Woman touching her face noticing first signs of PCOS

What Are The First Signs Of PCOS?

Written on October 4, 2023 by Sendra Yang, PharmD, MBA. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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Polycystic ovarian syndrome, or PCOS, was first described in 1935.[1] The prevalence ranges between 12% to 15%, depending on the diagnosis criteria.[1,2] PCOS is one of the most common causes of female infertility issues, impacting as many as an estimated 5 million women in the United States of reproductive age.[1,2] Continue reading to learn more about the first signs of PCOS.

More About PCOS

Even though the prevalence of PCOS is high, the syndrome is often underdiagnosed and frequently takes more than one visit with different healthcare providers to identify the disorder.[2] Multiple conditions are associated with PCOS, such as infertility, metabolic syndrome, obesity, type 2 diabetes, depression, cardiovascular risk, and endometrial cancer.[1] Healthcare system costs to diagnose and treat PCOS are approximately $4 billion, not including the expenses associated with comorbidities of PCOS.

PCOS is a condition where the ovaries produce abnormally high levels of androgens, which is considered a male sex hormone and is typically present in lower amounts in women.[3] As the name polycystic ovary syndrome implies, numerous tiny fluid-filled sacs, or cysts, form in the ovaries. Not all women with the condition will develop cysts, and some women who do not have PCOS can have cysts. The cysts are responsible for making the extra androgens. The higher androgen levels cause issues with the menstrual cycle and can cause many of the symptoms of PCOS.

First Signs And Symptoms Of PCOS

You may wonder, “What are the first signs of PCOS?” This is a question that many may have about PCOS. The signs and symptoms of the condition are not always clear or noticeable.[2] Some women may have only one symptom, while some may have all of them. The first signs of PCOS can include [2-4]:

  • Acne: PCOS can cause acne on the back, chest, and face and continue past the teenage years, which may be challenging to treat.
  • Hair growth: Excessive hair growth on the face, arms, chest, and abdomen affects close to 70% of PCOS patients.
  • Acanthosis nigricans: This condition results in darkening skin in body creases and folds such as at the back of the neck.
  • Irregular periods: Abnormal menstrual cycle involving missed or no periods or heavy bleeding during periods.
  • Weight gain: Around 40% to 80% of women with PCOS are obese and struggle with maintaining a healthy weight.

Other common signs and symptoms of PCOS may also involve thinning hair, skin tags, infertility, and cysts.[2-4] It is common for women to find out they have PCOS when they encounter issues getting pregnant. PCOS often begins shortly after the first menstrual period, around 11 or 12 years of age.[1,2]

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Causes Of PCOS

The exact cause of PCOS is not clearly understood.[1,2] However, genetics and the environment are contributing factors. Excess weight, family history, and resistance to insulin are also thought to play a role in the development of the condition.[2] The buildup of increased insulin levels can lead to higher androgen amounts, contributing to PCOS.[2,4]

Diagnosis Of PCOS

Healthcare providers will ask about your medical history and symptoms.[3,4] To diagnose PCOS, your healthcare provider will likely perform a pelvic exam to check whether your reproductive organs are healthy. Other tests include an ultrasound to visualize cysts and blood tests to look at androgen levels and check blood glucose.

To determine if a woman has PCOS, the healthcare provider will also evaluate if you have at least two of the following three symptoms [2]:

  1. Irregular periods or no periods
  2. Elevated levels of androgens
  3. Multiple cysts on ovaries

Treatment For PCOS

Currently, there is no cure for PCOS.[4] Once diagnosed with PCOS, your treatment will be based on your signs and symptoms, medical history, other comorbid health concerns, and whether you plan on getting pregnant.[3,4] Treatment strategies can involve medications, lifestyle changes, or both. The condition does not go away, but your healthcare provider can help manage your symptoms, and over time, the condition may change so that you can become less aware of the syndrome.

If you don’t plan to become pregnant, treatment options may include [3,4]:

  • Hormonal birth control pills help regulate your menstrual cycle
  • Medications (Metformin) to help control elevated blood glucose and insulin sensitivity
  • Medication that blocks the effects of androgen
  • Lifestyle changes such as a healthy diet and maintaining a healthy weight

If you plan on getting pregnant (now or in the future), treatment options include [3,4]:

  • Drugs that induce ovulation, since a successful pregnancy usually begins with ovulation
  • Surgical procedures to help restore ovulation by removing tissues in ovaries that produce the androgen hormone
  • In vitro fertilization (if other treatments do not help with ovulation)

Testing With Everlywell

Everlywell has a Women’s Health at-home lab test, a comprehensive hormone panel for women at all stages of life. The at-home lab test measures hormone and antibody levels to check for any abnormal levels that may be keeping you from feeling your best.

What Is Luteinizing Hormone?

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Can You Get Pregnant With PCOS?


  1. Rasquin LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease.[Updated 2022 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
  2. PCOS (polycystic ovary syndrome) and diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/pcos.html. December 30, 2022. Accessed September 25, 2023.
  3. Polycystic ovary syndrome (PCOS). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos. February 28, 2022. Accessed September 25, 2023.
  4. PCOS (polycystic ovary syndrome): Symptoms & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos. Accessed September 25, 2023.
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