Polycystic ovary syndrome, or PCOS, affects hormones, ovulation, and metabolism. Symptoms vary widely, and no single sign confirms the condition. Adult diagnosis follows the Rotterdam criteria, which require any two of three features. Other causes must be ruled out first, and because PCOS symptoms vary, two people can look quite different.
Cycles and Ovulation
Irregular ovulation is one of the three Rotterdam features. Some people have fewer than eight periods a year. Others bleed on a regular schedule, but ovulation may still be irregular. A provider will check ovulation with blood tests. An at-home ovulation predictor kit can show whether a surge occurs, but results are sometimes misleading in PCOS. Irregular ovulation can make conception harder to time since the uterine lining will sometimes thicken when periods are infrequent. Your provider may recommend periodic monitoring. Track start dates, flow, duration, and spotting in a calendar or app.
Hormones and Skin
Common signs include:
- Hirsutism: Coarse, dark hair on the face, chest, or back
- Acne: Persistent breakouts along the jawline, chin, or chest that often don’t respond to standard skincare
- Scalp hair thinning: Gradual loss at the crown that may progress slowly over time
Some people have high blood levels without visible signs, and others have visible signs while blood levels stay normal. Hair removal before a visit can hide signs, so mention any shaving, waxing, or laser treatment you use regularly. Note when PCOS symptoms started, since timing helps your provider rule out other causes such as adrenal conditions or medication effects. Keep a simple record of how often you manage hair growth. Check whether acne has shifted in location or severity. Take photos over several months, since gradual changes are hard to recall at an appointment. Bring that record to your visit, because it gives your provider a clearer picture than memory alone.
Ovaries and Metabolism
The third feature is polycystic ovarian morphology on ultrasound. The term refers to many small follicles arranged around the edge of the ovary, not true cysts, and it can appear in people without PCOS. Providers avoid this criterion within eight years of a first period, since ovaries naturally change during that time and the finding is less reliable. An internal ultrasound gives a clearer view than an abdominal one. Your provider may note follicle count and ovarian volume together. The 2023 international guideline also allows a blood test for anti-Müllerian hormone, or AMH, in adults when ultrasound is not appropriate or available.
AMH levels reflect follicle activity, and elevated levels can support a PCOS diagnosis alongside other features. Metabolic signs are not part of the Rotterdam criteria, but they matter because they affect long-term health. These signs include insulin resistance, weight gain around the waist, and dark, velvety skin patches called acanthosis nigricans. Fatigue after meals and strong carbohydrate cravings can also point to insulin resistance, even when fasting glucose looks normal.
Treat PCOS Symptoms Today
PCOS has no single treatment. Your care should match your goals, and those goals often change. You may need contraception in one decade and conception support in the next. Metabolic protection matters throughout, and they will revisit your plan whenever your goals shift. Ask which tests confirmed your diagnosis and which other causes were excluded. Schedule an appointment with your team to build a plan around what you want now.
