ovarian morphology (PCOM), such as an increased follicle number and/or ovarian volume, depending on the ultrasound technique and criteria used.

PCOM is an ovarian imaging feature, not a diagnosis of PCOS by itself.

This distinction is important because some people have PCOM without having PCOS. Conversely, a person can meet the diagnostic criteria for PCOS without having PCOM.

Ultrasound is therefore interpreted alongside menstrual history, signs of androgen excess, laboratory findings, and other clinical information rather than being used in isolation.

Anti-Müllerian Hormone (AMH)

In appropriate adults, AMH can be used as an alternative to ultrasound for identifying polycystic ovarian morphology.

However, AMH should not be used as a stand-alone test to diagnose PCOS. Its interpretation depends on factors such as age and the person’s overall clinical picture.

If an adult already has both irregular ovulation or menstrual cycles and hyperandrogenism, additional testing with ultrasound or AMH is generally not needed simply to establish PCOS.

The Diagnostic Framework

For adults, the commonly used diagnostic framework considers:

• Ovulatory dysfunction
• Clinical or biochemical hyperandrogenism
• Polycystic ovarian morphology

Generally, two of these three features are required after other potential causes have been excluded.

This means that an ultrasound showing PCOM alone does not establish PCOS.

PCOS Diagnosis in Adolescents

Diagnosing PCOS during adolescence requires additional caution because irregular menstrual cycles, acne, and other hormonal changes can be part of normal pubertal development.

The diagnostic approach for adolescents is therefore different from the adult approach.

Current international guidance does not recommend using ovarian ultrasound or AMH to diagnose PCOS in adolescents because these findings have limited specificity during this stage of development.

Healthcare professionals instead consider age-appropriate menstrual patterns and evidence of hyperandrogenism while carefully evaluating other possible causes.

Conditions That Can Resemble PCOS

Several conditions can produce symptoms similar to PCOS.

Depending on the individual situation, healthcare professionals may consider:

• Thyroid disorders
• Elevated prolactin
• Pregnancy
• Certain medications
• Adrenal conditions
• Other endocrine or hormonal disorders

Unusual, severe, or rapidly developing androgen-related symptoms may require more detailed investigation.

The exact evaluation depends on the person’s symptoms, medical history, physical examination, and test results.

Possible Long-Term Health Considerations

PCOS is associated with several longer-term health considerations, but these are associations rather than guarantees.

Having PCOS does not mean that someone will develop every condition listed below.

Blood Sugar and Type 2 Diabetes Risk

People with PCOS have a higher risk of abnormal glucose regulation and type 2 diabetes compared with people without PCOS.

Risk can vary depending on factors such as family history, age, body composition, and other metabolic characteristics.

Healthcare professionals may recommend periodic assessment of glucose regulation based on individual risk.

Blood Pressure and Cardiometabolic Health

PCOS can be associated with:

• Higher blood pressure
• Abnormal cholesterol levels
• Insulin resistance
• Other cardiometabolic risk factors

This does not mean that PCOS directly causes heart disease in every person.

Instead, it means that cardiovascular and metabolic risk factors can be important parts of long-term health assessment.

Sleep Apnea

Obstructive sleep apnea appears to be more common among people with PCOS, including independently of body mass index in some research.

Possible symptoms include:

• Loud or persistent snoring
• Waking during the night
• Unrefreshing sleep
• Excessive daytime sleepiness
• Morning headaches

Persistent symptoms should be discussed with a healthcare professional.

Endometrial Health

When ovulation occurs infrequently, the uterine lining may be exposed to estrogen without the regular progesterone pattern that accompanies ovulation.

Prolonged menstrual irregularity can increase the risk of endometrial hyperplasia and is associated with a higher risk of endometrial cancer.

This does not mean that most people with PCOS will develop endometrial cancer. The overall likelihood for an individual remains low, but persistent menstrual irregularity is an important issue to discuss with a healthcare professional.

Psychological Wellbeing

PCOS can also affect psychological wellbeing and quality of life.

Some people experience:

• Anxiety
• Depression
• Body image concerns
• Distress related to acne or unwanted hair
• Fertility-related stress
• Frustration related to delayed or difficult diagnosis

These concerns are legitimate parts of PCOS care and should not be treated as secondary to physical symptoms.

