6 Sneaky Signs You Could Have PCOS, According to a Gynecologist

Polycystic ovary syndrome—better known as PCOS—impacts an estimated 5 million people in the U.S. While many assume the condition revolves around infertility through the reproductive ages, complications from PCOS can expand beyond that. Often paired with insulin resistance, PCOS can increase one’s risk of type 2 diabetes, high blood pressure and heart disease. 

We’re here to break down what exactly PCOS is, plus the symptoms that may seem harmless but can be tell-tale signs of the condition. Here’s what to know. 

What is PCOS?

PCOS is a chronic condition that can impact those with female reproductive systems. It can cause hormonal changes and imbalances, like excess androgen levels, ovarian cysts and even infertility. Some symptoms can be managed with a targeted eating pattern, healthy lifestyle changes, medications and fertility treatments.

The symptoms aren’t just limited to cysts and difficulty with getting pregnant, however. We talked to founder of HerMD and gynecologist Somi Javaid, MD, about the unexpected symptoms those with PCOS may experience before being diagnosed. Javaid isn’t only an expert on the topic—she personally has PCOS, so she knows what she’s talking about.

“I’ve dealt with PCOS and went through infertility and delayed diagnosis because no one believed me,” Javaid tells EatingWell. “There are subtle signs that [people] may not recognize.” 

Here are six “sneaky” signs that you may have PCOS. If you have a combination of the below symptoms, be sure to talk to your healthcare provider for further treatment.

6 Sneaky Signs of PCOS

1. You Notice Skin Changes

An uptick in acne can be a symptom of PCOS, according to the gynecologist.

“Excess testosterone may give us acne,” Javaid explains. “A lot of people have acne, so they don’t know that maybe their acne is due to PCOS and may not be responding to what other people’s acne responds to because they have an underlying hormonal imbalance.” A 2022 study explored this connection, finding acne’s association with PCOS and hyperandrogenism.

Another sign of PCOS in the skin can be redness or a specific rash.

“There’s a rash that people with PCOS can present with, it’s called acanthosis nigricans,” the doctor says. “Not all acanthosis nigricans are due to PCOS, but those with PCOS can definitely have this discoloration, usually on the neck and in body folds. It’s often missed, and a lot of people don’t know that it can be associated with PCOS.”

2. You’re Experiencing Hair Loss or Thinning

Because PCOS can elevate testosterone levels in the body, signs like hair loss or thinning can be a likely symptom, according to Javaid. While hair loss or thinning can be caused by other factors like an iron deficiency or stress, male-patterned thinning can be a sign of a hormonal condition like PCOS, and research has helped present this connection.

3. You Have Irregular Hair Growth

On the other hand, you may experience hair growth, which can take the form of excessive or thickening hair in uncommon places.

“Upper lip hair, chin hair, on our face, but it tends to be thicker,” Javaid gives as examples. “You may have more hair in the midline between the chest wall and bikini line, but for those with PCOS, it extends further out onto their thighs.” One study highlights this symptom, noting that hirsutism (excess hair growth) is “not uncommon” for those with PCOS, even if normal androgen levels are detected.

While it can be a harmless symptom, if you’re having abnormal hair growth, consider your other health conditions before writing it off.

4. You’ve Gained Weight

There are many factors that may explain why you’re gaining weight, and gaining weight can be healthily explained by increased muscle mass. However, if you’re gaining weight and you’re unsure why, a hormonal imbalance could be the reason. There’s a 2019 journal article that showcases exactly this: PCOS can be a cause of weight gain or obesity, and vice versa. The article explores the potential mechanisms linking obesity with PCOS, which include mental and emotional health, energy expenditure, genetic factors and more.  

“The first thing many PCOS patients come to me for is, ‘I’m trying to lose a few pounds and no matter what I do, I can’t lose weight,’” Javaid notes. “Weight gain is a common symptom, especially when efforts are being made to lose weight and [you’re experiencing] resistance.” There are medications that can help with this resistance, but be sure to talk to your doctor for the best lifestyle option.

5. Your Menstrual Cycles Are Abnormal

While an irregular menstrual cycle is not always a telltale sign of PCOS, if you’re noticing long-term delays for your period, Javaid says this is a red flag.

“Most of us will have irregular cycles at some point in our life due to stress, a move, a change in the job, whatever it is, it’s not atypical for us,” she explains. “But if we continue to have irregular cycles or they start to go away completely—like 36 months at a time without a period and we’re not pregnant—that might be a sign of PCOS.”

There are foods that can support your cycle like colorful fruits and veggies, fatty fish and fermented foods, but you should talk to your doctor if your schedule is abnormal and you’re unsure of the cause.

6. You’re Experiencing Chronic Pain

Whether mild or severe, long-term pain anywhere should be addressed—and if yours is in the pelvic area, you should pay a visit to your gynecologist. 

“The ovaries can be cystic, so there may be a continual dull ache in the lower abdomen or pelvis area, and you don’t realize that’s a sign of PCOS,” Javaid states. 

The Bottom Line

PCOS is a fairly common condition that can be managed with the right medical treatment and promotion of a healthy eating pattern and lifestyle. The listed symptoms are often overlooked, but if you are experiencing one or a combination of the above signs, definitely talk to your doctor about your concerns.