Do I Have PCOS? A Symptoms Guide and What to Do Next
Polycystic ovary syndrome (PCOS) is diagnosed in an estimated 6–12% of women of reproductive age, yet studies suggest that up to 70% of affected women remain undiagnosed. PCOS is a complex hormonal and metabolic condition with a wide range of symptoms that vary significantly between individuals—making it easy to miss, dismiss, or misattribute to other causes. If you suspect PCOS, this symptom guide will help you identify relevant patterns and understand what steps to take next.
PCOS Symptoms Checklist
Review the following symptoms and note which apply to you. A pattern of multiple symptoms—particularly menstrual irregularities combined with signs of androgen excess—warrants formal evaluation.
Menstrual irregularities:
- Periods that come fewer than eight times per year (oligomenorrhea)
- Periods that are completely absent for three months or more (amenorrhea)
- Cycles that are unpredictably long (more than 35 days) or short (fewer than 21 days)
- Very heavy or very light periods
Signs of androgen excess:
- Coarse, dark hair on the face (especially the chin and upper lip), chest, abdomen, or back (hirsutism)
- Persistent acne, particularly along the jawline, chin, and neck, that does not respond well to topical treatments
- Hair thinning or loss at the scalp crown or temples (female-pattern hair loss)
- Oily skin
Metabolic and weight-related symptoms:
- Difficulty losing weight despite diet and exercise
- Weight concentrated in the abdomen
- Darkened, thickened skin in skin folds (neck, armpits, groin)—a sign of insulin resistance called acanthosis nigricans
- Strong cravings for sugar and carbohydrates
- Energy crashes after meals
Fertility and reproductive concerns:
- Difficulty getting pregnant
- History of multiple miscarriages
- Ovarian cysts identified on ultrasound
Mood and cognitive symptoms:
- Anxiety or depression, often worsening before periods
- Brain fog and difficulty concentrating
- Low energy or persistent fatigue
Understanding the Rotterdam Diagnostic Criteria
PCOS is diagnosed using the Rotterdam criteria, which require two out of the following three features:
1. Irregular or absent ovulation — manifested as irregular or absent periods.
2. Clinical or biochemical signs of hyperandrogenism — either visible signs (hirsutism, acne, scalp hair loss) or elevated androgens on laboratory testing (elevated total testosterone, free testosterone, DHEA-S, or low SHBG).
3. Polycystic ovarian morphology on ultrasound — ovaries containing 12 or more follicles measuring 2–9 mm in diameter, or increased ovarian volume (greater than 10 mL).
Crucially, you do not need to have ovarian cysts to have PCOS, and many women with polycystic-appearing ovaries on ultrasound do not have PCOS. The name is somewhat misleading—the condition is fundamentally one of hormonal and metabolic dysregulation, not a structural ovarian disease.
What Testing Is Needed?
A thorough PCOS evaluation includes several components. Laboratory testing should include: total and free testosterone, DHEA-S, androstenedione, SHBG, LH, FSH (and LH:FSH ratio), fasting insulin and glucose (for HOMA-IR calculation), HbA1c, a lipid panel, prolactin (to rule out hyperprolactinemia), free T4 and TSH (to rule out thyroid dysfunction), and AMH (anti-Mullerian hormone, a marker of ovarian reserve). Pelvic ultrasound is performed to evaluate ovarian morphology and rule out other structural causes of symptoms.
BHRT for PCOS
For women whose PCOS is primarily driven by hormonal imbalance rather than insulin resistance, bioidentical hormone replacement therapy (BHRT) can be a highly effective treatment tool. Natural progesterone helps regulate cycle timing, reduces androgenic stimulation of hair follicles, and supports the progesterone deficiency that results from chronic anovulation. In some cases, low-dose estrogen or testosterone modulation is also appropriate.
BHRT does not replace insulin sensitization strategies—in fact, it works best when combined with lifestyle modification, appropriate supplementation, and metabolic treatment. But for women who cannot tolerate synthetic hormones, or who prefer a more individualized approach, BHRT offers a flexible and personalized option.
Next Steps
If you recognize several of these symptoms in your own experience, the next step is a comprehensive evaluation with a provider experienced in PCOS and hormonal medicine. Generic testing and treatment from a provider unfamiliar with the complexity of PCOS often produces incomplete results.
Dr. Kenton Bruice, MD, offers expert PCOS evaluation and treatment at his clinics in Denver, Aspen, and St. Louis. His integrative approach—combining hormonal testing, metabolic assessment, BHRT, and lifestyle guidance—delivers a level of personalized care that goes far beyond the typical PCOS workup. Contact Dr. Bruice's office to schedule your evaluation.