What to do if you have PCOS

Discussing changes with your period with your OB/GYN likely feels natural. Issues with weight, facial hair and acne may seem like topics for other providers. But unexplained changes in these areas could be signs you have polycystic ovary syndrome (PCOS), a hormonal condition that can cause head-to-toe symptoms. Not only can PCOS affect your ability to get pregnant, it can impact your physical and mental health.¹

“Unfortunately, most people shy away from talking about their symptoms,” says Priyanka Venkataraman, M.D., a board-certified OB/GYN and the founder and CEO of Wayfinding Moms. “It can feel awkward to bring things up, or you may think that you’re the only one.”

But you’re not. In fact, 1 in 10 women of child-bearing age has PCOS.¹ Not sharing your symptoms with your ob-gyn might delay diagnosis and treatment, notes Dr. Venkataraman. Even if you’re not planning to have kids, it’s important to get treated for PCOS.

Learn the signs of PCOS so you can advocate for yourself if you think you might have the condition.  

PCOS is a health condition that causes an imbalance to your reproductive hormones and affects your ovaries.¹ Women with PCOS have higher levels of testosterone. That results in development of male characteristics, such as oilier skin, thinning hair, or excess facial or body hair.²

Too much testosterone also makes it harder for you to ovulate. Instead of releasing eggs, your ovaries hold onto them in fluid-filled sacs, known as cysts. (That’s where the “polycystic” part of the name PCOS comes from.) Most cysts are benign and painless, but occasionally, women can experience pelvic pain. If a cyst ruptures, it can cause severe pain and rarely cysts can become cancerous.^3,4

Signs of PCOS include:^5,6

• Irregular periods. Heavy periods or periods that come less often may also be PCOS symptoms, advises Dr. Venkataraman. But it isn’t a foolproof sign. If you take birth control pills, your periods may be regular, but you can still have PCOS.
• Weight gain. Being overweight or obese is associated with PCOS, as is unexpected weight gain or if you can’t seem to lose weight.
• High levels of male sex hormones, especially testosterone, which is the main sex hormone in men.  
• Excessive hair. Watch for new growth on the face, stomach or upper thighs.
• Bad acne. With PCOS, acne can appear even if you’ve never had it before, or it may seem resistant to treatments.
• Oily skin. Hormonal changes can lead to an increased production of oil.
• Infertility. Often, infertility is the reason women eventually get a PCOS diagnosis.
• Insulin resistance. Your body isn’t using insulin effectively. (Insulin is a hormone that regulates blood sugar.) It’s a risk factor for developing diabetes.⁷ So your blood sugar levels might be high and that would also show up in a blood test.

It’s important to note, PCOS shows up in women in different ways – some experience one or more symptoms while others will have none of them. If you or your health care provider think you might have PCOS, they’ll typically order bloodwork to check for higher levels of testosterone. They’ll also likely recommend an ultrasound to look for cysts. However, not all women who have cysts have PCOS.

Doctors usually diagnose PCOS if you have at least 2 of the 3 main symptoms:⁸

• Irregular periods
• Cysts on ovaries
• Hormonal imbalances

PCOS affects your whole body and can increase your chance of having other conditions, including:⁷

• Diabetes
• Heart disease
• High blood pressure
• High LDL (“bad”) cholesterol and low HDL (“good”) cholesterol
• Sleep apnea
• Stroke
• Depression and possibly anxiety

That’s why it’s best to get a diagnosis as soon as possible, which will allow you to begin treatment.

It depends on your symptoms. There are three main ways to treat PCOS.

Lifestyle changes
If you are overweight or obese, your provider may start by recommending lifestyle changes, such as tweaking your diet and exercise routine. Sometimes that’s all that is needed to improve some of the PCOS symptoms that affect quality of life, explains Dr. Venkataraman.

Losing weight may also be enough to help your periods become regular. Additionally, it may also help get your insulin back on track and even clear up hormonal issues.⁵

Birth control pills
Your doctor may recommend birth control pills, which can help regulate your periods.⁴ Certain birth control medicines are a great option for treatment, as they can also decrease the level of hormones that lead to issues like male-pattern hair loss and acne.

Other medications
Birth control isn’t an option if you’re trying to have a baby. In that case, work with your ob-gyn to develop a treatment plan to manage PCOS, recommends Dr. Venkataraman. That might include medications to help ovulation and/or regulate insulin. 

“Having a diagnosis of PCOS doesn’t mean you can’t get pregnant. You absolutely can,” says Dr. Venkataraman. Even if you don’t ovulate, there’s medication to help with that. “And many women with PCOS will get pregnant on their own, by through lifestyle changes that can impact ovulation, often without fertility treatments,” she adds.  

That said, it’s important to understand the potential risks a PCOS diagnosis can have on pregnancy, which include:^5,9,10

• Miscarriage
• Gestational diabetes, a form of diabetes that happens during pregnancy
• High blood pressure
• Preeclampsia, a complication from high blood pressure that can be life-threatening
• Preterm birth, or going into labor before 37 weeks

With your ob-gyn’s help, you can come up with a plan to prevent or lower these risks, says Dr. Venkataraman. “That might involve an early test for gestational diabetes,” she adds. “Or being put on medication to minimize the risk of preeclampsia.”

Many women don’t realize they have PCOS until they start trying to have a baby and go off birth control, says Dr. Venkataraman. So, if you spot symptoms of PCOS, let your doctor know.

PCOS may cause long-term medical issues.  It can also lead to pregnancy issues for you and the fetus. But once you have a diagnosis, PCOS can be managed and treated. If you notice something’s off about your body, talking openly with your healthcare provider is a key part of advocating for yourself and supporting your health.