PCOS Symptoms: Understanding Your Hormones

Polycystic ovary syndrome (PCOS) is one of the most common hormonal and metabolic conditions, estimated to affect 1 in 10 women in the UK. Despite how common it is, the journey to a diagnosis can be challenging; research shows it can take, on average, two years and multiple doctor visits to get a confirmed diagnosis.

PCOS is characterised by an imbalance of sex hormones, which can cause a host of symptoms – from irregular cycles and challenging skin issues to difficulty managing weight and long-term health risks. It’s a systemic condition, but with the right diagnosis and personalised management plan, its impact on your health and wellbeing can be controlled.

This article outlines everything you need to know about PCOS. We’ll also explain how our Advanced At-Home Hormone and Fertility Test can uncover the root causes of your symptoms and step towards a quicker diagnosis. 

What is Polycystic Ovary Syndrome (PCOS)?

PCOS is a complex condition characterised by three main features, of which you need to be experiencing at least two to receive a diagnosis (known as the Rotterdam criteria) (Teede et al., 2018):

1. Irregular or absent periods (oligomenorrhoea or amenorrhoea).
2. Increased androgen levels (hyperandrogenism), confirmed by blood tests (e.g., high testosterone) or physical symptoms (e.g. acne, excessive hair growth (hirsutism)).
3. Evidence of polycystic ovaries on an ultrasound scan or through a hormone blood test (specifically, high AMH).

It’s important to remember that ‘polycystic ovaries’ do not mean true cysts; they are actually immature follicles that haven’t developed correctly due to hormonal imbalances.

💡 Think you may have PCOS? 

Take our Advanced At-Home Hormone and Fertility Test to screen for Polycystic Ovary Syndrome and uncover the specific hormonal imbalances driving your symptoms.

Common Symptoms

PCOS manifests differently in everyone, but the most common symptoms are driven by elevated levels of androgen hormones (like testosterone) and metabolic dysfunction.

Cycle-Related Symptoms (Irregular Ovulation)

PCOS often prevents the ovaries from regularly releasing an egg (a process called anovulation). This hormonal disruption leads to:

• Irregular Periods: Cycles that are very long (more than 35 days apart) or no periods at all (amenorrhoea). This occurs because the hormonal communication involving which triggers ovulation is disrupted.
• Heavy Bleeding: When ovulation doesn’t happen, the uterine lining builds up excessively under the unopposed influence of oestrogen, resulting in unusually heavy periods when the lining finally sheds.

Skin and Hair-Related Symptoms (Hyperandrogenism)

These visible symptoms are direct consequences of high androgen activity in the skin and hair follicles:

• Hirsutism: Excessive hair growth, typically coarse and dark, in androgen-sensitive areas like the upper lip, chin, chest, or inner thigh.
• Hormonal Acne and Oily Skin: Androgens, particularly testosterone, stimulate the sebaceous glands to produce excess sebum, leading to persistent, often cystic, acne along the lower face and jawline.
• Scalp Hair Thinning: Conversely, in scalp follicles, androgens can cause a gradual thinning of the hair, often resulting in a widening part-line.

Metabolic and Weight Symptoms

PCOS affects your metabolism, which can lead to weight issues:

• Weight Gain: Many people with PCOS experience weight gain, particularly around the abdomen (central adiposity), making weight loss difficult.
• Acanthosis Nigricans: Dark, thickened patches of skin around the armpit, neck, or groin, which is a physical symptom of insulin resistance.

Mental Health and Fertility

Living with the physical symptoms and systemic nature of PCOS can take a toll:

• Mental Health: People with PCOS are more likely to experience mental health symptoms, including depression and anxiety, due to the combination of hormonal fluctuation and the negative impact of visible symptoms on their quality of life.
• Difficulty Conceiving: The hormonal imbalance causes irregular or absent ovulation, making conception tricky. However, it’s vital to know that most people with PCOS can get pregnant, often with minimal assistance.

Hormonal Causes and Diagnosis

The symptoms of PCOS are primarily driven by two key hormonal issues: high androgens and insulin resistance.

