What Are the Symptoms of PCOS?

Because PCOS is a syndrome, symptoms vary from person to person and may change over time.  Common patterns include:

• Irregular or absent menstrual cycles (oligo-ovulation or anovulation)

• Difficulty identifying ovulation

• Excess hair growth (hirsutism), often on the face, chest, or inner thighs

• Acne or oily skin

• Thinning hair or male-pattern hair loss

• Changes in weight distribution, often with increased central adiposity

• Difficulty conceiving

• Fatigue, mood changes, and blood sugar instability

Not all individuals experience the same symptoms, and symptom severity does not always reflect underlying hormone disruption.

How Is PCOS Diagnosed?

PCOS is diagnosed clinically, based on a combination of menstrual cycle patterns, hormone levels, and imaging when appropriate.

A diagnosis typically requires two of the following three criteria:

• Irregular or absent menstrual cycles due to oligo- or anovulation

• Elevated androgens (such as testosterone or DHEA), which may present as acne, excess hair growth, or hair thinning

• Polycystic ovarian morphology on ultrasound, reflecting multiple small follicles that have not progressed to ovulation

Diagnosis is individualized and should account for age, clinical presentation, and exclusion of other conditions that can mimic PCOS.

Why Does PCOS Develop?

PCOS is multifactorial and develops due to a combination of hormonal, metabolic, genetic, and environmental influences.  Common contributors include:

• Insulin resistance, which can stimulate excess androgen production and impair ovulation

• Elevated androgens, which interfere with normal follicle maturation

• Chronic low-grade inflammation, which can disrupt hormone signaling.  

• Stress-related hormone changes, including altered cortisol rhythms

• Genetic predisposition, which influences susceptibility

These factors often interact rather than acting in isolation, which is why PCOS can look different from one person to another.  Daily patterns such as nutrition, movement, sleep, and stress physiology can influence how these systems interact. We explore this in more detail in our article on PCOS and lifestyle factors: how daily patterns influence hormone regulation.

Long-Term Health Considerations in PCOS

PCOS can be associated with long-term health considerations, particularly when ovulation is absent for extended periods.  These may include:

• Challenges with ovulation and fertility

• Insulin resistance and Type 2 diabetes

• Cardiometabolic risk factors

• Mood disorders such as anxiety or depression

• Endometrial overgrowth when estrogen is unopposed by regular ovulation

Understanding PCOS as a whole-body condition - not only a reproductive one - allows for more comprehensive and forward-looking care.

Our Restorative Approach to PCOS

Our approach to PCOS centers on restoring ovulatory function and metabolic stability rather than suppressing symptoms.

Care is guided by careful evaluation of:

• Menstrual cycle patterns and ovulatory function

• Metabolic health and insulin regulation

• Thyroid function

• Inflammatory patterns

• Sleep and stress physiology

Because PCOS is heterogeneous, care is individualized and timelines vary.  Our goal is to seek understanding first, then intervene thoughtfully and proportionately.

Ongoing Education in PCOS

We regularly publish educational articles exploring specific aspects of PCOS, including:

• Why PCOS is increasingly diagnosed

• The role of lifestyle patterns in hormonal regulation

• PCOS and inflammation

• PCOS and sleep

• Thyroid health and PCOS

• Restorative fertility care in PCOS

• PCOS across midlife: perimenopause and menopause

These resources are updated as new material becomes available.

Frequently Asked Questions

Can PCOS improve over time?

Hormone patterns can change over time, especially when contributing factors are identified and addressed.

Do I need to be trying to conceive to address PCOS?

No. PCOS care is important for overall health, regardless of pregnancy intentions.

Does birth control treat PCOS?

Hormonal suppression may manage certain symptoms but does not address underlying hormone signaling or restore ovulation.

Is PCOS something I will always have?

PCOS reflects a tendency toward certain hormone patterns.  With appropriate care, many individuals experience meaningful improvement in symptoms and cycle function.