What Is PCOS? Here’s What to Know from a Provider
Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects something like 1 in 10 women – and many don’t even know they have it.
Key facts
PCOS affects an estimated 10–13% of people with ovaries of reproductive age – and many don’t know it. In fact, as many as 70% of women with PCOS do not know they have the condition.
More than half of women with PCOS develop type 2 diabetes by age 40 and the condition can put you at higher risk for heart disease, ovarian cysts, obesity, and infertility.
PCOS is the leading cause of female infertility, but that does not mean you won’t be able to get pregnant if you’re diagnosed with the condition.
Navigating a PCOS diagnosis (or even trying to get one) can feel like being handed a puzzle with a few missing pieces. Many of my patients come to me feeling frustrated by symptoms that seem disconnected – like stubborn weight gain, unexpected hair growth, or unpredictable cycles – and even more exhausted by the search for clear answers.
I put together this guide to help you understand the basics of PCOS, answering questions like what it is, how it’s diagnosed, treatment options, and more. And if after reading, you still have questions, we can work together to find the right path forward for you!
Symptoms and Signs: What to Look For
What is PCOS? Is PCOS a chronic illness?
Polycystic ovary syndrome (PCOS) is a common hormonal disorder in which the ovaries produce abnormally high levels of androgens and throw off your hormonal balance. Androgens (like testosterone, for example) are a type of sex hormone that everyone has – created in either the testicles or the ovaries, as well as the adrenal gland – but people born male tend to produce more of these hormones.
Hormones are chemical messengers in your body that control essential functions like metabolism, growth, reproduction, and more. So when your hormones are dysfunctional, that can have a real affect on your everyday life.
I often remind my patients that the name “polycystic ovary syndrome” is a bit of a misnomer and can be misleading. You don’t actually need “cysts” on your ovaries to be diagnosed with PCOS. When they are present, the "cysts" seen on ultrasounds are actually small, immature follicles that didn't develop fully due to hormone levels. Some researchers have even suggested updating the name to reduce stigma, lessen confusion, and “offer a more accurate representation of the condition’s complex pathophysiology.”
PCOS is considered a chronic metabolic and hormonal condition that can occur any time after puberty. While there is currently no cure, take heart: it is a highly manageable and treatable condition.
What are the symptoms and signs of PCOS? How do I know if I have it?
PCOS can look different from person to person and you don’t need to have every symptom in order to be diagnosed. However, the most common signs include:
Irregular menstrual cycles: Missing periods or having very heavy, unpredictable ones
Facial hair: Excess hair growth on the chin, upper lip, or chest
Hair loss: Thinning hair on the scalp, similar to male-pattern baldness
Acne: Persistent breakouts, often along the jawline, that don't respond to typical treatments
Weight changes: Gaining weight or difficulty losing weight despite diet and exercise
Infertility: Because many people with PCOS do not ovulate regularly, PCOS can make it harder to get pregnant. In fact, it is the most common reason for infertility in women
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Diagnosis and Treatment: What to Know
What causes PCOS?
Like we covered, the symptoms of PCOS result from the imbalance of hormones, particularly excess androgens. But the root cause of PCOS is not known today.
However, researchers are learning more about this condition all the time and there is clear evidence that genetics plays a role. The National Institutes of Health note that, “there are 19 possible changes, or variants, in genes that can increase a person’s risk of developing PCOS. These variants could explain why the features and symptoms of PCOS are so different from one person to the next.”
There is emerging evidence that PCOS could be linked to “geography, diet and nutrition, socioeconomic status, and environmental toxins” as well, but more research needs to be done.
How is PCOS diagnosed?
Typically, providers diagnose PCOS using the Rotterdam criteria – named after the city in the Netherlands where they were established by American and European experts. To be diagnosed, two of three markers should be present:
Irregular or absent periods
Clinical or biochemical signs of high androgens (acne, irregular hair growth, or high testosterone in bloodwork)
Polycystic ovaries visible on an ultrasound
More recently, we are using a blood test called antimüllerian hormone (AMH) alongside the Rotterdam criteria to help make a PCOS diagnosis. An elevated AMH may indicate PCOS and is useful especially if getting an ultrasound is not accessible.
