What is PCOS and why symptoms vary: causes, hormonal imbalance, and risk factors

Polycystic ovary syndrome (PCOS) symptoms affect people with ovaries across adolescence, the reproductive years and into later adulthood. Globally it affects roughly 6–13% of women of reproductive age, yet many people remain undiagnosed — estimates suggest up to 70% worldwide may not know they have PCOS (World Health Organization). Early recognition matters because PCOS is not only about irregular periods or acne; it raises lifetime risks for metabolic problems such as insulin resistance and type 2 diabetes, cardiovascular risks and impacts on fertility and mental health (WHO: https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome?utm_source=openai).

Why PCOS symptoms vary

  • Hormonal imbalance is central. Most people with PCOS have higher levels of androgens (“male” hormones such as testosterone) and varying degrees of insulin resistance. These hormonal differences produce different symptoms — excess hair growth and acne from androgens, and weight gain and metabolic changes from insulin resistance.
  • Genetic and environmental factors combine. Family history, ethnicity, body weight, diet, activity and age all influence how PCOS looks in a person.
  • Age changes the picture. Teens, women trying to conceive and older adults often present with different dominant concerns (see next section).
  • Heterogeneous condition — not everyone has ovarian “cysts.” The name can be misleading: small follicles on ultrasound are common, but having ovarian cysts is not necessary to diagnose PCOS. Diagnosis is clinical and based on symptoms, exams and tests (see Mayo Clinic on diagnosis).
Common and age-specific symptoms to watch for: menstrual changes, skin & hair signs, weight and metabolic issues, mood and sleep disturbances PCOS symptoms cover several domains. They often appear together but can also occur in isolation. Below are the common and some lesser-known signs, with how they often present at different life stages.

Menstrual and reproductive signs

Irregular periods

Cycles that are infrequent, very heavy, very light, unpredictable or absent. This is one of the most common early clues (WHO). Teenagers: cycles can be irregular for 1–2 years after menarche, so persistent or worsening irregularity after that timeframe needs evaluation. Reproductive-age women: missed periods, difficulty conceiving, or recurrent early pregnancy loss may be the presenting complaint. Older adults: menopausal transition may unmask metabolic risks previously hidden. – Infertility/ovulatory problems: PCOS is a leading cause of anovulation (lack of regular ovulation) and infertility. Fertility-focused evaluation is a common route to diagnosis.

Skin, hair, and cosmetic signs

  • Hirsutism (excess terminal hair growth) — face, chest, abdomen, back, and inner thighs. Up to ~70% of women with PCOS may have hirsutism (Women’s Health fact sheet).
  • Acne and oily skin — commonly begins in adolescence or persists into adulthood.
  • Androgenic hair thinning or male-pattern hair loss on the scalp — less visible but psychologically distressing for many.

Weight and metabolic symptoms

  • Weight gain, especially central/abdominal fat. Many people with PCOS are overweight, which can worsen insulin resistance, though PCOS also occurs in lean individuals.
  • Insulin resistance signs and increased diabetes risk — more than half of people with PCOS develop type 2 diabetes by age 40 if untreated (CDC: https://www.cdc.gov/diabetes/risk-factors/pcos-polycystic-ovary-syndrome.html?utm_source=openai). Because of this, screening for glucose intolerance and lipid abnormalities is a core part of evaluation.

Mood, sleep and quality of life

  • Anxiety, depression and negative body image are more common in people with PCOS and can be as important to treat as physical symptoms (WHO).
  • Sleep disturbances, including poor sleep quality and increased risk of obstructive sleep apnea in those with obesity, may occur.

