What Is PCOS?Irregular Periods, Chin Hair, Acne and the Condition Behind Them

Your periods come when they want. There’s a dark hair on your chin you pluck most mornings. Your skin breaks out around your jaw, your hair is thinner at the part, and the scale hasn’t moved despite your best efforts. Each problem has its own explanation, and you’ve been given a different one every time.

What it can look like

The lists from the three sources overlap.

• Periods. Irregular or missed periods, or long gaps, per the NHS¹, OWH³ and Cleveland Clinic². See late or irregular periods.
• Extra hair. OWH³ says excessive facial and body hair affects up to 70% of women with PCOS. Cleveland Clinic² lists heavy hair growth on the arms, chest and abdomen. See chin hairs.
• Acne. All three list it. See adult acne.
• Thinning hair. OWH³ and Cleveland Clinic² list scalp hair thinning, and the NHS¹ lists hair loss. See why your hair is thinning.
• Weight. OWH³ lists difficulty managing weight, and Cleveland Clinic² says obesity affects 40% to 80% of people with it.
• Skin. Patches of dark skin, especially in folds of the neck and armpits, and OWH³ adds skin tags. See dark patches and skin tags.
• Mood, energy and fertility. The NHS¹ lists mental health issues, fatigue and fertility difficulties.

Not everyone has all of them. That’s part of why it’s missed.

Why it happens

The exact cause is unknown, OWH³ and the NHS¹ say. The pieces they describe: genes, high levels of androgens, which OWH says can prevent the ovaries from releasing an egg each cycle, and insulin. Cleveland Clinic² says insulin can cause the ovaries to make and release androgens, which suppresses ovulation, and that people with PMOS tend to have chronic low-grade inflammation. The NHS says it may be to do with hormones such as insulin and testosterone not working properly, and that Asian ancestry may raise the risk.

How it’s diagnosed

There’s no single test. OWH³ says doctors use a physical exam, pelvic ultrasound and blood tests, and that you may be diagnosed if you have at least two of several criteria: irregular periods, signs of high androgens or multiple ovarian cysts. Cleveland Clinic² says it’s diagnosed with at least two of three features: irregular or missed periods, signs of excess androgens, or a polycystic appearance of the ovaries on ultrasound. The NHS¹ says doctors check hormone and insulin levels in blood, with an ultrasound for patients 18 and older.

Why it’s worth getting diagnosed

It isn’t only about periods and hair. OWH³ says more than half of women with PCOS will have diabetes or prediabetes before age 40, and lists high blood pressure, unhealthy cholesterol, sleep apnea, depression, anxiety and endometrial cancer. The NHS¹ lists type 2 diabetes, high blood pressure, cardiovascular disease, fatty liver disease and uterine cancer, and says regular monitoring is important. Cleveland Clinic² lists diabetes, hypertension, cardiovascular disease and depression.

What treatment looks like

The NHS¹ says there’s no cure, but there are treatments and lifestyle changes that can help. The treatments depend on what you need.

• For irregular periods: hormonal birth control, per the NHS¹, OWH³ and Cleveland Clinic².
• For extra hair: the NHS¹ mentions spironolactone, an anti-androgen, and OWH³ and Cleveland Clinic² list anti-androgen medicines. OWH also lists hair removal.
• For insulin and weight: metformin, which Cleveland Clinic² calls an insulin-sensitizing medicine, and lifestyle changes including weight loss, per OWH³.
• For getting pregnant: the NHS¹ and Cleveland Clinic² mention medicines to induce ovulation, such as clomiphene or letrozole, IVF, and in some cases surgery.

The play

Try this: a symptom timeline

Write down when your periods started to change and how many cycles you’ve had in the last year.

List hair, skin and weight changes, with approximate dates, and whether anyone in your family has PCOS, diabetes or irregular cycles.

Add every medicine and supplement you take. A timeline gets you further than “everything is off.”

When to get checked

The NHS¹ says to see a GP if you think you may have PMOS or your symptoms affect your everyday life, work and relationships. Cleveland Clinic² says to contact a provider for irregular menstrual cycles, excess hair growth, acne or difficulty getting pregnant. OWH³ says to seek care for irregular periods or fertility concerns.

Book an appointment if any of these fit:

• Your periods are irregular or you’ve missed several in a row
• You have new hair growth on your face, chest or abdomen, or thinning at your scalp
• Acne persists despite treatment
• You’re gaining weight without a clear reason, or have darkened skin patches
• You’re trying to get pregnant and cycles are unpredictable
• You have family members with diabetes or PCOS

One thread, many symptoms. A single appointment can tie them together.