How Is PCOS Treated?

There is no single treatment that is appropriate for everyone with PCOS.

Management depends on:

• Main symptoms
• Metabolic health
• Reproductive goals
• Whether pregnancy is desired
• Other health conditions
• Current medications
• Potential treatment risks
• Personal preferences

The goal is usually to address the person’s specific concerns rather than treat PCOS as though everyone experiences it in the same way.

Lifestyle and Daily Habits

Lifestyle management can be an important part of PCOS care.

Nutrition

There is no single “PCOS diet” that is universally best for everyone.

A balanced eating pattern can include:

• Vegetables
• Fruits
• Whole grains
• Beans and lentils
• Nuts and seeds
• Protein-rich foods
• Unsaturated fats
• Minimally processed foods

There is generally no need to completely eliminate carbohydrates.

Instead, meals can be structured around a variety of nutrient-dense foods and appropriate portions that fit the person’s preferences and needs.

No individual food should be presented as a cure for PCOS.

Physical Activity

Regular physical activity can support general metabolic and cardiovascular health.

A combination of aerobic activity and resistance exercise can be useful.

Examples include:

• Walking
• Cycling
• Swimming
• Dancing
• Bodyweight exercises
• Resistance-band exercises
• Free-weight training
• Gym-based resistance exercises

The most useful activity plan is one that is realistic enough to maintain consistently.

For a broader discussion of resistance and gym exercise for women, see:

Benefits of Gym Workouts for Women: Strength, Health & Confidence

Weight Management

If weight management is an individual goal, gradual and sustainable changes may be more useful than extreme dieting.

However, weight loss should not automatically be treated as the primary goal for every person with PCOS.

People with PCOS can benefit from improvements in fitness, metabolic health, nutrition, sleep, and overall wellbeing even when body weight changes little.

A person’s care should also avoid weight stigma and recognize individual differences.

Medical Treatments

Medical treatment depends on the person’s symptoms, reproductive goals, medical history, and potential risks.

Managing Irregular Periods

Healthcare professionals may recommend hormonal treatment to help manage menstrual irregularity and reduce concerns associated with prolonged periods without ovulation.

Combined oral contraceptive pills may be appropriate for some people who do not want to become pregnant and have no contraindications.

Other approaches may be considered depending on the person’s circumstances.

Managing Acne and Excess Hair

Hormonal contraceptives and other treatments may be considered for acne or unwanted hair growth when appropriate.

Treatment choices depend on pregnancy plans, medical conditions, potential risks, and individual preferences.

Persistent or significant symptoms should be evaluated rather than self-treated based solely on a suspected PCOS diagnosis.

Metformin

Metformin can improve insulin sensitivity and may be used for some people with PCOS, particularly when metabolic concerns are present.

It is not a universal treatment for everyone with PCOS.

A healthcare professional should determine whether it is appropriate based on the person’s overall health and treatment goals.

Fertility Treatment

When PCOS affects ovulation and pregnancy is desired, treatment may focus on helping achieve regular ovulation.

For many women with PCOS-related anovulatory infertility who have no other infertility factors, current international guidance identifies letrozole as the preferred first-line pharmacological treatment for ovulation induction.

Other fertility treatments may be considered when appropriate.

Because fertility treatment depends on individual circumstances, medication should not be started based solely on information in an online article.

PCOS and Pregnancy

Having PCOS can make ovulation less predictable, but it does not mean that pregnancy is impossible.

Some people with PCOS become pregnant naturally, while others need fertility support.

If pregnancy is being planned, it can be useful to discuss:

• Menstrual and ovulation patterns
• Existing medical conditions
• Blood pressure
• Metabolic health
• Current medications
• Overall preconception health

People who have been trying to conceive without success should discuss their situation with an appropriate healthcare professional rather than assuming PCOS is the only possible cause of infertility.

What to Do If You Suspect You Have PCOS

If you think you may have PCOS, arranging a healthcare evaluation is more useful than trying to diagnose yourself from a list of symptoms.

