Wellness·6 min read

PCOS Is Hard to Diagnose. Here’s What to Look Out For.

Do I Have...PCOS?
Design: theSkimm | Photo: Pexels
September 1, 2022

About 5%-15% of women between the ages of 15 and 44 have PCOS. And yet there’s a lot of confusion about what it is. No need to Google it. We got you.

Let’s start with the basics. PCOS is…

  • A misleading acronym. It stands for polycystic ovarian syndrome. That sounds like it means having cysts in your ovaries. But that’s not the whole story.

  • Caused by a hormone imbalance. More on hormones here.

  • Hard to diagnose. But typically includes two of the following:

    • Hyperandrogenism. Aka when you have more male hormones (androgens), like testosterone, than women typically have.  

    • Ovulatory dysfunction. Meaning irregular ovulation, which makes for an irregular menstrual cycle. 

    • Multiple small “cysts” (or follicles containing immature eggs) on your ovaries. Hence the “polycystic” in PCOS. 

Symptoms include…

  • Unpredictable cycles. Your menstrual cycle is timed to when you ovulate, so if that’s off (likely thanks to excess androgens), then your period may be sporadic, long, or irregular.

  • Hair loss or excess hair growth. More than 70% of women with PCOS have hirsutism, Aka unwanted hair growth. The culprit: again, those extra androgens we mentioned. 

  • Acne. Another side effect of those male hormones, which can make your skin more oily. 

  • Dark skin patches. Insulin resistance or issues with insulin secretion are likely to blame. Reminder: Insulin is the hormone that controls how much glucose (sugar) is in your blood, and can be part of the hormone imbalance linked to PCOS. Full circle.

Side effects could be...

  • Infertility. People with PCOS might not ovulate regularly, and that can make it hard to get pregnant. Good news: There are fertility treatments out there that can help.

  • Sleep apnea. Adults with PCOS experience this more than people without the syndrome do. It could be related to insulin resistance and metabolic syndrome. About that...

  • Risk of metabolic syndrome. That’s the name for a bunch of conditions that often occur together, including high blood pressure, high blood sugar, and abnormal cholesterol levels that increase risk of cardiovascular disease. Another reason to try and ID the issue early: More than half of women with PCOS get type 2 diabetes or prediabetes by age 40.

  • Depression. Women with PCOS experience it more often than the general population. (Read more about mood disorders and how to treat them here.)

  • Risk of COVID-19. New research is looking at whether people with PCOS could be more at risk of infection.

Factors to consider...

  • Genetics. There’s no specific test for PCOS, but you could be more susceptible if your mom, sister, or aunt has it.

  • Race. Some studies show that there may be a higher incidence in women of Black, Middle Eastern, and South Asian descent.

  • Insulin levels. Up to 70% of women with PCOS have insulin resistance, meaning their cells can’t process glucose effectively. And that can lead to weight gain.

  • The unknown. More research is in the works to better understand PCOS, including one study aimed at finding genes associated with the condition.

Similar symptoms could also mean… 

A different kind of hormone disorder. A few examples:

  • A thyroid disorder. One of these could also throw off your cycle.

  • High prolactin levels. Another possible trigger for irregular periods because that can mess with your estrogen levels.

  • Congenital adrenal hyperplasia. This can lead to extra male hormones, too. Cue the unwanted hair. 

If you think you have PCOS, you should…

  • Go to your doctor. We mean your OB-GYN or endocrinologist.  

  • Run some tests. A doc might administer a physical exam, blood tests, and even ask you to drink a sugar beverage (this tests for insulin resistance) to figure out what’s going on.

  • Have an ultrasound. During it, your doc will check your ovaries for multiple cysts and examine the lining of your uterus (which could be thicker than average if you have PCOS). You might also have a pelvic exam to make sure your reproductive organs are functioning as they should.

  • Advocate for yourself. PCOS is tough to diagnose, but at the same time, can be overdiagnosed (There’s a debate in the medical community about this.). You know your body best. And if you don’t feel comfortable sharing your concerns with your doc, it may be time to find a new one. You’re allowed to do that. 

  • Consider treatment. A doctor might prescribe drugs to help your body respond to insulin. They could also talk to you about fertility meds, if your body needs help ovulating. And hormonal birth control can help manage acne and hair concerns. 

  • Prioritize exercise and healthy eating. It can be challenging to stay fit because your body may be more resistant to insulin. But managing a healthy weight can help get your menstrual cycle back on track, and prevent or reverse metabolic syndrome. Eating low-carb foods, healthy fats and protein, and limiting processed foods and added sugars could help regulate hormones. And you know we’re going to say it: Regular exercise is always a good idea.

  • Check your insurance plan. Your insurance company may help pay for fertility treatment if PCOS is making it tough to get pregnant. Birth control is also often covered.

  • Join a ‘cysterhood.’ Yep, that’s a word some PCOS support groups use. And you can find a group here or here. And follow social media accounts like this or this one that continue the conversation around PCOS.


PCOS is a condition that millions of millennial women deal with, but it can take years before many get treatment. If you’re experiencing symptoms, like infertility or unexplainable weight gain, talk to your doctor and advocate for yourself. Although there isn’t exactly a cure, help is out there to manage your symptoms and side effects.

theSkimm consulted with OB-GYN and REI fellow Dr. Arielle Bayer for this guide.

This content is for informational and educational purposes only. It does not constitute a medical opinion, medical advice, or diagnosis or treatment of any particular condition. 

Subscribe to Skimm Well

Sign up here to receive our wellness newsletter filled with actionable advice, expert-vetted content, product recs, and more — delivered directly to your inbox.