Recognising PCOS symptoms: these are the signs

You blame your acne on your skin, your erratic cycle on stress, your weight on your lifestyle. One by one they look like separate complaints. Only when you lay them side by side can a picture emerge. PCOS symptoms fall into three groups: a disrupted cycle, signs of too many male hormones, and metabolic complaints.

My take: with PCOS no single sign is proof on its own, but the pattern says everything. If you recognise something in several groups, that is a good reason to have your hormones checked. Below you walk calmly through the three groups.

Group 1: a disrupted cycle

The most common sign of PCOS is an irregular period. Think of fewer than eight times a year, or a cycle that repeatedly lasts longer than 35 days. Sometimes the period stays away entirely. The cause is that ovulation often fails to happen, so your cycle does not get going as it should.

• Fewer than eight periods a year
• A cycle that keeps lasting longer than 35 days
• Months without a period without being pregnant
• Difficulty predicting your fertile days

Group 2: signs of too many androgens

With PCOS your body often makes more male hormones (androgens) than usual. You see this back in your skin and your hair. For many women these signs are the most visible and often the most distressing.

• Stubborn acne, especially along the jawline, that does not respond to ordinary products
• Excess hair growth on the face, belly, chest or back (hirsutism)
• Thinning scalp hair, especially at the crown or parting
• Quickly oily skin or scalp

These skin and hair complaints are often treated separately, while together they can point to a hormonal cause. Mainly bothered by hair loss? Then also read our article on hair loss and which hormones to test.

Group 3: metabolism and weight

For many women PCOS goes together with insulin resistance, a reduced sensitivity to insulin. That can lead to weight gain around the belly and difficulty losing weight, even when you do not eat differently. Not every woman with PCOS is overweight: insulin resistance can also occur at a healthy weight. So do not only watch the scales, but also complaints such as fatigue after meals or strong cravings for sweets.

Which sign goes with which value?

Symptoms give a suspicion, blood values give direction. The table below links each group of signs to the value that usually says the most about it. No single value makes a diagnosis on its own.

When is it more than an erratic cycle?

A single irregular month is normal. It becomes more interesting when you recognise something in several groups, or when a pattern has persisted for a while. Then it can be worth looking beyond a single symptom. The NHG and Thuisarts.nl describe PCOS as a combination of complaints, not as one isolated result.

• You have signs from at least two of the three groups above
• Your cycle has been irregular for more than half a year
• You are trying to conceive and your cycle is unpredictable
• PCOS, type 2 diabetes or early cardiovascular disease run in your family

If you mainly recognise general complaints such as fatigue and mood swings, also read about hormonal imbalance, because the cause may lie elsewhere.

What a blood test can add

With PCOS you mainly look at testosterone, SHBG and the ratio between LH and FSH. A raised testosterone with a low SHBG often fits the picture. The Women's Hormones panel measures these values in one draw. If jawline acne is your main complaint, read which hormones to test for hormonal acne.

Which hormones exactly are worthwhile and when to draw blood, you can read in our article on PCOS testing: which hormones and blood values. Want the complete overview first? Then read our PCOS pillar on symptoms, causes and diagnosis.

An abnormal result is not a diagnosis on its own. PCOS is established with the Rotterdam criteria, together with your symptoms and, if needed, an ultrasound. So always discuss your result with a doctor.

Frequently asked questions

How many PCOS symptoms should I have?

There is no fixed number. For the diagnosis, two of the three Rotterdam criteria count, not the number of separate complaints. If you recognise signs from several groups, a check can be worthwhile.

Can you have mild PCOS?

Yes. One woman mainly has an irregular cycle, another mainly skin complaints. The severity and the picture vary greatly per person. That is why an individual assessment matters.

Does acne always point to PCOS?

No. Acne has many causes and by no means always belongs to PCOS. In combination with an irregular cycle or excess hair growth it can be a sign that makes looking further worthwhile.

Sources

• NHG and Thuisarts.nl, Polycystic ovary syndrome (PCOS), Dutch College of General Practitioners. Available via thuisarts.nl.
• International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023, ESHRE and partners.

Every blood test result via Lunara receives a professional review by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.