Age-specific presentation — quick summary

  • Teens: persistent irregular or absent periods beyond 1–2 years after menarche, worsening acne, rapid weight gain, or early signs of excess hair growth should prompt assessment.
  • Reproductive-age adults: difficulty conceiving, irregular cycles, hirsutism, acne, and progressive weight gain are common reasons to seek care.
  • Older adults: the focus is often on metabolic screening (glucose and lipids), cardiovascular risk modification and managing long-term consequences of years of anovulation.
Red flags and when to see a doctor: infertility concerns, sudden weight gain, heavy bleeding, rapid hair loss or insulin resistance signs

When to seek medical help urgently or without delay:

  • New or sudden heavy vaginal bleeding, very severe pelvic pain or any acute severe change in bleeding pattern.
  • Rapid, unexplained weight gain over weeks to months.
  • Symptoms of high blood sugar — extreme or increasing thirst, passing large volumes of urine, persistent fatigue, or unexplained vision changes — which may indicate diabetes or marked insulin resistance (CDC).
  • Rapid or patchy hair loss on the scalp (alopecia) or sudden onset of severe hirsutism — these can suggest serious hormonal changes that require prompt evaluation.
  • Trying to conceive for 6–12 months without success (earlier if older than 35).
  • Any signs of severe depression, suicidal thoughts, or anxiety that interfere with daily life — mental health support should be sought immediately.
Practical guidance on urgency: mild acne, gradual weight gain, and mildly irregular cycles can often be assessed in routine outpatient care; the red-flag symptoms above require faster work-up.

Diagnosis at Sanchet Hospital: clinical evaluation, key tests (hormone profile, ultrasound, glucose and lipid screening) and multidisciplinary assessment

Dr. Suneeta Agarwal at Sanchet Hospital is an expert at treating PCOS. When you come in for PCOS treatment, this is what you can expect:
  • Detailed history: menstrual pattern, weight history, hair and skin changes, family history of diabetes or PCOS, fertility history, medication, and lifestyle review.
  • Physical examination: blood pressure, BMI, and waist circumference, skin and hair exam for hirsutism and acne, thyroid and pelvic exams as needed.
  • Discussion of concerns and goals: whether symptom control, fertility, or long-term metabolic health is the priority. A patient-centered approach means treatment is tailored to your goals.

Key tests commonly used to confirm PCOS and assess risks

  • Hormone profile
  • Glucose testing
  • Lipid profile
  • Pelvic ultrasound
  • Additional tests when indicated: liver function tests (for fatty liver), sleep studies if sleep apnea suspected, and andrology tests if fertility issues involve partners.

Multidisciplinary assessment at Sanchet Hospital

  • Gynecologist/reproductive specialist: menstrual problems, contraception, fertility evaluation and ovulation induction.
  • Endocrinologist: complex hormonal or metabolic issues such as insulin resistance, diabetes, thyroid dysfunction.
  • Nutritionist/dietitian: personalized dietary plans to manage weight and insulin sensitivity.

PCOS Treatment and management strategies: medical treatments, fertility support, diet & exercise plans, mental health support, and follow-up care available at Sanchet Hospital

PCOS has no single cure, but symptoms and long-term risks can be effectively managed. The choice of treatment depends on the person’s age, symptoms and goals (e.g., contraception vs fertility).

Lifestyle as first-line therapy

  • Diet and exercise: Even modest weight loss (5–10% of body weight) improves menstrual regularity, ovulation and insulin sensitivity in those who are overweight. A balanced, lower-glycemic-index diet, portion control and regular physical activity (aerobic + resistance training) are recommended (WHO fact sheets). Sanchet Hospital’s nutritionists can design individualized meal and activity plans.
  • Sleep and stress management: Improving sleep hygiene and reducing chronic stress (mindfulness, therapy) helps hormonal balance and mood.

Medications (examples commonly used; your doctor will individualize)

  • Combined oral contraceptives (COCs): regulate menstrual cycles, reduce androgen levels and help with acne and hirsutism. Often first-line for those not seeking pregnancy.
  • Metformin: improves insulin sensitivity and may help with weight and menstrual regularity; it is often used when metabolic issues or glucose intolerance are present.
  • Anti-androgen medications: for stubborn hirsutism/acne in combination with contraception.
  • Topical and dermatologic treatments: retinoids, antibiotics for acne; laser hair reduction or electrolysis for hirsutism.
  • Fertility drugs and assisted reproduction: for those trying to conceive, ovulation induction (agents such as letrozole or other ovulation-stimulating medications), intrauterine insemination (IUI) or in vitro fertilization (IVF) may be recommended after assessment. Your gynecologist or fertility specialist will review options and risks.