Before an appointment, you may find it helpful to track:

• Period dates and cycle length
• Changes in acne
• Facial or body hair growth
• Scalp hair changes
• Relevant weight changes
• Current medications and supplements
• Pregnancy or fertility concerns
• Other unusual symptoms

A qualified healthcare professional can then assess the overall pattern and determine whether PCOS or another condition may explain the symptoms.

When Should You Seek Medical Advice?

Consider speaking with a healthcare professional if you experience:

• Persistent irregular periods
• Unexpected absence of periods
• New or significant unwanted hair growth
• Persistent acne together with menstrual or other hormonal changes
• Unexplained scalp hair thinning
• Difficulty becoming pregnant
• Concerns about blood sugar, blood pressure, or cholesterol
• Concerning or unusual menstrual bleeding

Not every menstrual or hormonal change is caused by PCOS.

Urgent medical assessment may be appropriate for symptoms such as unusually heavy bleeding, severe pelvic pain, fainting, or symptoms associated with a possible pregnancy.

Frequently Asked Questions About PCOS

Can irregular periods alone mean I have PCOS?

Not necessarily. Irregular periods can occur for many reasons. PCOS is diagnosed using a broader clinical assessment and by considering other possible causes.

Does having polycystic ovaries mean I have PCOS?

No. Polycystic ovarian morphology is an imaging finding and does not automatically mean that someone has PCOS.

Can I have PCOS without polycystic ovaries?

Yes. A person can meet the diagnostic criteria for PCOS without having polycystic ovarian morphology.

Can thin people have PCOS?

Yes. PCOS can occur in people across different body sizes.

Does PCOS mean I cannot get pregnant?

No. PCOS can affect ovulation, but many people with PCOS become pregnant naturally or with appropriate fertility support.

Is there a permanent cure for PCOS?

There is no single permanent cure that applies to everyone. Management focuses on symptoms, health risks, reproductive goals, and quality of life.

Do I have to lose weight if I have PCOS?

Not necessarily. Weight loss should not automatically be the goal for everyone with PCOS. Healthcare can instead focus on the individual’s metabolic health, physical activity, nutrition, symptoms, and personal goals.

Is there one best diet for PCOS?

No. There is no universally best PCOS diet. A balanced and sustainable eating pattern is generally more practical than restrictive approaches.

Is exercise helpful for PCOS?

Regular physical activity can support general health and metabolic wellbeing. Both aerobic and resistance exercise can be incorporated according to ability and preference.

Does PCOS last forever?

PCOS is considered a long-term condition, but symptoms and health needs can change over time. Management can therefore change as a person’s circumstances and goals change.

Which doctor treats PCOS?

Depending on the situation, PCOS may be evaluated or managed by a primary care clinician, gynecologist, endocrinologist, or reproductive endocrinology and fertility specialist.

Conclusion

PCOS is a complex condition that can affect menstrual cycles, ovulation, androgen-related features, metabolic health, fertility, and psychological wellbeing.

Because its presentation varies, having one possible feature does not automatically mean that someone has PCOS. Diagnosis requires an appropriate clinical assessment and, when necessary, testing to consider other possible causes.

Management can then focus on the concerns that matter to the individual, whether those involve menstrual irregularity, androgen-related symptoms, metabolic health, fertility, or quality of life.

PCOS should not be reduced to a weight problem or a fertility problem. With appropriate healthcare and a management approach suited to the individual, many people with PCOS can address their symptoms and long-term health needs.

Medical Disclaimer

This article is intended for general educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. PCOS can present differently from person to person, and symptoms that resemble PCOS may have other causes. If you have persistent, severe, or concerning symptoms, speak with a qualified healthcare professional for an appropriate evaluation.

References

1. World Health Organization (WHO). Polycystic ovary syndrome (PCOS).
   World Health Organization — Polycystic Ovary Syndrome
2. Teede HJ, Tay CT, Laven JJE, et al., on behalf of the International PCOS Network. Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology & Metabolism. 2023;108(10):2447–2469.
   2023 International Evidence-Based PCOS Guideline — Journal of Clinical Endocrinology & Metabolism
3. American Society for Reproductive Medicine (ASRM). Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.
   ASRM — 2023 International PCOS Guideline Recommendations
4. Monash Centre for Health Research and Implementation. International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. International PCOS Network.
   Monash University — International PCOS Guideline 2023

Written By: ZAHEER ABBAS