15 Common PCOS Symptoms
PCOS, or polycystic ovarian syndrome, is a hormone-related condition that can affect your cycle and infertility. If untreated, PCOS can eventually develop and increase the risk of type 2 diabetes. It is diagnosed by having two out of the following three symptoms listed below. As a syndrome, there is a collection of symptoms that are patient-dependent. Due to this, PCOS can present very differently from person to person. It is important to understand your root causes driving your condition and receive proper treatment for each cause.
Polycystic Ovarian Syndrome is diagnosed when you have 2 out of the 3 (or possibly all) of the following:
1. ELEVATED ANDROGENS (TESTOSTERONE / DHEA)
Testosterone (ovarian) can be elevated due to insulin resistance. This is because increased blood insulin signals the ovaries to produce more testosterone
DHEA (adrenal) can be elevated due to stress / inflammation. DHEA is an enzyme that combines with testosterone, and at elevated levels leads to acne and hair loss.
2. POLYCYSTIC OVARIES ON ULTRASOUND
Small cysts due to the follicle trying to produce an egg
DIFFERENT from an ovarian cyst
3. ANOVULATORY CYCLES / IRREGULAR PERIODS
Irregular periods due to lack of or delayed ovulation
Stress, high testosterone levels can affect ovulation
Outside of these 3 diagnostic criteria, it is important to identify any other symptoms you may have.
Why each can be a symptom of PCOS:
1. Irregular Periods
A period is considered irregular if your cycle is less than 21 days or more than 35 days, missing 3 or more periods in a row, or if your flow is much lighter or heavier than usual. Irregular periods are one of the common PCOS symptoms. Having a regular period is dependent on ovulation and also hormones. It is vital to have a normal period because if you don’t this is your body sending you a signal that there is something imbalanced with your hormones. When your period is irregular you have delayed ovulation or you are just not ovulating.
Source: NIH
2. Acne
Acne is another one of the common PCOS symptoms because acne is highly dependent on hormone activity. In each pore of our skin, we have sebaceous glands that produce sebum, an oil-like liquid, which helps to moisturize and protect our skin. When too many dead skin cells collect on the top of the skin in conjunction with high amounts of sebum, this can create a clog in our sebaceous glands and will result in inflammation. Our body will respond to this inflammation by sending white blood cells to the site of the clog which forms the white-headed acne.
High testosterone levels are one of the diagnostic criteria for PCOS, and it can also impact acne. Testosterone gets converted in to Dihydrotestosterone (DHT) and this is what causes the increase in sebum in the sebaceous glands to further produce acne. This is why acne is one of the common PCOS symptoms.
Source: 30881413 European Journal of Obstetrics and Gynecology
3. Hair Loss
Now, everyone has various hair textures and thickness, but if you are noticing that you are shedding more hair than usual, this can be one of the common PCOS symptoms. Female hair loss is due to the miniaturization of the hair follicle, and increasing terminal follicles. DHT is made from a reaction between testosterone and the enzyme dehydroepiandrosterone or DHEA. DHT is an opponent of hair follicles and the more it is produced the more it will create hair loss and miniaturize the hair follicle. High levels of testosterone, an indicator of PCOS, will catalyze this reaction to form DHT and therefore lose hair.
Source: 18044135, American Hairloss
4. Hirsutism
Hirsutism is another one of the many common PCOS symptoms. Affecting 5-10% of females, it is defined as the male-like pattern of hair growth on a female, typically around the face, back, and upper stomach. This is the result of high testosterone and PCOS. Hirsutism can be caused by past drug use from anabolic steroids, oral contraceptives, or high blood pressure medications. The reason for the hair growth is from the hair follicles becoming overstimulated as a result of high testosterone levels, and they will therefore grow at a rapid rate and will also increase pigmentation of the hair.
5. Long Menstrual Cycle
Having a long menstrual cycle is another one of the common PCOS symptoms. The average menstrual cycle is 3 to 7 days, so anything longer than 7 days would be considered a long menstrual cycle. These prolonged cycles are due to the fact that the hormone balance of estrogen and progesterone can be changed due to the high testosterone levels. Ovulation becomes delayed when your menstrual cycle is too long due to high androgen levels. One of the androgens, testosterone, can become high because of high insulin due to blood sugar imbalances. When insulin is high, it will signal the ovaries to produce more testosterone. Another one of the androgens, DHEA, is more commonly caused to become high due to stress. Additionally, it is important to note that the long periods can be detrimental because of an elevated loss of blood which may cause anemia.
