Recognizing the Classic Triad of PCOS

The classic triad of polycystic ovarian syndrome (PCOS) refers to a cluster of symptoms that commonly occur with the syndrome. These three symptoms are hirsutism, anovulation, and obesity.

Woman on her bed holding her stomach in pain

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The Classic Triad

The classic triad is not a complete indicator for PCOS. Just because you only have two, one, or none of these symptoms does not mean you don't have PCOS. You can still have a diagnosis of PCOS without these features, but it is helpful for you to know that they may occur. Women with PCOS can experience a wide variety of effects, and here is a closer look at each of the symptoms of the classic triad:


Hirsutism is excessive body hair in places such as the face, neck, chest, back, and toes.This symptom is caused by an excess of male hormones, or androgens, such as testosterone circulating in the bloodstream.

For women, hirsutism can be extremely distressing. Fortunately, there are many hair removal options available today, from over-the-counter products to professional services and prescription medications. Each method has its advantages and disadvantages, and it's important for a woman to determine what works best for her and to speak with her healthcare provider beforehand.


Anovulation is when the body doesn't ovulate or release a mature egg. Ovulation normally occurs around 14 days before the next period.

Anovulation results in irregular periods, missed periods, infertility, and abnormal bleeding. High levels of androgens and changes in luteinizing hormone and insulin levels can contribute to anovulation.

If you are having regular monthly periods, it is most likely that you are ovulating. Your doctor can determine whether you are regularly ovulating by checking tests, including blood work or transvaginal ultrasound.

Anovulation is treated in a few different ways. Managing stress, weight, and getting regular exercise can help reduce symptoms.

Medications prescribed to help treat anovulation include:

If you are not trying to get pregnant, your practitioner will likely prescribe hormonal contraception, such as the pill, which regulates menstrual cycles.

If you want to get pregnant, your healthcare provider may prescribe FSH, hCG, or GnRH. You will also want to work closely with a reproductive endocrinologist to develop the best plan for you.


Extra body weight and PCOS often go hand in hand, however, experts aren't sure which came first: Does PCOS cause weight gain, or does weight gain cause PCOS?

Women with extra body weight are more likely to develop PCOS, and data support some people are genetically predisposed to developing both conditions (there is a genetic link between the two).

  • The close association between obesity and PCOS is supported by epidemiological data, revealing that between 38 percent to 88 percent of women with PCOS are either overweight or obese.
  • A meta-analysis of relevant studies reported in the literature showed that women with obesity had an odds ratio of 2.77 for the development of PCOS compared with their non-obese counterparts.

However, there are many women with PCOS who are not overweight or obese.

Many women with PCOS follow a healthy diet and exercise plan but still have a weight problems. This isn't as simple as too many calories in and not enough out. There is something more complex at work.

Insulin resistance is common among women with PCOS. This is a condition where the body produces extra insulin, but the cells cannot use it properly, resulting in high blood sugar. Insulin resistance can make losing weight difficult. Insulin resistance can occur in people with PCOS who are not overweight, but weight gain can make it worse.

Other hormonal issues common with PCOS may also bring challenges to weight loss.

Studies show losing as little as 5 to 10 percent of your body weight may reduce other PCOS symptoms, including anovulation.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Radiopedia. Polycystic ovarian syndrome.

  2. Heidelbaugh JJ. Endocrinology update: hirsutism. FP Essent. 2016;451:17-24. PMID. 27936531

  3. Osmosis. Anovulatory.

  4. Children's Hospital of Philadelphia. Managing Menstrution with Hormonal Contraceptives.

  5. Barber TM, Franks S. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf). 2021 Oct;95(4):531-541. doi:10.1111/cen.14421

  6. The Centers for Disease Control and Prevention. PCOS (Polycystic Ovary Syndrome) and Diabetes.

  7. UpToDate. Patient education: Polysystic Ovary Syndrome (PCOS) (Beyond the Basics).

By Nicole Galan, RN
Nicole Galan, RN, is a registered nurse and the author of "The Everything Fertility Book."