Signs and Symptoms of PCOS

Close-Up Of Young Woman With Hair Loss Against White Background
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Polycystic ovarian syndrome (PCOS) is an endocrine disorder and a common cause of infertility in women. In PCOS, hormonal irregularities can directly affect the reproductive system, leading to irregular or absent ovulation. While the cause of PCOS is unknown, it can affect up to eight percent of women.

PCOS is characterized by the formation of tiny, fluid-filled cysts in the ovaries. During an ultrasound examination, the benign cysts will typically resemble a string of pearls.

PCOS is a complex disorder which can manifest with an array of frustrating and often serious symptoms. Inflammation, insulin resistance, and an increase in male hormones (androgens) all contribute to the characteristic features of the disease.

The five most common signs of PCOS are as follows.


PCOS is the primary cause of ovulatory infertility. As a result, women with PCOS will typically face more difficulty when trying to conceive. It is common for women with PCOS to have absent or irregular periods. In some months, ovulation may not even occur.

Excessive Facial and Body Hair Growth

Hirsutism is the medical term used to describe excessive hair growth. It is caused by the excessive production of androgen (most especially testosterone, the hormone associated with male physical characteristics). Women with PCOS may experience excessive hair growth on the chest, face, back, lower abdomen, fingers, and toes.

Hair loss

Women with PCOS may also experience hair loss, again due to excessive androgen production. It may develop on its own or be accompanied by hirsutism. The hair loss is often similar to that seen in male pattern baldness with a thinning along the hairline and/or the crown of the head. In extreme cases, women with PCOS may experience alopecia, the development of one or more circular bald patches that can merge one into the next.

Insulin Resistance and Type 2 Diabetes

Insulin resistance is common in PCOS, affecting as many as 70 percent of women with the disease. Insulin resistance results in an increase in blood sugar levels. While the condition may have few recognizable symptoms, it is considered a primary risk factor for the development of type 2 diabetes.

Type 2 diabetes can manifest with a spectrum of frustrating and sometimes serious symptoms. These include fatigue, blurred vision, frequent infections, slow-healing sores, frequent urination, and increased hunger and thirst. Long-term disease can lead to complications affecting the heart, kidney, eyes, nerves, and hearing.

Skin Problems

It is not unusual for hormonal imbalances will often affect the skin. With PCOS, women will often experience acne or develop skin tags. In more extreme cases, they may experience a condition called hidradenitis suppurativa (HS) characterized by unsightly and sometimes foul-smelling bumps or boils in the armpit, breast, or groin area.

Another condition known as acanthosis nigricans can manifest with patches of dark, thickened skin on the neck, thighs, or vulva. This is typically a sign of insulin resistance.

Sleep Apnea

Sleep apnea, characterized by snoring and abnormal breathing at night, is also seen in women with PCOS. Sleep apnea appears linked to a combination of increased weight and high levels of testosterone (the latter of which directly affect sleep receptors in the brain). Sleep apnea is also known to contribute to high blood pressure and can cause metabolic changes associated with insulin resistance.

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  • McCartney, C. and Marshall, J. "Polycystic Ovary Syndrome." New England Journal of Medicine. 2016; 375:54-64.