Irregular periods, difficulty getting pregnant, and excessive hair growth (hirsutism) are a few common symptoms of polycystic ovary syndrome (PCOS). PCOS symptoms can also differ in severity and many people have it without knowing. Even though there’s no cure for PCOS, there are many helpful ways to manage your symptoms — from following healthy lifestyle habits to taking medication. 

Polycystic ovaries

Polycystic ovaries are one of the main features of PCOS. This is when your ovaries contain many fluid-filled sacs (follicles) that surround your eggs. These cysts aren’t harmful but can lead to hormonal imbalances — which can affect your menstrual cycle. Despite its name, you don’t actually have cysts, and not everyone with PCOS will have polycystic ovaries. 

You can check for polycystic ovaries by getting an ultrasound — your GP will request one if it’s appropriate. 

Irregular or absent periods

If your ovaries aren’t producing eggs (ovulating) each month, your periods might be irregular or absent. On average, the length of your menstrual cycle lasts around 28 days — though it’s normal for it to be slightly shorter or longer.

Irregular or absent periods don’t always indicate PCOS — they’re often linked to other health conditions, like an underactive thyroid, or can be caused by exercising too much.

If you’re concerned about your periods, you should seek advice from your GP. You should also keep a diary for at least 3 months to track your symptoms — this will help you notice any changes to your cycle. 

High levels of male hormones 

Hyperandrogenism is one of the key features of PCOS. It’s a medical condition characterised by high levels of “male” hormones (androgens) — like androstenedione and testosterone. While they’re called male hormones, they’re essential for female health too. But your androgen levels can become too high if you have PCOS. 

The main causes of hyperandrogenism include:

  • hyperinsulinaemia — raised insulin levels
  • problems with your adrenal glands  
  • hyperprolactinemia — high levels of a hormone called prolactin
  • adrenal hyperplasia — low levels of cortisol and high levels of androgens
  • Cushing’s syndrome

Raised androgen levels can lead to:

  • heavy periods 
  • excess body hair 
  • hair loss on your scalp
  • oily skin and acne

Plus, high testosterone levels can contribute to mood swings or changes in your mental health.

Heavy bleeding 

If you have PCOS, you might experience heavier bleeding during your period. This condition is called menorrhagia and is usually caused by an imbalance of “female” hormones — like oestrogen and progesterone

You might have menorrhagia if during your period you:

  • change your sanitary products every 2 hours or more frequently
  • pass blood clots larger than the size of a 10p coin
  • lose more than 80 ml (half a small cup of water) of blood in less than 7 days 
  • bleed for more than 7 days 
  • bleed through your clothes or bedding
  • use two types of sanitary products together — like tampons and pads

If you’re worried about heavy periods, you should go to your GP for advice or request a gynaecology referral. 

Heavy bleeding doesn’t always indicate PCOS, and most women have a good idea of what is an average amount of blood for them. 

Find out more about the different types of female hormones and their functions.

Excessive hair growth (hirsutism)

Hirsutism is relatively common and affects up to 10% of women. PCOS is one of the most common causes of hirsutism because it raises your male hormone levels (androgens) — like testosterone. Higher levels of androgens stimulate your hair follicles, which is what increases your hair growth. 

Hirsutism typically affects the following areas of your body: 

  • face — like on your upper lip, chin, and neck
  • nipples
  • stomach
  • lower back
  • buttocks 
  • legs

Getting diagnosed with hirsutism usually involves getting a blood test to check your testosterone levels. You can do this through your GP, or by using a finger-prick hormone blood test at home.

Find out more about the causes and treatment of hirsutism.

Female pattern hair loss or thinning hair

Some people with PCOS experience female pattern hair loss (FPHL). This condition usually affects the middle of your scalp and is caused by excess androgen levels.

Hair loss or thin hair from PCOS is usually treated with anti-androgens — taken as oral medication, or applied with a topical treatment like minoxidil to your scalp. It’s usually most effective to use both types of treatment together. If you’re concerned about your hair, you should speak to your GP for advice. 

