When Oludara Adeeyo began missing her period for long stretches as a teenager, her pediatrician didn’t think much of it. “They told me I was going through this because I was an athlete,” she recalls. When Adeeyo did bleed every five or seven months, it was super heavy—and crampy. “I would literally go through a box of extra-heavy period pads with wings in two days.”
By the summer of Adeeyo’s freshman year at college, she’d gained 30 pounds—for seemingly no reason at all—and once bled for a month straight. Adeeyo’s doc referred her to a gynecologist; after a round of blood tests and an ultrasound, they diagnosed her with polycystic ovary syndrome (PCOS). Though no one really understands what causes the hormonal disorder, experts do know that PCOS makes you overproduce sex hormones called androgens—which can confuse the heck out of your body, Joshua Klein, MD, FACOG, a reproductive endocrinologist and co-founder of Extend Fertility in New York City.
As the name suggests, it can also cause you to develop cysts—or, more accurately, a bunch of tiny, immature follicles, which are basically stunted egg cells—in your ovaries. That was true for Adeeyo, although not everyone with PCOS gets them. Frustratingly, this condition can come along with some painful and emotionally challenging symptoms. It can also go undiagnosed (and untreated) for long periods, and though it’s not technically life-threatening, it can affect your fertility and make you susceptible to other disorders down the road, experts say. Here are five potential signs of PCOS to watch for.
1. Your period is unpredictable—and when it comes, it’s gushing.
It’s not uncommon for a person’s cycle to fluctuate, G. Thomas Ruiz, MD, an ob-gyn at the MemorialCare Orange Coast Medical Center in Fountain Valley, California, tells SELF. The loss of a loved one, the death of a parent—any high-stress situation can cause someone to miss a period or two, he explains. But, as Dr. Ruiz notes, once that fraught situation passes, your period should (in theory) come back. Off- and on-again menses might also mean you’ve gained or lost some weight recently, swapped birth control methods, started a new medication, or are dealing with an infection, like pelvic inflammatory disease (which develops when STIs move from your vagina to your uterus, fallopian tubes, or ovaries), or even COVID-19.
Aside from those factors though, most menstruating people bleed *roughly* every 21 to 35 days, Alla Vash-Margita, MD, a gynecologist at the Adolescent Gynecology and Endocrinology Program at Yale Children's Hospital, tells SELF. While doing so less often doesn’t necessarily mean a person has PCOS (or any other health issue), it is something that might make an ob-gyn’s ears perk up. That’s because those extra androgens can impact your ovaries, a.k.a. the organs responsible for your cycle and ability to get pregnant. That means you also might have fertility problems. Dr. Ruiz says that, if you’ve been trying for a year with no success, you might have something going on (and PCOS could be one culprit to look into).
PCOS can also change how your period looks and feels. If you haven’t had one in several months, then suddenly it arrives, there might be a big buildup of endometrial tissue (a.k.a. the uterine lining) and, as a result, the bleeding might be “heavy, long, and painful,” says Dr. Vash-Margita. Adeeyo, who’s now a Los Angeles-based mental health therapist and author, recalls that her month-long period was pretty heavy with a dark red color. “I felt as if someone cut me up on the inside,” she says. “It would be lighter in the mornings, but for the most part, it was constant bleeding and I justified it because I hadn’t had a period for months prior so I was like, ‘Oh this is just built-up blood.’ Girl, please.”
2. You have (or once had) deep cystic acne on your jawline, face, chest, or arms.
Acne can show up in a ton of ways—and for a boatload of reasons. But PCOS pimples tend to look and feel a lot different than, say, a random cluster of whiteheads, Gil Weiss, MD, an ob-gyn and assistant professor of clinical medicine at Northwestern Memorial Hospital, tells SELF: You’ll typically see large, deep cysts, rather than small, superficial pimples, Dr. Weiss says. (They may or may not appear red, depending on your skin tone.) For Dr. Vash-Margita, where acne shows up also factors into her PCOS suspicions. “It’s usually severe, inflammatory acne on the face, upper chest, upper back, upper arms.”
So why might PCOS trigger these types of breakouts? It comes back to those excess androgens, which can stimulate your oil glands and make an ideal environment for acne-causing bacteria to thrive. (Still, acne alone wouldn’t constitute a diagnosis, Dr. Vash-Margita reiterates—it’s just one potential indicator.)
Perhaps a bit more subtle sign of PCOS? Even if cystic acne faded long ago (say, you exited your tumultuous teen years and the hormonal pandemonium that went with it—thank God), Dr. Vash-Margita says that the skin condition can sometimes lead to a lot of scarring—and a doc might note that when considering a diagnosis.
3. You have more—or less—hair in places that aren’t your usual.
It’s not uncommon to get a few stray strands on your chin every now and then, or some growth on your upper lip. Still, if you’re dealing with hair in places that aren’t typical for you, Dr. Vash-Margita says it could be something to pay attention to because excess androgens cause it to sprout in unexpected spots.
Still, she rarely makes a PCOS diagnosis based on this alone—rather, she asks the person how they feel about it. “Some people are okay with facial hair, and some people are bothered by it. You can never assume,” she explains, noting that the upper lip, chin, sideburns, lower abdomen, or lower back can be growth areas. Hair loss can also be a potential sign that something’s up because androgens can cause thinning, particularly at the top of your head, and widening down your middle part, which is known as androgenetic alopecia.
4. Your insulin levels are off.
A lot of people with PCOS have a higher risk of insulin resistance, meaning the body loses its sensitivity to the hormone, Dr. Klein says. People who have PCOS tend to have, on average, elevated levels of blood sugar and insulin, he explains, which can lead to more serious health problems, like heart disease and type 2 diabetes. Scientists aren’t exactly sure why, but “we do know that the reproductive hormonal imbalance and metabolic disruption that is common in PCOS is involved,” Dr. Klein says. This can—but not in all cases—be accompanied by more body fat than is normal for you, particularly around your waist. Nearly half of all people with PCOS also have metabolic syndrome, a cluster of health markers—including high blood pressure, blood sugar, and a type of fat in the blood called triglycerides—that can absolutely mess with your health, Dr. Vash-Margita says.
5. You’re feeling depressed and out-of-sorts.
According to Dr. Klein, there’s no question that PCOS and mental health are intertwined—people with the condition are at a higher risk for things like depression, anxiety, and eating disorders. As for whether living with PCOS causes those things to happen, that’s scientifically TBD, he notes: “It’s a little messy. It’s not a very straight-line type of relationship.”
Still, as Dr. Ruiz says, how a person feels about their PCOS symptoms may play a role—particularly when they don’t feel like they’re in the driver’s seat when it comes to certain body changes. “I feel like [PCOS] controls my life,” Adeeyo says. “Things that may impact other women a little impact me gravely.”
How PCOS is treated will depend largely on your age, overall health, and what symptoms are more bothersome to you—some hormonal birth control pills or androgen blockers can help offset cystic acne and hair growth, while other meds can help keep insulin levels in check. If fertility is the issue, treatments like ovulation-inducing medications or in vitro fertilization (IVF) can help.
If you’re wondering if you might have PCOS, or even struggling with a few of these symptoms, Adeeyo stresses that a little self-compassion can go a long way. “Be kind to yourself—there is nothing wrong with your body. It just operates differently and you need to find what helps you optimize your body’s ability to take care of you. Do not give up.”
Related:
