A Beginner’s Guide to PCOS

Written by Kathleen Morrison
Medically Reviewed by Andrea Sleeth WHNP-BC, MSCP

Key takeaways

• PCOS is a complex condition that impacts your hormone levels. It is the most common hormonal disorder in reproductive-aged women.
• Symptoms vary widely and can include irregular or absent periods, excess hair growth, acne, weight gain, and difficulty getting pregnant.
• Insulin resistance doesn't cause PCOS, but it can worsen symptoms and increase your risk of developing type 2 diabetes and cardiovascular issues over time.
• Diagnosis requires at least two of three criteria: irregular ovulation, signs of excess androgens, or polycystic ovaries on ultrasound.
• While there's no cure, treatments like hormonal birth control and medications can help manage symptoms and reduce long-term health risks.
• Lifestyle changes and support options, such as weight loss, exercise, and diet can help aid PCOS symptoms alongside treatment.

Polycystic ovarian syndrome (PCOS) is the most common hormonal disorder among reproductive-aged women. And, because it’s so common, that means we know everything there is to know about it, right? Right?? Sigh, not quite. While as many as 5.2% of women have PCOS, it often goes undiagnosed, and the exact causes of PCOS aren’t totally understood.

So, in the name of medical self-advocacy, we’re here to supply you with as much knowledge about this tricky syndrome as we can!

Read on as we answer the most common questions about PCOS, including what it is, how it’s diagnosed, symptoms and causes, and treatments for PCOS.

Let’s dive in.

What does PCOS stand for?

Alright, first things first. PCOS stands for polycystic ovary syndrome. Let’s break down what that actually means.

• Polycystic: “Poly” means “many” and “cystic” refers to cysts, or small, fluid-filled sacs
• Ovarian: Dealing with the ovaries, or the female reproductive organs that produce eggs
• Syndrome: A group of symptoms that happen together

How do polycystic ovaries happen? Well, inside your ovaries, there are thousands of follicles that each contain one immature egg.

When an egg is mature, the follicle breaks open and releases the egg–this is the process of ovulation. But if an egg doesn’t fully mature and the follicle doesn’t release it, the follicle can swell up and become a cyst.

So, the name “PCOS” comes from the fact that some people with this condition often have multiple follicles-turned-cysts in their ovaries.

But! Not everyone with PCOS has ovarian cysts, and having them doesn’t mean you 100 percent have PCOS.

What is PCOS?

Okay, now we know where its name comes from. But what is PCOS exactly?

PCOS is a complex condition that impacts your hormone levels. If you have PCOS, your ovaries produce higher levels of “male” hormones called androgens, and lower levels of estrogen and progesterone. This hormonal imbalance is known as hyperandrogenism, and it’s one of the main signs a doctor will check for during your diagnosis of PCOS.

Hyperandrogenism can cause several issues, including:

• Problems with ovarian follicle development
• Irregular ovulation, or you don't ovulate at all
• Irregular or absent periods
• Ovarian cysts
• Growth of excess facial and body hair

Because it can seriously mess with ovulation, PCOS often makes it more difficult to get pregnant. PCOS can also increase your risk of developing diabetes, high blood pressure, sleep disorders, cardiovascular disease, depression, and endometrial cancer. Recognizing the signs and symptoms can help you seek out a diagnosis and treatment for PCOS so you can help stop it from impacting your quality of life. So, with that in mind, let’s talk PCOS symptoms.

What are the symptoms of PCOS?

The symptoms of PCOS can vary widely from person to person, both in terms of which symptoms you have and how severe they are. Some of the most common symptoms include:

• Polycystic ovaries: As the name suggests, one of the most common signs of PCOS is having enlarged ovaries with multiple small cysts.

• Irregular periods: The average menstrual cycle is about 28 days, though it’s normal to have cycles that last between 21 and 35 days. About 80 percent of women with PCOS have cycles longer than 45 days or have no period at all.

  If you do get a period, it might be very heavy because you’re getting rid of several months of endometrium build-up.

  If you’re experiencing long gaps in your cycles, you may want to chat with your healthcare provider about cycle regulation/monitoring—these gaps can increase your risk of endometrial cancer.

• Excess hair growth: Due to the high levels of androgen hormones, PCOS can cause excess hair growth – called hirsutism – on the face, chest, back, or lower stomach.

• Acne and oily skin: The hormonal imbalance associated with PCOS can make your skin oily and cause hormonal acne on your face, chest, and back.

• Thinning hair or alopecia: PCOS can cause hair thinning on the scalp and can sometimes lead to alopecia.

• Weight gain: PCOS can make it difficult to maintain a healthy weight and can lead to unexplained weight gain. A weight care consult can help here.

• Skin darkening or skin tags: PCOS can cause patches of darker skin around your neck, armpits, groin, or under your breasts. You might also find extra bits of skin, known as skin tags, in the same areas.

• Difficulty getting pregnant: Many people are unaware that they have PCOS until they have trouble getting pregnant, due to disrupted ovulation. PCOS remains a common cause of infertility among women, but there are ways to combat it.

You definitely don’t have to have all the symptoms of PCOS to be diagnosed, and it’s possible for symptoms to be mild or go unnoticed.