Source: 17039468
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6. Irritability
Irritability can be one of the common PCOS symptoms too. Testosterone is linked with aggression, and at elevated levels, it can cause females to be irritable. Another connection that is possible is that high testosterone disrupts the menstrual cycle so females feel irritable due to this too.
Source: 24076484, Harvard Health
7. Depression
Depression is another one of the common PCOS symptoms. Studies show that females with symptoms of PCOS, hirsutism, acne, and hair loss have higher plasma testosterone levels and additionally have higher depression cases. The link between depression and high testosterone can originate from women who may feel less confident if they are dealing with additional symptoms like infertility, hair loss, facial hair growth, etc. Additionally, depression can be a symptom of PCOS due to nutrient imbalances which result in increased testosterone levels that imbalance estrogen and progesterone.
Source: 11955793, Harvard Health
8. Oily Skin
Along with acne, oily skin can also be another one of the common PCOS symptoms. As previously mentioned, testosterone converts into DHT and this is what makes you produce more sebum. The sebum is an oil-like liquid, so this excess production of the sebum is what makes oily skin one of the common PCOS symptoms.
Source: 30881413, European Journal of Obstetrics and Gynecology
9. Insulin Resistance
About 70% of women with PCOS also have insulin resistance. For this reason, insulin resistance is another one of the common PCOS symptoms. Insulin is a hormone released from the pancreas when you eat food, and its job is to take sugar into cells for energy. Think of it like the cell accepting the sugar is a lock and insulin is the key. When you are insulin resistant the cells deny the insulin with the sugar, so your blood sugar rises along with insulin levels. This would mean that the cell or “lock” changes so that the insulin or “key” no longer fits.
Insulin resistance causes high levels of testosterone because when insulin levels are high in the blood, it will stimulate an enzyme called 17-hydroxylase which will stimulate the ovaries to make more testosterone. Additionally, this process will inhibit the synthesis of a binding protein to testosterone which increases the abundance of free testosterone in the blood.
10. Infertility
Another one of the common PCOS symptoms of high testosterone is infertility. When hormone levels are imbalanced, it will make fertility harder to achieve. Increased androgen levels in those with PCOS makes it harder for women to become pregnant because as a result, progesterone and estrogen are decreased. These two hormones are vital for ovulation, and preparation for a successful pregnancy.
Source: 420268
11. Dark Skin Patches
Another one of the common PCOS symptoms is rough or dark skin patches. This symptom is linked with insulin resistance, which we know causes higher testosterone levels in those with PCOS. High insulin levels in the blood cause activation of insulin growth factor IGF-1 receptors on skin cells called keratinocytes and also fibroblasts which initiate rapid cell growth. This is what will cause dark or rough patches on the skin.
Source: 27921251
12. Headaches
There is some evidence to suggest that headaches are one of the common PCOS symptoms as well. DHT as mentioned before has been shown to be impacted and a related factor in headache prevalence in those with PCOS.
Source: 23971241
13. Weight Struggles
Weight struggles can occur due to insulin resistance making it one of the common PCOS symptoms. In the US, about 80% of the PCOS population is either overweight or obese. Your weight may be increasing, though you don’t feel like you are changing your lifestyle habits as much. The cause of this possible weight gain is due to insulin resistance. When your cells do not accept sugar from the hormone insulin for energy, this can make it much easier to shuttle the sugar into fat stores, making weight gain occur.
Source: 9408743, 27510482, 20436797
14. Food Cravings
Food cravings can also be one of the common PCOS symptoms due to insulin resistance. Blood sugar imbalances can cause you to go through periods of intense cravings and feeling hungry even though you might have just eaten a meal an hour ago. This is because even though you just ate, your blood sugar might have spiked and the cells aren't accepting the sugar from insulin anymore. This is because you are insulin resistant, and it will make you feel unsatisfied because you are not utilizing the energy from that meal. As a result, you have cravings for sweets to fulfill that need for energy.
15. Anxiety
In addition to irritability, anxiety is another one of the common PCOS symptoms. Because of the aggressive nature that testosterone can bring about at high levels, this can cause females specifically to gain anxious tendencies and episodes. The link between anxiety and high testosterone can originate from women who may feel less confident if they are dealing with additional symptoms like infertility, hair loss, facial hair growth, etc. In addition, anxiety can be a symptom of PCOS due to nutrient imbalances which result in increased testosterone levels that imbalance estrogen and progesterone.
Source: 24076484, Harvard Health