Why is it important to make sure periods are regular?
One reason we want to make sure periods are regular is that if you are going months without a period, the lining of the uterus can build up and create a risk for abnormal cells. This can lead to things like endometrial cancer. It's okay to skip a period if you are using some kind of hormonal birth control (like IUD or the pill) because this helps keep the uterine lining normal!
What are the treatment options for PCOS? What other ways can I manage it?
Managing PCOS is about finding the right "toolkit" that matches your specific symptoms and lifestyle. Typical medication options include:
Metformin: Often used for type 2 diabetes, Metformin is frequently prescribed "off-label" for PCOS to help manage insulin resistance and regulate cycles.
Hormonal birth control: Can help regulate periods and lower androgen levels to clear skin.
Spironolactone: An anti-androgen medication, spironolactone is often used specifically to target PCOS acne and facial hair.
Fertility medications: Medications like letrozole and clomiphene can help induce ovulation if you are struggling with fertility
GLP-1 medications: Drugs like Ozempic or Wegovy are proving to be good options for losing weight, improving insulin resistance, and lowering androgens – though they have not been whitelabeled specifically for PCOS as of today.
Diet and lifestyle changes can also help manage PCOS:
Blood sugar: There is no "perfect" diet, but focusing on blood sugar balance can be key if you’re resistant to insulin. Try to pair carbs with protein, like eating an apple with peanut butter or crackers with cheese to prevent insulin spikes.
High fiber and lean protein: People with PCOS show evidence of all-over inflammation. Prioritize high fiber foods and lean proteins that are anti-inflammatory like leafy greens, berries, and healthy fats like avocado. Try to avoid fried foods, read meat, sugary beverages, and processed foods as well.
The basics: Focus on the wellness basics. In addition to changing how you fuel your body, daily exercise and establishing a consistent sleep schedule in particular can be crucial in managing PCOS symptoms.
What questions should I ask my provider?
You should always feel empowered to ask your provider questions. Your voice matters! Patients who feel respected are more likely to stay engaged with their health and result in better health outcomes. My practice is rooted in patient autonomy: honoring your right to be an active, informed partner in every medical decision we make together.
Here are some examples of questions you could ask your provider at your next visit:
I have a particular symptom that worries me, could it be related to PCOS?
Can I be tested for insulin resistance or hormone imbalances? Could I get an ultrasound performed on my ovaries?
My main goal related to PCOS is [your answer]. What is the best way to achieve that?
What medications could work best for PCOS in my case?
PCOS and pregnancy
It’s true: PCOS is a leading cause of infertility, in large part because many people with PCOS do not ovulate regularly (and you must ovulate in order to become pregnant). Research also shows that “other PCOS-related symptoms — such as insulin resistance, inflammation, and metabolic changes — can also impact reproductive health.”
But to be clear: Having PCOS does not mean you can’t get pregnant. Aside from lifestyle changes that can help increase your chances, there are many fertility options available today: oral medications like letrozole and clomiphene, injectable gonadotropins, in vitro fertilization, and more.
Don’t forget this
Living with PCOS can come with a lot of stigma and scrutiny. Many people with it are criticized for their weight or facial hair or report feeling “less feminine” because of hair loss or infertility.
But I want to assure you: Your worth is not tied to your hormone levels, the number on the scale, or your ability to conceive. The symptoms you experience are not a reflection of your discipline or your gender identity – they are the result of a complex biological hormonal imbalance. You deserve to be treated with dignity and compassion when you see a provider and in your everyday life.
My goal is to help you manage the symptoms so you can feel comfortable in your skin, but please know that you are already worthy of respect and kindness. If you’re looking for someone to walk beside you as you navigate PCOS or another condition, schedule a visit today.
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