HOW TO SPOT AND MANAGE COMMON PCOS SYMPTOMS

Updated May 2024 | 5 min read
Expert contributors Helena Teede, Professor of Women’s Health, Monash University; Dr Sonia Davison, endocrinologist, Jean Hailes for Women’s Health
Words by Angela Tufvesson

PCOS is a complicated condition that’s difficult to diagnose. So, what are the common PCOS symptoms and how do you treat them?

Weight gain. Acne. Irregular periods. Fertility troubles. Excess facial or body hair. These are some of the most common symptoms of polycystic ovary syndrome (PCOS), a complex condition that affects 8 to 13% of women* of reproductive age.

PCOS can be tricky to diagnose, and while there’s no known cure, the good news is there’s a lot that can be done to manage symptoms.

What is PCOS?

Ovaries contain follicles in which eggs develop. Normally, only two to five follicles develop at the one time, scattered throughout the ovary.

A woman may be diagnosed with polycystic ovaries if she has a larger number of follicles – or cysts – developing at the same time (‘polycystic’ literally means ‘many cysts’). These partially formed follicles rarely grow to maturity or produce eggs that can be fertilised.

Polycystic ovaries are generally larger than normal ovaries and have a slightly different appearance.

What are common PCOS symptoms?

According to Better Health Channel, common PCOS symptoms include:

• irregular menstrual cycles or no period at all (amenorrhoea)
• excessive facial and/or body hair growth
• scalp hair loss
• acne
• fertility issues
• stress, anxiety and depression
• weight gain
• sleep apnoea.

Signs of PCOS may vary between women, says endocrinologist Dr Sonia Davison from Jean Hailes for Women’s Health. “Not everyone has the same presentation – for example, some women may have mostly regular periods, but have acne and excess hair growth and not be overweight,” she says. “Others may be overweight, never have periods and have scalp hair thinning.”

How is PCOS diagnosed?

According to Jean Hailes for Women's Health, PCOS is usually diagnosed when two of the three following criteria are met.

• The ovaries are ‘polycystic’, meaning medical scans show there are multiple follicles accumulated in the ovaries, or the size of the ovaries has increased.
• High levels or suspected high levels of male hormones are detected.
• A woman is experiencing problems with periods, such as irregularity or lack of ovulation.

PCOS is difficult to diagnose because symptoms can vary dramatically. Multiple cysts on the ovaries (as shown by a scan), may not always indicate PCOS. Blood tests are typically used to understand more about any potentially high hormone levels.

What causes PCOS?

The exact cause of PCOS isn’t fully understood. Helena Teede, a professor of women’s health at Monash University, says a combination of genetic, hormonal and environmental factors are believed to play a part in the development of PCOS.

“If you've got PCOS in your family, it’s very highly inherited, and it’s also caused by a hormonal environment in the uterus that has excess male hormones and other ovarian hormones,” she says.

According to Jean Hailes for Women's Health, there’s also a connection between insulin resistance – a condition where your body produces more insulin than usual – and PCOS. Insulin resistance is present in around 85% of women with PCOS. It’s believed high levels of insulin affect how the ovaries work, which triggers the symptoms.

And then there’s weight gain, a common PCOS symptom that also worsens insulin resistance. “High insulin causes weight gain, and problems with weight gain cause high insulin, so it’s a bit of a vicious cycle,” says Prof Teede.

PCOS and your health

Never heard of PCOS? You’re certainly not alone. Awareness of the condition remains low, so much so that research suggests as many as 70% of women with PCOS remain undiagnosed.

Prof Teede says PCOS usually appears in adolescence, but women who are diagnosed don’t typically receive a diagnosis until much later in life.

“Most adolescents are actually missed – they’re put on the oral contraceptive pill and they don’t find out they’ve got it until their late 20s or early 30s when they want to have children,” she says.

Receiving a diagnosis later in life matters because PCOS is often associated with increased risk factors for type 2 diabetes, high cholesterol and cardiovascular disease, as well as a greater chance of fertility challenges because of problems with the menstrual cycle.

There’s also evidence that PCOS can affect mental health. A recent study, co-authored by Prof Teede, found women with PCOS are more likely to experience low self-esteem, psychological distress and eating disorders.

Treating common PCOS symptoms

Prof Teede says education and empowerment are the most important forms of PCOS treatment. “If you understand the condition, you can have some influence over it,” she says. “If you don’t understand the condition, it’s something that happens to you.”

Lifestyle changes – like eating a healthy, balanced diet and getting regular exercise – may also be important, especially when it comes to managing weight gain. “If weight excess is a problem, even 5 to 10% weight loss can improve ovarian function and have an impact on symptoms,” says Dr Davison.

According to Jean Hailes for Women's Health, other forms of treatment for PCOS may include medications and hormonal treatments such as the contraceptive pill and anti-androgen therapy (androgen is a steroid hormone) to manage excess hair growth, acne and to help regulate the menstrual cycle.

When it comes to fertility, Prof Teede says problems with falling pregnant are treatable for most women with the condition. “Sometimes lifestyle changes and a small degree of weight loss is all that’s needed; sometimes it’s medication and rarely is it IVF,” she says.

Support with managing PCOS symptoms

Managing the symptoms of PCOS with a multidisciplinary approach may help reduce the risk of long-term health problems caused by the condition. Better Health Channel recommends including the following healthcare professionals in your PCOS management team.

• Your GP
• An endocrinologist, to treat underlying hormonal issues
• A gynaecologist, if you're concerned about bleeding or fertility
• A dietitian, exercise physiologist and/or physiotherapist to help with lifestyle changes
• A psychologist to provide mental wellbeing support

A GP at your fingertips

Looking for a convenient way to speak to a GP? Our partnership with GP2U, an online video GP service, makes it easier for you to access telehealth services. Speak to a GP from the convenience of your own home – GP2U doctors can issue prescriptions, referrals to specialists and provide medical certificates just like visiting a GP in a practice. All HCF members with health cover can access a standard GP consultation (up to 10 minutes) for a fee of $50. See hcf.com.au/gp2u for more information.

If you’re experiencing depression or need to talk to someone now, call Lifeline on 13 11 14.

Want to know more about PCOS? Download Monash University’s AskPCOS app, an evidence-based resource developed by leading PCOS experts from around the world.