Understanding PCOS

Written By Izzy Asuncion

Polycystic Ovary Syndrome (PCOS) is a condition that affects about 1 in 10 menstruators of reproductive age, yet many still don’t know exactly what it is or how it impacts their health. 

This past summer, I noticed that my period had become more irregular, and I began to feel a shift in my overall health. At first, I didn’t think much of it. Given my family’s health history—both sides have a history of diabetes, high blood pressure, heart disease, and more—it didn’t seem too unusual.

However, things didn’t really click until my best friend, who had recently been diagnosed with PCOS, told me I should get checked out. He noticed that the symptoms I was experiencing lined up with his own. That’s when I learned that many of the health issues I’ve been dealing with could be connected to PCOS.

I’ve since been diagnosed with PCOS, and honestly, it wasn’t something I ever expected to hear. But now that it’s happened to me, I want to share this with you. If you’ve been diagnosed with PCOS—or suspect you might have it—understanding the condition can feel overwhelming. But don’t worry, you’re not alone. There are ways to manage the symptoms and reduce the long-term risks.

PCOS is a complex hormonal disorder that can affect everything from your menstrual cycle to your fertility, skin, weight, and more. In this guide, we’ll walk through the basics of what PCOS is, what it looks like in real life, how it’s diagnosed, and most importantly, how you can manage it and feel better.

What is PCOS?

At its core, “Polycystic Ovary Syndrome”  is a hormonal imbalance that affects how your ovaries function. The name “polycystic” means “many cysts,” but not all menstruators with PCOS have cysts, and not all menstruators with cysts have PCOS. So, if your ultrasound shows cysts, that doesn’t automatically mean you have PCOS. The condition is more about the imbalance of certain hormones, such as “insulin” and “androgens” (the so-called “male hormones” that menstruators also produce in smaller amounts).

While PCOS can look different for everyone, it typically involves three main things:

1. Irregular or absent periods – Hormonal imbalances often interfere with regular ovulation, causing unpredictable or even absent periods.

2. Excessive androgen levels – High levels of testosterone and other androgens can cause physical symptoms like unwanted facial hair, acne, and thinning hair on the scalp.

3. Polycystic ovaries – Your ovaries may develop multiple small cysts (fluid-filled sacs), but not all menstruators with PCOS show this on an ultrasound.

What Causes PCOS?

There isn’t a single clear cause of PCOS, but it seems to be a combination of genetics and environmental factors. If your mother or sister has PCOS, there’s a higher chance you might develop it, too.

The main underlying causes of PCOS include:

- Insulin resistance Many menstruators with PCOS have difficulty processing insulin, a hormone that helps your body use sugar. When insulin levels are high, it can trigger the ovaries to produce more testosterone, leading to many of the symptoms we associate with PCOS.

- Hormonal imbalance: Elevated levels of luteinizing hormone (LH and testosterone along with a lower level of follicle-stimulating hormone (FSH can prevent your ovaries from releasing eggs (ovulation). This can lead to irregular or missed periods and difficulty getting pregnant.

- Genetics As with many health conditions, your family history plays a role. If PCOS runs in your family, you may be more likely to develop it.

Common Symptoms of PCOS

PCOS affects each person differently, and you may experience one or several of these symptoms. The most common ones include:

Irregular periods Maybe your periods are few and far between, or maybe they’re super heavy. Either way, irregular or absent periods are one of the hallmark signs of PCOS.

Excess hair growth (hirsutism Higher levels of androgens can lead to excess hair growth on the face, chest, back, or belly. This can be distressing, but it’s a very common symptom of PCOS.

Acne and oily skin Elevated testosterone levels can also cause acne, particularly along the jawline, back, and shoulders.

Scalp hair thinning: Thinning or hair loss on the scalp is another symptom linked to higher androgen levels in menstruators with PCOS.

Weight gain:  Many menstruators with PCOS experience difficulty maintaining a healthy weight, particularly around the abdomen. Insulin resistance plays a big role in this symptom, making it harder to lose weight.