High Androgens: The Core Driver

People with PCOS often have higher-than-normal levels of androgens, such as testosterone. This hormonal elevation, known as hyperandrogenism, is the direct cause of the skin, hair, and cycle issues.

High androgen levels disrupt the delicate balance of hormones like LH and FSH, preventing follicles from maturing properly and causing a build-up of immature follicles in the ovaries – the ‘polycystic’ appearance seen on scans.

Insulin Resistance: The Metabolic Link

Many people with PCOS experience insulin resistance, meaning their body doesn’t respond properly to the hormone insulin.

To compensate, the body produces excess insulin. These high levels then have a crucial negative effect on the ovaries:

• They stimulate the ovaries to produce even more androgens (testosterone).
• They decrease the production of sex hormone-binding globulin (SHBG), a protein that regulates testosterone. Low SHBG means more free testosterone is active in the bloodstream, amplifying androgenic symptoms.

This interconnected hormonal loop is what drives the severity of PCOS symptoms.

PCOS and Ethnicity

PCOS affects people of all ethnic backgrounds, but research shows that those from ethnic minority communities, especially those who are Black or South Asian, are at a higher risk. 

Interestingly, the symptoms can differ depending on your ethnicity (VanHise et al., 2023): women of South Asian and Middle Eastern descent are often more likely to experience excessive body and facial hair, while women of East Asian descent are more likely to experience irregular periods.

Managing PCOS with Hertility

There is no cure for PCOS, so management is focused on controlling symptoms and mitigating long-term health risks such as Type 2 diabetes, cardiovascular disease, and endometrial cancer.

The first step is always diagnosis and a personalised plan, often involving a multidisciplinary team.

When to Get Tested

If you suspect you have PCOS based on a history of irregular periods, signs of hyperandrogenism (acne, hirsutism), and difficulty managing weight, testing is vital. Early diagnosis allows for a proactive approach to long-term health.

Testing a full panel of personalised hormones provides essential diagnostic data needed to find the root cause, tailored to your symptoms and concerns.

1. Confirm Hyperandrogenism: Hertility tests measure Testosterone, SHBG, and DHEAS to confirm if androgen levels are elevated and if the free (active) testosterone is high. This is a core diagnostic pillar.
2. Assess Ovarian Health: We check AMH (often high in PCOS) and the ratio of LH to FSH to confirm ovulatory dysfunction and the polycystic feature of the condition.
3. Rule Out Other Conditions: We check thyroid-stimulating hormone (TSH) and Free Thyroxine to ensure thyroid conditions, which can mimic cycle irregularity and weight issues, are ruled out.

Managing Your Condition

Effective management is often achieved through a combination of lifestyle changes and targeted medical support (NHS, 2022):

• Lifestyle Management: This is the foundation of PCOS treatment. Focusing on a healthy, sustainable diet (often a low Glycaemic Index approach to manage insulin spikes), regular exercise (including cardio and weight training to target abdominal fat), and stress management can significantly improve symptoms and help regulate ovulation.
• Medication: Treatments are symptom-specific and may include hormonal birth control (to regulate periods and reduce androgens), anti-androgen therapy (like Spironolactone, to target hair and acne), or insulin-sensitising agents (like Metformin) to manage blood glucose.

If you are struggling with a recent diagnosis or symptoms, you don’t need to suffer in silence.

💡 Take control of your hormones today

Take our Advanced At-Home Hormone and Fertility Test to screen for Polycystic Ovary Syndrome and uncover the specific hormonal imbalances driving your symptoms.

References

• https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/ 
• https://www.verity-pcos.org.uk/what-is-pcos.html 
• https://womenshealth.gov/a-z-topics/polycystic-ovary-syndrome 
• Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R. J., & International PCOS Network (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and sterility, 110(3), 364–379. https://doi.org/10.1016/j.fertnstert.2018.05.004 
• VanHise, K., Wang, E. T., Norris, K., Azziz, R., Pisarska, M. D., & Chan, J. L. (2023). Racial and ethnic disparities in polycystic ovary syndrome. Fertility and sterility, 119(3), 348–354. https://doi.org/10.1016/j.fertnstert.2023.01.031