What are the signs and symptoms of PCOS?

Young women with PCOS commonly have one or more signs:

• Irregular periods that come every few months, not at all, or too frequently. [1,2] 
• Irregular ovulation [1,2]
• Problems when trying to get pregnant and recurrent miscarriages [3]
• Problems in later stages of pregnancy, such as gestational diabetes mellitus, hypertensive disorders of pregnancy, preterm delivery, and birth of small for gestational age infant [4]
• Hair growth on the face or other parts of the body (a condition called hirsutism),
• Acne and other skin problems such as seborrhea, androgenic alopecia and, in severe cases, signs of virilization, patches of dark skin on the back of neck and other areas, called acanthosis nigricans [5]
• Problems with weight gain or trouble losing weight [6] Up to 60% of women with PCOS are overweight or obese. [7] 
• Insulin resistance: Up to one-third of women with PCOS will show impaired glucose tolerance by the age of 30 and every year up to 10% of them will develop type 2 diabetes. [8]
• Diabetes: Women with PCOS may be seven times more likely to develop diabetes because of problems with blood sugar imbalance they experience. [7]

If you have some or all of the above signs, you might have PCOS. There can be other reasons why you might have one or more of these signs, but only your health care provider can tell for sure.

What causes PCOS?

PCOS is caused by an imbalance in the hormones that act as chemical messengers in your brain and your ovaries. Many girls also have increased levels of insulin from the pancreas, and PCOS usually happens when the insulin levels are too high. [8] This results in extra testosterone production by the ovaries. The pituitary gland in your brain makes the hormones such as the luteinizing and follicle stimulating hormones, called LH and FSH. After getting the signal from the hormones LH and FSH, the ovaries make estrogen and progesterone, which are the female sex hormones. All normal ovaries also make a little bit of the androgen testosterone — a male sex hormone.

With PCOS, LH levels are often high when the menstrual cycle starts and the levels of LH are higher than FSH levels. Because the LH levels are already quite high, the surge that sets off the chain reaction causing ovulation does not happen at all. Without this LH surge, ovulation does not occur and periods are irregular (as one of the symptoms of polycystic ovary syndrome).

The pancreas is an organ that makes the hormone insulin. High levels of insulin can cause the ovaries to make more testosterone as well. Having PCOS means that the ovaries are not getting the right hormonal signals from your pituitary gland. Without these signals, you will not ovulate and your period may be irregular, or you may not have a period at all. [1,2,7,8] In addition, most women with PCOS present with increased circulating levels of free fatty acids (FFAs), which have been shown to cause insulin resistance. [9]