Polycystic ovary syndrome, or PCOS, is one of the most common hormonal conditions we see in the office — affecting an estimated 1 in 10 women of reproductive age — yet it remains widely misunderstood. Many patients spend years being told their symptoms are unrelated before receiving an accurate diagnosis. Here’s what PCOS actually is, how we diagnose it, and what treatment can look like.
What is PCOS?
PCOS is a hormonal condition involving an imbalance of reproductive hormones that can affect ovulation, metabolism, and, for some, appearance-related symptoms like acne or hair growth. Despite the name, you don’t need to have ovarian cysts to be diagnosed with PCOS, and having cysts on an ultrasound doesn’t automatically mean you have the condition.
Common symptoms
- Irregular, infrequent, or absent periods
- Difficulty conceiving
- Excess facial or body hair growth (hirsutism)
- Persistent acne, particularly along the jawline
- Weight gain or difficulty losing weight
- Thinning hair on the scalp
- Dark, velvety patches of skin (a sign of insulin resistance)
Symptoms vary widely from person to person — some patients have very irregular cycles with minimal other symptoms, while others experience the full range.
How we diagnose PCOS
We use the Rotterdam criteria, which requires at least two of the following three findings: irregular or absent ovulation, clinical or lab signs of elevated androgens, and polycystic-appearing ovaries on ultrasound. Diagnosis typically involves a detailed history, bloodwork to check hormone levels and rule out other conditions, and sometimes a pelvic ultrasound.
Treatment options
Treatment is tailored to your specific symptoms and goals — there’s no one-size-fits-all approach. If you’re not trying to conceive, hormonal birth control is often used to regulate cycles and manage acne or excess hair growth. If you are trying to conceive, we may recommend ovulation-inducing medications, sometimes alongside a referral to a fertility specialist.
Because PCOS is closely tied to insulin resistance for many patients, we also often discuss metabolic health — nutrition, physical activity, and, when appropriate, medications like metformin. None of this is about weight for its own sake; it’s about supporting your hormonal balance and long-term health, including reducing risk factors for type 2 diabetes and cardiovascular disease later in life.
Managing PCOS long-term
PCOS is a chronic condition, but it’s very manageable with the right care team. Most of our patients find that once they have an accurate diagnosis and a personalized plan, their symptoms become far more predictable and manageable — and many go on to have healthy pregnancies when that’s part of their goals.
The bottom line
If your periods have always been irregular, if you’ve struggled with stubborn acne or hair growth, or if you’ve been told your symptoms are “just how your body is,” it’s worth a conversation. PCOS is common, well-studied, and treatable — you don’t have to keep guessing on your own.
Think you might have PCOS?
Schedule an evaluation with our team to get real answers and a personalized treatment plan.