Symptoms of PCOS – What to Watch For and When to Seek Help

Polycystic Ovary Syndrome (PCOS) is more than just irregular periods. It's a complex hormonal condition that affects many aspects of a woman’s health — from reproductive function to skin, hair, weight, and even mood. And because PCOS symptoms can vary so widely from person to person, it’s not always easy to spot.

In this post, we’ll break down the key symptoms of PCOS, including both the more well-known signs and the subtler clues that might be easy to overlook. If you're wondering "Could I have PCOS?", read on to better understand what to look for — and what steps to take next.

Common Symptoms of PCOS

These are the signs most women associate with PCOS — and they often show up early.

1. Irregular or Missed Periods

This is often one of the first signs. PCOS disrupts ovulation, leading to infrequent, absent, or very heavy periods. You might go months without a cycle or have fewer than nine per year.

2. Excess Facial or Body Hair (Hirsutism)

High androgen (male hormone) levels in PCOS can cause unwanted hair growth, especially on the chin, upper lip, chest, or abdomen. Around 70% of women with PCOS experience this.

3. Acne and Oily Skin

Persistent acne – especially on the lower face, jawline, chest or back – can be linked to PCOS. Androgens increase oil production in the skin, making breakouts more common and harder to treat.

4. Weight Gain or Difficulty Losing Weight

Many women with PCOS gain weight easily, particularly around the belly. This is often tied to insulin resistance, which also makes weight loss more difficult.

5. Polycystic Ovaries on Ultrasound

Despite the name, not all women with PCOS have ovarian cysts. When they do, the ovaries may appear enlarged with many small, immature follicles in a “string of pearls” pattern.

6. Fertility Challenges

Because of irregular ovulation, PCOS is a common cause of infertility. Some women only discover they have PCOS when they struggle to conceive.

Symptoms of PCOS

Lesser-Known PCOS Symptoms You Might Miss

Some PCOS symptoms are subtle — but just as important.

1. Thinning Hair on the Scalp

While PCOS can cause unwanted hair in some places, it can also lead to hair thinning on the scalp (often around the crown or hairline), similar to male-pattern baldness.

2. Dark Skin Patches (Acanthosis Nigricans)

These are velvety, darkened patches of skin often found on the neck, underarms, or groin. They’re linked to insulin resistance and are a major clue in PCOS.

3. Skin Tags

Small, soft growths of skin, especially around the neck or underarms, are more common in women with PCOS and may be linked to insulin issues.

4. Mood Swings, Anxiety, or Depression

PCOS doesn’t just affect your body — it can impact your mind too. Many women report feeling anxious or down, and studies show higher rates of anxiety and depression in those with PCOS.

5. Sleep Issues and Fatigue

Sleep disturbances, including sleep apnea, are more common in women with PCOS, particularly if they also struggle with weight. Fatigue is another common complaint, often linked to blood sugar imbalances.

6. Increased Risk of Metabolic Health Issues

Women with PCOS are more likely to have insulin resistance, high cholesterol, high blood pressure, and a higher lifetime risk of type 2 diabetes or heart disease — even if these don’t show immediate symptoms.

When to Seek Support

Not everyone with PCOS has all of these symptoms — and you don’t need to check every box to seek help. If you're experiencing a combination of the signs above, especially irregular periods and signs of high androgens (like acne or unwanted hair), it’s worth speaking to a healthcare provider.

PCOS is not one-size-fits-all. You might only have a few mild symptoms, or your symptoms might shift over time. But understanding what to look for is the first step toward getting the right diagnosis and support.

If you’re noticing changes in your cycle, skin, hair, or mood — or if you just feel like your body is out of balance — you deserve answers. Don’t hesitate to advocate for yourself.

Coming up next: In our final blog post of this series, we’ll cover how PCOS is diagnosed — what tests to expect and how healthcare professionals put the puzzle pieces together.