PCOS Explained: Symptoms, Diagnosis and Long-Term Health

Creator: Balance Hormones Editorial Team
Published: 2026-10-23

Last reviewed 2026-10-23 · 5 min read · By the Balance Hormones editorial team

Medical disclaimer: This content is educational, not medical advice. It does not diagnose or treat any condition. Always consult a qualified clinician about your symptoms, tests, and treatment options. In an emergency, call 911 or your local emergency number.

Polycystic ovary syndrome, or PCOS, is one of the most common hormonal conditions affecting people with ovaries during their reproductive years. The Endocrine Society estimates that it affects up to about 1 in 10 women of reproductive age, and the NICHD notes that many people with PCOS do not know they have it. Despite the name, PCOS is not simply a problem with ovarian cysts. It is a whole-body condition involving hormones, ovulation, and metabolism.

This guide explains the main features of PCOS, how it is diagnosed, and the long-term health considerations clinicians monitor. It is educational and does not offer treatment advice.

What happens in PCOS?

In PCOS, the ovaries often do not release an egg regularly (ovulation is irregular or absent), and the body tends to produce higher levels of androgens, hormones such as testosterone that are usually present at lower levels in women. Many people with PCOS also have insulin resistance, meaning the body’s cells do not respond normally to insulin. To compensate, the pancreas makes more insulin, and high insulin levels can in turn prompt the ovaries to make more androgens.

On ultrasound, the ovaries may contain many small follicles, partially developed egg sacs that did not mature. These are what the word “polycystic” refers to, though they are not true cysts, and not everyone with PCOS has them.

What causes PCOS?

The exact cause is not known. The NICHD and Mayo Clinic describe a combination of factors, including genetics (PCOS often runs in families), insulin resistance, higher androgen levels, and low-grade inflammation. It is not caused by anything a person did.

Common symptoms

Symptoms vary a lot between individuals and can change over time:

Irregular periods: infrequent, very long cycles, missed periods, or, less commonly, very heavy bleeding.
Signs of higher androgens: extra hair growth on the face, chest, back, or abdomen (hirsutism), acne that persists into adulthood, and thinning scalp hair.
Difficulty getting pregnant because of irregular ovulation. PCOS is a common cause of infertility, though many people with PCOS do become pregnant, sometimes with medical help.
Weight changes: many, but not all, people with PCOS have overweight or obesity, and some find weight harder to manage. PCOS also occurs in people with a lower body weight.
Darkened, velvety skin patches (acanthosis nigricans) on the neck, armpits, or groin, which can be a sign of insulin resistance.
Skin tags and, in some people, mood symptoms such as anxiety or depression.

How PCOS is diagnosed

There is no single test for PCOS. Many clinicians use criteria in which at least two of the following three features are present, after other causes have been ruled out:

Irregular or absent ovulation, usually shown by irregular periods.
Signs of high androgens, either clinically (such as hirsutism or acne) or in blood tests.
Polycystic-appearing ovaries on ultrasound.

Because ovaries normally look “polycystic” during adolescence, ultrasound is generally not used to diagnose PCOS in the first years after periods begin. Diagnosis in teens relies more on irregular cycles and signs of high androgens.

Ruling out other conditions

Several other conditions can look like PCOS, so clinicians typically check for them. These may include thyroid disease, high prolactin levels, non-classic congenital adrenal hyperplasia, and, less commonly, Cushing’s syndrome or androgen-secreting tumors. A clinician may order blood tests for hormones such as testosterone, thyroid-stimulating hormone (TSH), prolactin, and 17-hydroxyprogesterone, along with a pregnancy test where relevant.

Long-term health considerations

PCOS is linked with several health risks that make ongoing care important:

Type 2 diabetes and prediabetes. Insulin resistance increases the risk. The Endocrine Society notes that more than half of women with PCOS develop type 2 diabetes by age 40, and clinicians often recommend periodic blood sugar testing.
Heart and blood vessel health. PCOS is associated with higher cholesterol, high blood pressure, and other cardiovascular risk factors.
Endometrial health. When ovulation is infrequent, the uterine lining may not shed regularly. Over time, this can increase the risk of endometrial hyperplasia and endometrial cancer, which is one reason clinicians pay attention to how often periods occur.
Sleep apnea, particularly in people with obesity.
Pregnancy complications, such as gestational diabetes and high blood pressure in pregnancy.
Mental health. Higher rates of depression, anxiety, and disordered eating have been reported. These deserve the same attention as physical symptoms.

How PCOS is generally managed

There is no cure for PCOS, but symptoms and risks can be managed. Care is individualized and depends on a person’s main concerns, for example regulating periods, managing unwanted hair or acne, reducing diabetes risk, or getting pregnant. Organizations such as the NICHD and the NHS describe approaches that include lifestyle measures (healthy eating, regular physical activity, and, for people with overweight, modest weight loss, which can help improve cycles and insulin sensitivity in some people) and prescription treatments chosen by a clinician based on goals and health history. Fertility support is available through specialists for those who want to conceive.

Be cautious about products marketed as “PCOS cures,” special diets that promise to reverse PCOS, or supplements making strong claims. Evidence for many of these is limited, and some may interact with medications.

Which clinicians treat PCOS?

PCOS care may involve a primary care clinician, gynecologist, endocrinologist, reproductive endocrinologist (for fertility), dermatologist (for skin and hair concerns), dietitian, and mental health professional. Because PCOS has many dimensions, coordinated care can be helpful.

Questions to ask your clinician

Do my symptoms and tests meet the criteria for PCOS, and were other conditions ruled out?
Should I be screened for prediabetes, diabetes, high cholesterol, or sleep apnea?
How often should I expect a period, and what should I do if they are far apart?
What are the options for the symptoms that bother me most?
If I want to become pregnant now or in the future, what should I know?
Can you refer me to a dietitian or mental health professional?

The bottom line

PCOS is common, often underdiagnosed, and affects more than the ovaries. Diagnosis is based on a combination of irregular ovulation, signs of high androgens, and ovarian appearance, after other conditions are excluded. Because it carries long-term metabolic and reproductive considerations, regular follow-up with a clinician is an important part of living well with PCOS.

Sources

Hypothyroidism Explained: Underactive Thyroid Symptoms, Causes and Diagnosis

Low Testosterone in Men: Symptoms, Testing and What Guidelines Say