Women often get diagnosed with PCOS after talking with a doctor about the more noticeable symptoms like infertility, acne, weight gain, or irregular periods.

But the sooner you suspect you have it, the sooner you can start looking into the treatments for PCOS that best suit your needs.

Wisp treatment options are available only after consultation with a licensed medical professional. You should consult with your healthcare provider before starting a new supplement or treatment regimen. Individual results may vary.

Can insulin resistance cause PCOS?

Insulin resistance doesn’t directly cause PCOS, but it can significantly contribute to how severe symptoms become.

You should know that PCOS is a complex syndrome with multiple contributing factors (including genetic and developmental influences).

So, there isn’t one single “root cause” for everyone.

In other words, you didn’t “cause” this—your body is responding to a real metabolic-hormonal feedback loop that can be treated and managed.

Insulin resistance and PCOS loop into a vicious cycle

Insulin resistance and PCOS can feel like they’re ganging up on you because they really do feed into each other in a vicious cycle.

When your cells are insulin-resistant, your body has to pump out more insulin to keep blood sugar in a safe range.

Those higher insulin levels can stimulate the ovaries and adrenal glands to make more androgens (like testosterone) and reduce SHBG (sex hormone binding globulin), which increases free, active androgens.

That hormone imbalance is a big part of what drives a set of symptoms like irregular ovulation, acne, and excess hair growth.

Over time, this cycle doesn’t just impact periods and fertility; it also raises long‑term risks like prediabetes, type 2 diabetes, and cardiovascular issues if it’s not addressed.

Breaking this cycle often starts with insulin-sensitizing approaches like metformin alongside lifestyle tweaks that can help reduce your symptoms.

Insulin resistance vs prediabetes in PCOS

Insulin resistance describes how your cells respond to insulin (they need more insulin to do the same job).

Prediabetes is a blood-sugar diagnosis that can happen when insulin resistance has been present long enough that glucose levels start trending higher than normal.

• You can have insulin resistance in PCOS even if your blood sugar is still “normal.”
• PCOS is associated with a higher risk for type 2 diabetes and heart disease over time, which is why screening matters.
  

How is PCOS diagnosed?

Alright, to get a PCOS diagnosis, providers look for at least two of the three following symptoms:

• Irregular periods or no periods at all
• Signs of hyperandrogenism
• Polycystic ovaries

During a diagnosis, your health care provider should ask about your menstrual cycle, your medical history, and your symptoms. They can check for physical signs of high levels of androgens, like hair growth and acne, and confirm the hormone levels with blood tests.

A pelvic exam or ultrasound will show the doctor if you have cysts on your ovaries, though not everyone with PCOS has cysts.

Unfortunately, getting a diagnosis for PCOS isn’t always a straightforward process. This can be because doctors need to rule out other possible hormonal conditions with symptoms similar to PCOS, such as thyroid disease.

So, it’s important to listen to your body, keep track of your symptoms, and advocate for yourself medically if you are able.

How do I treat PCOS?

While there is no cure for PCOS, there are several treatment options available to help manage your symptoms and reduce your risk of long-term complications. Treatments for PCOS include:

• Hormonal birth control: If you’re not planning to become pregnant, taking hormonal birth control is one of the best treatments for PCOS–whether you choose birth control pills, the patch, the ring, or a hormonal IUD. Birth control can regulate your periods, reduce your androgen levels, and help with symptoms like PCOS acne, and hair growth.

• Fertility treatments: If you have PCOS, you can still absolutely get pregnant. But you should talk with a doctor about taking medication that stimulates ovulation. The medication clomiphene stimulates ovulation in 70 to 80 percent of cases, but your doctor can recommend intrauterine insemination or IVF if you’re still struggling to conceive.

• Antiandrogens*: Remember how PCOS makes you have higher levels of androgen hormones? Well, your doctor can prescribe medications called antiandrogens like spironolactone. These help lower androgen levels and reduce PCOS acne and hair growth.

*Wisp only offers spironolactone. For other anti-androgen options, we recommend you see a qualified in-person provider for full evaluation and treatment.

Lifestyle strategies that can help support PCOS women

We wish there were a magic pill to make PCOS disappear, we really do. But, since there’s not one great PCOS natural treatment, it can be helpful to maintain a healthy weight through:

• Diet
• Daily exercise
• Limiting alcohol consumption
• Avoiding cigarettes.

This can help support healthy androgen production, regulate ovulation, and improve irregular menstrual periods.

Does birth control help PCOS?

Good news here! Birth control is one of the most common and effective treatments for managing PCOS symptoms.

Hormonal birth control regulates your menstrual cycle, ensuring that you have a period (if you want one).

It also ensures your uterine lining doesn’t build up month after month, which can cause extra heavy periods or can put you at a high risk of endometrial cancer.

Besides regulating your period, birth control helps lower your androgen production and helps balance out your hormones. This means that the pill can serve as a PCOS acne treatment–along with other prescription skincare products if needed–and can help reduce unwanted hair growth.

That said, it’s important to find the pill that works best to help you manage your symptoms.

At Wisp, we connect you with licensed providers who help you figure out your best treatment, so you can get back to living your best life.

This blog post is for informational and educational purposes only and should not be taken as professional advice. Always consult with a qualified professional before making any decisions based on the information provided here.