Mental health support

Screening for anxiety and depression should be routine. Cognitive-behavioural therapy (CBT), counseling and support groups improve coping and quality of life.

Follow-up and monitoring

Regular follow-up is important to monitor cycle control, metabolic markers (glucose and lipids), medication side effects and mental health. Long-term monitoring for diabetes, cardiovascular risk and endometrial health (irregular anovulatory cycles increase the risk of endometrial hyperplasia over time).

How Sanchet Hospital supports comprehensive PCOS care

  • Integrated clinics where gynecology, endocrinology, and nutrition work together to create a tailored plan.
  • On-site diagnostic labs (hormone assays, glucose testing) and high-quality pelvic ultrasound.
  • Fertility counseling and referral to reproductive specialists when needed.
  • Dermatology and mental health services to address acne, hair issues and emotional wellbeing.
Practical next steps — what you can do now and what to expect at your appointments

If you suspect PCOS:

1. Track your symptoms for 2–3 months: menstrual dates (or absence), weight changes, acne flare-ups, hair growth patterns, mood changes, sleep quality. Bring this to your appointment. 2. Make a list of questions and goals: Do you want contraception, symptom relief, weight loss, or pregnancy? 3. Primary evaluation: start with a gynecologist or a general physician; they can order initial blood tests and an ultrasound and refer you to an endocrinologist or fertility specialist as needed. 4. Tests to expect: hormone profile (testosterone, DHEA-S, TSH, prolactin), fasting glucose and/or OGTT, HbA1c, lipid profile, pelvic ultrasound. 5. Lifestyle changes to begin immediately: moderate-intensity physical activity most days, cut back on processed high-sugar foods, prioritize regular sleep and stress management. A 5–10% weight loss can make a measurable difference. 6. Mental health: if you feel persistently low, anxious or overwhelmed, ask for counseling referral early — psychological support is an essential part of PCOS care.

Myths and clarifications

  • Myth: “You must have ovarian cysts to have PCOS.” Fact: Ovarian follicles may be present but are not required for diagnosis; clinical symptoms and hormone testing are key (Mayo Clinic).
  • Myth: “PCOS only affects fertility.” Fact: PCOS has widespread effects on metabolism, mood, skin and long-term health; fertility is one part of the condition’s impact.
  • Myth: “PCOS always occurs with obesity.” Fact: Many with PCOS are overweight, but lean PCOS exists and still needs appropriate evaluation and management.

When to consult which specialist

  • Gynecologist: primary contact for irregular periods, contraception, and fertility treatment.
  • Endocrinologist: if metabolic issues, insulin resistance, or complex hormonal imbalance are the main concern.
  • Nutritionist/dietitian: for personalized diet and weight-management plans.
  • Dermatologist: for acne and hair problems.
  • Mental health professional: for anxiety, depression or body-image issues.

Final takeaway

PCOS is a common but varied condition. Recognising early signs — irregular periods, acne, excess hair, unexplained weight gain, mood changes or symptoms of insulin resistance — and getting timely, comprehensive evaluation can prevent long-term complications and improve quality of life. Sanchet Hospital, Paschim Vihar offers a patient-centred, multidisciplinary pathway (gynecology, endocrinology, nutrition, dermatology and mental health) to diagnose, explain and treat PCOS according to your personal goals — whether that’s regulating cycles, improving skin, managing weight and metabolic risk, or pursuing pregnancy. If you have ongoing menstrual irregularities, new metabolic symptoms (thirst, excessive urination, rapid weight changes), trouble conceiving, or are concerned about mood and self-image related to PCOS symptoms, schedule an evaluation so you can get a tailored plan and the support you need.