Polycystic ovarian syndrome — commonly known as PCOS — is an increasingly common condition affecting women, and it can have major effects on the body. You’ve probably heard that PCOS can increase a person’s risk of infertility and miscarriage, but what you may not know is that it can also come with an increased risk of cardiovascular disease, type two diabetes, and mood disorders.

In light of how seriously the condition can affect a person’s body and life, it’s obviously crucial that people secure diagnoses so they can work to address the issues related to PCOS. Unfortunately, one of the most frustrating things about this particular condition is that it’s complex, and diagnosing the issue is rarely a straightforward process.

Ultimately, you can only know you have PCOS after receiving a diagnosis from a medical professional. With that being said, there are signs that you may be dealing with the condition, and OB/GYN Banafsheh Bayati, MD, the Medical Co-Founder of Perelel Health is on hand to break them down. 

Here, Dr. Bayati speaks to the diagnostic criteria and process for PCOS, the signs that someone may be experiencing the condition, and the value of early diagnosis. 

How is PCOS diagnosed?

“PCOS is a syndrome characterized clinically by oligomenorrhea (less frequent cycles) and hyperandrogenism (excess male hormones), as well as the frequent presence of associated risk factors for cardiovascular disease, including [issues such as] obesity, glucose intolerance, and obstructive sleep apnea along with the increased risk of mood disorders,” says Dr. Bayati. 

Sounds complicated? It is. There’s no single test for PCOS, which is why providers need to really understand a patient’s medical history and symptoms. A provider should also do a physical exam.

“A thorough physical exam should assess pubertal timeline, weight fluctuations, excess hair growth or thinning, signs of insulin resistance as well as acne,” says Dr. Bayati. “A pelvic exam along with a transvaginal ultrasound can be very helpful. Blood tests are often required and preferably done in a fasting state to assess hormonal levels along with lipids. Glucose tolerance tests are also done.”

How do you know if you have PCOS?

“Common signs include irregular cycles (frequent or delayed), skipping cycles, heavy or prolonged cycles, difficulty in conceiving a pregnancy, acne, excess facial or body hair, male pattern hair thinning, skin changes (darkening in some areas and skin tag development), weight issues as well as mood changes,” says Dr. Bayati.

If you’ve experienced some (or all) of these things, a chat with your doctor may be in order.

If someone suspects they may have PCOS, what’s the best way for them to bring this up with their doctor? Is there any specific testing they can request?

Finding a provider who understands PCOS is key, says Dr. Bayati, as this gives you access to information about the condition and its long-term effects. It’s also a good idea to maintain continuity of care with a physician who understands your medical history and genetic factors that may predispose you to PCOS. 

Since PCOS is a syndrome, there’s no single test that a patient can request if they suspect they may be affected.

“Testing and evaluation will vary and should be targeted and specific,” says Dr. Bayati. “But in general, hormonal labs (including serum androgen levels, thyroid and adrenal labs), as well as fasting lipids (cholesterol and triglyceride assessment) and assessment of glucose tolerance, will be necessary for most. Inflammatory markers can also be tracked.”   

What role do hormonal imbalances play in PCOS?

“Simplistically stated, PCOS is noted by an imbalance in reproductive hormones. This imbalance, with an increase in androgens, causes issues with ovarian function and ovulation.  It can then lead to issues such as cycle regularity, infertility, acne, and hair changes,” says Dr, Bayati. “But the underlying cause may be a metabolic imbalance causing this hormonal imbalance.”

But PCOS’s effects go beyond reproductive hormonal imbalances. “Many with PCOS have insulin resistance which can [lead to things like] weight issues, darkening of the skin, glucose intolerance, elevated cholesterol, and triglycerides,” says Dr. Bayati. “The metabolic imbalance is just as important as it affects the cardiovascular, immune, and psychological health of the women and may ultimately be driving the hormonal imbalance."

How common is PCOS?

PCOS is on the rise among women. “A systematic review in 2020 noted prevalence from 4% increasing to up to 26% worldwide.  On average, one in ten women is diagnosed with PCOS across the world,” says Dr. Bayati.  

Is PCOS commonly misdiagnosed or undiagnosed?

That’s a resounding yes.

“PCOS is undoubtedly one of the most complex disorders affecting women’s health and hormonal balance,” says Dr. Bayati. “Because of various manifestations of this disorder, as well as lack of uniformly accepted diagnostic criteria, the condition can be mis or underdiagnosed.”

More information and research are needed, but in the meantime, according to Dr. Bayati, targeting both metabolic and hormonal balance is key to addressing cases of PCOS.

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What are some evidence-backed ways women can balance their hormones?

The best method varies from person to person and depends on factors like age, medical history, family-building plans, and more. But one thing is universal: The critical first step is recognizing the imbalance. From there, lifestyle changes (such as dietary adjustments, physical activity, and stress reduction) are helpful. Some people will benefit from supplements and medications.

While hormonal balance can be restored in the short-term, regulating metabolic imbalances requires lifelong commitment and support.

Many women are diagnosed with PCOS while experiencing infertility or miscarriages. How can earlier detection help them better navigate the process of trying to conceive?

It’s not just about securing a diagnosis — it’s also about the medical community better understanding the condition and how it affects each fertility journey.

“As a society, we need more research and focus on women’s health,” says Dr. Bayati. “A greater understanding of the genetics and environmental factors involved in PCOS may help improve fertility rates. It is possible that the sooner we address underlying metabolic concerns that may lead to hormonal imbalances, we can help adolescents and young adults navigate health factors that contribute to fertility as well as risks of cancer, cardiovascular disease, diabetes, and mental health issues.”

What are some major misconceptions about PCOS?

There are a few, according to Dr. Bayati. The first is that individuals believe they did something to cause the condition. The second is that PCOS only affects overweight people.

And the third misconception? People with PCOS can not get pregnant. While the condition can make trying to conceive more difficult, a PCOS diagnosis does not automatically cause infertility. 

If you struggle with irregular cycles, weight management, glucose metabolism, insulin insufficiency, and/or hormonal imbalances due to PCOS, Perelel’s PCOS Support supplement may be able to help maintain your hormonal balance, mood, regular menstrual cycles and promote healthy ovulation and ovarian function. Click here to learn more, and use the code RESCRIPTED15 for 15% off your first purchase! 

Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, Marie Claire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.