Infertility: Since PCOS can interfere with ovulation, many menstruators struggle to get pregnant. However, this doesn’t mean you can’t conceive—it just may require extra help in some cases.

Skin changes: Darkened skin, especially around the neck, armpits, and groin, is another common symptom. Some menstruators also develop small, soft skin tags.

How is PCOS Diagnosed?

If you suspect you have PCOS, the first step is to see your healthcare provider. They will consider your symptoms and may conduct several tests to confirm the diagnosis.

Typically, your doctor will perform a combination of:

Blood tests: to check for hormone imbalances (like elevated testosterone, LH, and insulin).

Ultrasound: to check for cysts on your ovaries (though it’s important to note that not everyone with PCOS will have cysts, and not everyone with cysts has PCOS).

Physical exam: to assess symptoms like excess hair growth or acne.

A diagnosis is generally made if you meet at least two of the following three criteria (known as the “Rotterdam Criteria”

1. Irregular or absent periods.

2. Elevated levels of male hormones (androgens), causing physical symptoms like excessive hair growth or acne.

3. Polycystic ovaries (on ultrasound).

Managing PCOS: Treatment and Lifestyle Tips

While there’s no cure for PCOS, the good news is that there are plenty of ways to manage symptoms and improve your overall health. Treatment will depend on your individual needs—whether you're trying to regulate your periods, manage acne or hair growth, or boost fertility.

1. Diet and Lifestyle Changes

Balanced diet: A diet that’s rich in whole foods, low in processed sugars, and high in fiber can help improve insulin sensitivity and manage weight. You don’t need a strict diet plan, but focusing on whole grains, lean proteins, vegetables, and healthy fats can make a big difference.

 Exercising/ Regular physical activity—whether it’s walking, yoga, or strength training—helps improve insulin sensitivity and maintain a healthy weight. Even small changes can lead to big improvements in your overall health.

2. Medications

 Birth control pills: These are often prescribed to regulate periods, reduce acne, and manage excessive hair growth by balancing hormone levels.

Metformin: This drug, commonly used for type 2 diabetes, can help improve insulin sensitivity and regulate periods in menstruators with PCOS.

Anti-androgens: Medications like “spironolactone” can block the effects of excess testosterone, reducing symptoms like acne and excessive hair growth.

   - Ovulation-stimulating drugs: If you’re trying to conceive, medications like “clomiphene” or letrozole can help you ovulate more regularly.

Cosmetic Treatments

Laser hair removal: electrolysis can help manage unwanted facial and body hair.

Acne treatments: like topical medications, oral antibiotics, or even certain types of birth control pills can help improve skin appearance.

Support and Care:

• Talking to others with PCOS can help you feel less isolated. Online support groups or local communities can provide a wealth of advice and emotional support.

•  A healthcare provider who understands PCOS can help you create a personalized plan to manage symptoms and reduce the risks of complications.

Long-Term Considerations

Living with PCOS means more than just managing symptoms in the short term. It’s also about taking steps to protect your long-term health. Without management, PCOS can increase your risk of:

Infertility: Though treatment options exist, untreated PCOS can lead to difficulties getting pregnant.

Type 2 diabetes: Insulin resistance is common in PCOS and can increase your risk of developing diabetes.

Heart disease: Menstruators with PCOS are at higher risk for developing cardiovascular problems, like high blood pressure and high cholesterol.

Endometrial cancer: If you’re not ovulating regularly, you might have a higher risk of developing thickened uterine lining, which can increase the risk of cancer.

PCOS is a condition that can bring a lot of challenges, but with the right care, you can manage your symptoms and lead a healthy, fulfilling life. Whether you’re navigating fertility issues, managing acne, or just learning to live with the ups and downs of PCOS, remember that you’re not alone. With the right tools, support, and treatment, you can feel empowered to take control of your health and your future.

If you suspect you have PCOS, or if you’ve recently been diagnosed, it’s important to reach out to a healthcare provider who understands the condition. Together, you can come up with a plan that works best for you.