What are the symptoms of PCOS?

Because the characteristic features of PCOS—absence of ovulation, indicated by irregular menstrual periods or no periods at all; high androgen levels; and growths in one or both ovaries, often clumps of ovarian follicles that have stopped developing—are wide ranging, so, too, are the symptoms of the condition.

Often, people and health care providers may not suspect PCOS because the symptoms may seem unrelated. These can include:1,2

  • Menstrual irregularities:
    • No menstrual periods—called amenorrhea
    • Skipped periods—called oligomenorrhea
    • Very heavy periods
    • Bleeding but no ovulation—called anovulatory periods
  • Infertility
  • Increased hair growth on the face, chest, belly, or upper thighs—a condition called hirsutism
  • Severe, late-onset, or persistent acne that does not respond well to common treatments
  • Insulin sensitivity
  • Obesity, weight gain, or trouble losing weight, especially around the waist
  • Oily skin
  • Patches of thickened, dark, velvety skin—a condition called acanthosis nigricans

For many adolescents, these symptoms may also be part of puberty, especially early in the process. A health care provider may consider PCOS treatments for severe symptoms even without a diagnosis of PCOS.3

Because many people don't consider oily skin, increased hair growth, or acne to be symptoms of a serious health condition, they may not mention these things to their health care providers. As a result, many people aren't diagnosed with PCOS until they have trouble getting pregnant, or until they have menstrual irregularities.

Although PCOS is a leading cause of infertility, many people of reproductive age with PCOS can and do get pregnant. Pregnant people who have PCOS, however, are at higher risk for certain problems, such as miscarriage. Learn more about PCOS-related pregnancy problems.

People with PCOS are also at higher risk for the following health issues:

  • Cardiovascular disease
  • Depression, anxiety, and other mental health issues
  • Endometrial hyperplasia external link, a condition in which the lining of the uterus becomes too thick, and endometrial cancer, also called uterine cancer
  • Insulin resistance, when the body doesn’t use insulin well
    • Too much glucose and insulin in the blood can contribute to metabolic syndrome and type 2 diabetes.
    • More than one-half of people with PCOS have insulin resistance.6
    • Patches of thickened, dark, velvety skin, called acanthosis nigricans, are associated with insulin resistance.
  • Metabolic syndrome, a group of risk factors for heart disease and type 2 diabetes
    • About 25% to 45% of people with PCOS have metabolic syndrome.7
  • Obesity
    • Obesity is a risk factor for many health problems, including diabetes, heart disease, high blood pressure, and sleep apnea.
    • About 4 out of 5 people with PCOS also have obesity.5
  • Obstructive sleep apnea, a disorder that causes pauses in breathing during sleep
    • Sleep apnea increases the risk of high blood pressure, heart attack, and diabetes.8
    • People with PCOS are at much higher risk for obstructive sleep apnea than others, including those without PCOS and those with obesity.9
  • Type 2 diabetes
    • If not managed, diabetes can damage the kidneys and can lead to blindness, nerve damage, and foot problems.10 Type 2 diabetes also increases the risk for heart disease and high blood pressure.
    • More than one-half of people with PCOS will have either type 2 diabetes or prediabetes before their early 40s.11

Just because a person is diagnosed with PCOS does not mean they will experience all these issues. However, they and their health care providers may want to monitor their health for signs of these issues as part of their regular care.

Citations

  1. American College of Obstetricians and Gynecologists. (2022) FAQs: Polycystic ovary syndrome (PCOS). Retrieved July 26, 2024, from https://www.acog.org/en/womens-health/faqs/polycystic-ovary-syndrome-pcos external link  
  2. Office on Women’s Health. Polycystic ovary syndrome. Retrieved July 26, 2024, from https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
  3. ACOG Committee on Adolescent Health Care. (2019; Reaffirmed 2024). Committee Opinion No. 789. Screening and management of the hyperandrogenic adolescent. Retrieved July 26, 2024, from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/screening-and-management-of-the-hyperandrogenic-adolescent external link
  4. National Heart, Lung, and Blood Institute (NHLBI). The Heart Truth®. Retrieved July 26, 2024, from https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-truth
  5. ACOG. (2018). Practice Bulletin No. 194: Polycystic ovary syndrome. Retrieved July 26, 2024, from https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/06/polycystic-ovary-syndrome external link
  6. Goodarzi, M. O., Dumesic, D. A., Chazenbalk, G., & Azziz, R. (2011). Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nature Reviews: Endocrinology, 7(4), 219–231. PMID: 21263450
  7. Ehrmann D. A. (2005). Polycystic ovary syndrome. The New England Journal of Medicine, 352(12), 1223–1236. PMID: 15788499
  8. NHLBI. (2022). What is sleep apnea? Retrieved July 26, 2024, from https://www.nhlbi.nih.gov/health/sleep-apnea
  9. Fogel, R. B., Malhotra, A., Pillar, G., Pittman, S. D., Dunaif, A., & White, D. P. (2001). Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome. The Journal of Clinical Endocrinology and Metabolism, 86(3), 1175–1180. PMID: 11238505
  10. National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Preventing diabetes problems. Retrieved July 26, 2024, from https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems
  11. Lorenz, L. B., & Wild, R. A. (2007). Polycystic ovarian syndrome: An evidence-based approach to evaluation and management of diabetes and cardiovascular risks for today's clinician. Clinical Obstetrics and Gynecology, 50(1), 226–243. PMID: 17304038
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