PCOS Symptoms Checklist: Signs to Know

What are the main symptoms of PCOS?

PCOS manifests differently from person to person. The most common symptoms include:

Menstrual irregularity Fewer than eight periods per year, cycles shorter than 21 or longer than 35 days, or absent periods altogether. This is the symptom that most often brings people to seek care 1Ref 1Teede HJ, Tay CT, Laven JJE, Dokras A, et al. (2023).Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.PCOS symptom spectrum, diagnostic approach, psychological co-morbidities, and the need for comprehensive assessment.

Elevated androgen signs - *Hirsutism* — coarse, dark hair on the face (upper lip, chin, jaw), chest, lower abdomen, or inner thighs - *Acne* — often cystic, located on the jawline, chin, and lower face - *Androgenic alopecia* — thinning hair at the crown of the scalp rather than the hairline

Polycystic-appearing ovaries on ultrasound The ovaries contain many small follicles that did not complete ovulation. This is a finding on imaging, not a symptom you feel.

Weight and metabolic features Central weight gain (abdomen rather than hips and thighs) is common, as is insulin resistance, which may show up as darkened, velvety skin patches in skin folds (acanthosis nigricans).

How is PCOS diagnosed — what are the criteria?

PCOS is diagnosed using the Rotterdam criteria, which require two of the following three features 2Ref 2Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004).Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).Rotterdam criteria: diagnosis requires two of three features — oligo/anovulation, clinical/biochemical hyperandrogenism, polycystic ovaries on ultrasound1Ref 1Teede HJ, Tay CT, Laven JJE, Dokras A, et al. (2023).Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.PCOS symptom spectrum, diagnostic approach, psychological co-morbidities, and the need for comprehensive assessment: 1. Irregular or absent ovulation (shown by irregular periods or blood tests) 2. Clinical or biochemical signs of elevated androgens (visible hirsutism, acne, hair thinning, or elevated testosterone on labs) 3. Polycystic-appearing ovaries on pelvic ultrasound

Importantly, PCOS is a diagnosis of exclusion — your clinician will first rule out other causes of these symptoms, such as thyroid disease, elevated prolactin, congenital adrenal hyperplasia, and other hormonal conditions. This is why bloodwork (LH, FSH, testosterone, DHEA-S, thyroid function, prolactin) is part of the evaluation.

Can I have PCOS without all of these symptoms?

Yes. Because only two of the three Rotterdam criteria are needed, several PCOS phenotypes exist. Some people have irregular periods and polycystic ovaries on ultrasound but no visible androgen signs. Others have androgen signs and irregular periods without polycystic ovaries. A lean person with regular-ish periods can still have PCOS 1Ref 1Teede HJ, Tay CT, Laven JJE, Dokras A, et al. (2023).Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.PCOS symptom spectrum, diagnostic approach, psychological co-morbidities, and the need for comprehensive assessment.

Conversely, having these symptoms does not automatically mean PCOS. Thyroid disorders, for instance, commonly cause irregular periods and fatigue. Acne alone has many other causes. A proper evaluation distinguishes PCOS from other conditions.

Are there symptoms that are often overlooked in PCOS?

Mood and mental health. Depression and anxiety are significantly more common in people with PCOS than in the general population — the 2023 international guideline flags psychological assessment as an essential part of PCOS care 1Ref 1Teede HJ, Tay CT, Laven JJE, Dokras A, et al. (2023).Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.PCOS symptom spectrum, diagnostic approach, psychological co-morbidities, and the need for comprehensive assessment.

Sleep disturbance. Obstructive sleep apnea occurs at higher rates in PCOS, even at normal body weight. Excessive daytime sleepiness, snoring, or unrefreshing sleep are worth mentioning to a clinician.

Fertility concerns. Because PCOS involves irregular or absent ovulation, it is the most common cause of ovulatory infertility. If you are trying to conceive and have irregular cycles, raising this with a gynecologist is an important step.

When should I see a clinician about possible PCOS?

See a gynecologist or endocrinologist if: - Your periods have been irregular (fewer than 9 per year, or consistently shorter than 21 or longer than 35 days) for more than a year after your cycles first established - You have noticed significant new hair growth on the face or body - You are experiencing persistent cystic acne that does not respond to standard skincare - You have been trying to conceive for six months or more with irregular cycles - You have other symptoms that suggest a hormonal imbalance

Clarifying the cause of these symptoms enables targeted treatment and prevents long-term complications. Gale can help you organize your symptom history and prepare for this visit.