PCOS doesn’t always cause hair loss and thinning hair — it could be linked to another medical condition, like an overactive thyroid

Find out more about the causes of hormonal imbalances

Weight gain

Some people with PCOS find managing their weight difficult — this can often result from insulin resistance.

Insulin is a hormone that regulates your blood sugar levels. If you’re insulin resistant, your body compensates by producing more insulin. This means your body absorbs too much glucose (sugar) which can result in weight gain — this can make PCOS symptoms worse, as having excess fat causes your body to produce even more insulin.

High insulin levels can also lead to your ovaries producing too much testosterone — this interferes with the normal development of the follicles, preventing ovulation. Insulin resistance and carrying excess weight also increases your risk of type 2 diabetes and heart disease.

Losing weight with PCOS can be more difficult, but there’s a range of things you can do to help you manage your weight

Find out more about how PCOS affects your weight

Oily skin and acne

PCOS often leads to acne as it causes your ovaries and adrenal glands to produce excess androgens, which stimulates oil production. 

Acne typically affects the following areas of your body:

  • face — usually on your jawline, cheeks, and chin
  • neck
  • chest
  • back

If you think you have acne, you should speak to your GP for advice. Depending on the severity of your acne, they might prescribe you oral medication or a topical cream to apply to the affected areas. Usually, a combination of both treatments is the most effective. And in some cases, your GP might refer you to a dermatologist. 

Difficulty getting pregnant 

Some people with PCOS have difficulty with fertility — but most people can still get pregnant. 

The main reason you might have difficulty getting pregnant is because of how PCOS affects ovulation. A hormonal imbalance might prevent the development and release of a mature egg. If this happens, you don’t ovulate and fertilisation can’t happen. 

If a mature egg becomes fertilised, imbalanced hormone levels might also mean the lining of your womb doesn’t build up properly — so a fertilised egg can’t implant.

There’s a range of fertility treatments for PCOS that are very effective, but not everyone with PCOS needs them to get pregnant.

Find out more about how PCOS affects fertility and the treatments available. 

How to get tested for PCOS

PCOS is based on 3 main features — irregular periods, excess androgens, and polycystic ovaries. 

You only need 2 out of 3 symptoms for a PCOS diagnosis, which usually involves:

  • answering questions about your menstrual cycle — it’s a good idea to keep a diary of your symptoms each month
  • a blood test to check your hormone levels — like testosterone
  • an ultrasound scan — to check if your ovaries have a lot of follicles in them

Only two of these are needed for your doctor to make a PCOS diagnosis, so you might not necessarily need an ultrasound scan.

You can request a blood test for PCOS from your GP, or you can order a home PCOS blood test. 

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References

Carmina, E., Azziz, R., Bergfeld, W., Escobar-Morreale, H. F., Futterweit, W., Huddleston, H., … & Olsen, E. (2019). Female pattern hair loss and androgen excess: a report from the multidisciplinary androgen excess and PCOS committee. The Journal of Clinical Endocrinology & Metabolism, 104(7), 2875-2891. 

National Health Service. Heavy Periods. Retrieved 10 May 2021 from https://www.nhs.uk/conditions/heavy-periods/ 

National Health Service. Polycystic ovary syndrome. Retrieved 10 May 2021 from https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/ 

National Health Service. Excessive hair growth (hirsutism). Retrieved 10 May 2021 from https://www.nhs.uk/conditions/hirsutism/ 

Oehler, M. K., & Rees, M. C. P. (2003). Menorrhagia: an update. Acta obstetricia et gynecologica Scandinavica, 82(5), 405-422.

Wallach, E. E., Barbieri, R. L., Smith, S., & Ryan, K. J. (1988). The role of hyperinsulinemia in the pathogenesis of ovarian hyperandrogenism. Fertility and sterility, 50(2), 197-212.

Zandi, S., Farajzadeh, S., & Safari, H. (2010). Prevalence of polycystic ovary syndrome in women with acne: hormone profiles and clinical findings. Journal of Pakistan Association of Dermatologists, 20(4), 194-198.

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Olivia Hunt

Written by Olivia Hunt

11th Jun 2021 • 8 min read