PCOS symptoms fall into three groups: a disrupted cycle, signs of too many male hormones, and metabolic complaints. If you recognise something in more than one group, that is a reason to have your hormones checked. No single sign proves PCOS on its own, it is about the pattern.
I notice that many women see their complaints as separate for a long time. The acne belongs to your skin, the irregular cycle to stress, the weight to your lifestyle. Only when you lay them side by side does a picture appear. Below you walk through the three groups calmly.
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 keeps lasting longer than 35 days. Sometimes the period stays away entirely.
The cause is that ovulation often fails to happen. Without ovulation your cycle does not get going as it should. That can make the period unpredictable, and getting pregnant harder to time.
Watch for these cycle signals:
- Fewer than eight periods a year
- A cycle that keeps lasting longer than 35 days
- Months without a period while you are not pregnant
- Trouble predicting your fertile days
Group 2: signs of too many androgens
In PCOS the body often makes more male hormones (androgens) than usual. You see that in the skin and hair. These signals are the most visible for many women, and often the most distressing.
Common signs:
- Stubborn acne, especially along the jawline, that does not respond to usual 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. Do you mainly have hair loss? Then read our article on hair loss and which hormones to test.
Group 3: metabolism and weight
In many women PCOS goes together with insulin resistance, a reduced sensitivity to insulin. That can lead to weight gain around the belly and trouble losing weight, even if you do not eat differently.
Not every woman with PCOS has overweight. Insulin resistance can play a part at a healthy weight too. So watch not only the scales, but also complaints like fatigue after meals or strong cravings for sweets.
When is it more than an erratic cycle?
A single irregular month is normal. It gets more interesting if you recognise something in more than one group, or if a pattern has lasted a while. Then it makes sense to look beyond a single symptom.
Consider having your hormones checked if you recognise this:
- You have signals from at least two of the three groups above
- Your cycle has been irregular for more than six months
- 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 like fatigue and mood swings, also read about hormonal imbalance, because the cause can lie elsewhere too.
What a blood test can add
Symptoms give a suspicion, blood values give direction. In 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 Hormones Women panel measures these values in one draw. Which hormones are useful exactly and when to test best, you read in our article on PCOS testing: which hormones and blood values. Want the full 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 complaints 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. Diagnosis counts two of the three Rotterdam criteria, not the number of separate complaints. If you recognise signals from more than one group, a check is useful.
Can you have mild PCOS?
Yes. One woman mainly has an irregular cycle, another mainly skin complaints. The severity and the picture differ greatly per person. That is why an individual assessment matters.
Does acne always point to PCOS?
No. Acne has many causes and does not always belong to PCOS. Combined with an irregular cycle or excess hair growth, it can be a signal that makes looking further worthwhile.
References
- Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016;31(12):2841-2855. PMID: 27664216.
- Teede HJ, Tay CT, Laven J, et al. International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Monash University, ESHRE and ASRM, 2023.
- NHG and Thuisarts.nl. Polycystic ovary syndrome (PCOS). Dutch College of General Practitioners. Available via thuisarts.nl.
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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