Symptoms of PCOS: How to Identify Early Warning Signs

One minute you’re battling stubborn acne like a teenager, the next you’re wondering why your jeans suddenly don’t fit; and no, it’s not just from skipping the gym. If your body feels like it’s sending mixed signals, you’re not alone. Polycystic ovary syndrome (PCOS) is a hormonal condition that affects an estimated 3.7% to 22.5% of reproductive-aged women in India. Even more surprising? Up to 70% of those affected remain undiagnosed across the globe.

PCOS is a common condition that affects the way a woman’s ovaries function.

The three main features include:

• Irregular periods: When the ovaries do not release eggs (ovulation) regularly

• Excess androgens: Higher levels of ‘male’ hormones, which can cause symptoms such as increased facial or body hair

• Polycystic ovaries: Enlarged ovaries containing multiple small fluid-filled sacs (follicles) surrounding the eggs. Despite the name, these are not true cysts.

A diagnosis of PCOS is usually made if at least two of these features are present.

PCOS symptoms can be subtle, confusing, or easily mistaken for other health issues. From unexpected weight gain to thinning hair and mood swings, recognising the early signs is key to early intervention. In this blog, we will explore the symptoms of PCOS in women, how to spot them, even when periods seem regular, and when it's time to seek medical advice.

What is PCOS & why does it often go undiagnosed?

PCOS is a hormonal imbalance characterised by irregular ovulation, elevated levels of androgens (male hormones), and the presence of multiple cysts on the ovaries. However, the name can be misleading; many women with PCOS do not have visible cysts on their ovaries, and not all ovarian cysts mean PCOS.

Symptoms of PCOS often go undiagnosed because they frequently mimic or overlap with other conditions. Irregular periods, acne, or weight gain might be dismissed as normal changes or stress-related. Moreover, there is no single medical test to confirm PCOS, making clinical judgement essential. An additional important point in the Indian context is the high prevalence of ‘lean PCOS’ where women have normal weight but still show hormonal and metabolic abnormalities, highlighting that PCOS is not always linked to obesity.

Common symptoms of PCOS in women

Symptoms of PCOS vary from person to person, but there are a few hallmark signs to watch out for:

• Irregular or missed periods: This is often the first noticeable sign. Women may have fewer than nine periods in a year or periods that are more than 35 days apart.

• Excess hair growth (hirsutism): Facial and body hair, particularly on the chin, chest, or back, may grow due to elevated androgen levels.

• Acne and oily skin: Persistent acne, especially along the jawline or on the back, is commonly linked to symptoms of PCOS in women.

• Weight gain or difficulty losing weight: Many women with PCOS find it harder to lose weight due to insulin resistance.

• Thinning hair or hair loss: This can resemble male-pattern baldness.

• Darkened skin patches: Known as acanthosis nigricans, these may appear on the neck, armpits, or groin.

• Mood swings or depression: Hormonal imbalances can also affect mental health.

• Fertility issues: Difficulty conceiving due to irregular ovulation is a major concern for many women with PCOS.

• Long term issues: PCOS is linked to a higher risk of developing health conditions later in life, including type 2 diabetes and elevated cholesterol levels.

Symptoms of PCOS in females with regular periods

One common myth is that having a regular menstrual cycle rules out PCOS. In reality, symptoms of PCOS with regular periods are not uncommon. While irregular periods are a hallmark sign, many women continue to menstruate on schedule and still meet the criteria for a PCOS diagnosis.

In such cases, it’s important to pay attention to other key symptoms, such as:

• Persistent acne or excessively oily skin, especially if it doesn’t respond to standard skincare treatments.

• Mood swings, anxiety, or low mood, which can be influenced by hormonal imbalances.

• Signs of insulin resistance such as intense sugar cravings, frequent fatigue, or energy crashes.

• Difficulty with fertility or ovulation, even if periods appear regular.

• Dark patches of skin (acanthosis nigricans), especially on the neck, armpits, or groin.

What causes polycystic ovary syndrome (PCOS)?

The exact cause of PCOS is not fully understood, but it often has a genetic component and can run in families. It is closely linked to hormonal imbalances, particularly involving insulin. Insulin helps regulate blood sugar levels, but many women with PCOS are resistant to its effects, causing the body to produce more insulin. This excess insulin stimulates increased production and activity of hormones such as testosterone. Being overweight or obese can further raise insulin levels, worsening the condition.

How to test for PCOS and get a proper diagnosis

Getting a proper diagnosis for PCOS involves more than just identifying one or two symptoms; it requires a comprehensive assessment of your overall hormonal, metabolic, and reproductive health. Healthcare professionals typically begin with a detailed medical history and physical examination, followed by general hormone evaluations. Understanding how to test for PCOS is key to receiving the right care, as the diagnosis is often based on a combination of clinical signs and findings rather than a single test and vague symptoms. 

When to see a doctor for PCOS symptoms

It’s time to consult a healthcare provider if:

• You have irregular periods or have stopped menstruating altogether

• You’re experiencing excess hair growth on body parts or severe acne

• You’re gaining weight without significant lifestyle changes

• You’re struggling to conceive after trying for over a year.

• You have symptoms of insulin resistance, like skin darkening, fatigue after meals, or excessive hunger

Managing PCOS symptoms through lifestyle & diet

The symptoms of PCOS in females can vary widely, and while there’s no one-size-fits-all solution, adopting the right lifestyle and dietary habits can significantly ease these symptoms and improve overall hormonal health.

• Focus on a low-GI diet

Eating foods with a low glycaemic index, such as oats, sweet potatoes, and lentils can help regulate blood sugar levels and improve insulin sensitivity. 

• Increase fibre intake

Fibre-rich foods such as leafy greens, beans, and whole grains aid digestion and slow the absorption of sugar, supporting hormonal balance and appetite control.

• Exercise regularly

A mix of cardio and strength training can improve insulin resistance, support weight management, and reduce symptoms like fatigue and mood swings.

• Manage stress effectively

Chronic stress can elevate cortisol, which disrupts hormones further. Yoga, meditation, or even short daily walks can make a meaningful difference.

• Get enough sleep

Poor sleep affects hormone regulation and can lead to increased cravings and fatigue. Aim for 7-9 hours of quality sleep each night.

Spot the symptoms early & take control of PCOS

If your skin’s staging a rebellion, your periods are unpredictable, and your energy vanishes by lunchtime, it might not be just 'one of those days'. These could be early symptoms of PCOS, quietly nudging you to pay closer attention.

PCOS isn’t a quick-fix condition, but it’s far from unbeatable. The sooner you tune into your body’s signals, the better equipped you are to manage them. With the right guidance, healthy lifestyle tweaks, and support, you can move from confusion to clarity and take charge of your hormonal health. Remember, it’s about understanding your body and making it work with you, not against you.

Frequently Asked Questions

1. What is PCOS?

Polycystic ovary syndrome (PCOS) is a hormonal disorder affecting how the ovaries work. It can cause irregular periods, excess hair growth, and weight gain.

2. What are the early signs of PCOS?

Common early signs include irregular or missed periods, acne, oily skin, weight gain, and excessive hair growth on the face or body.

3. Can PCOS cause hair thinning or hair loss?

Yes, many women with PCOS experience thinning hair on the scalp due to increased androgen levels.