Irregular menstrual cycles, hormonal acne, weight gain—they're all symptoms of polycystic ovary syndrome, or PCOS. That said, they're also pretty commonplace complaints in the grand scheme of being a woman—which can make hormonal imbalances like PCOS tricky to detect. 

PCOS is extremely common, affecting as many as 5 million women of reproductive age in the U.S. But getting a clear diagnosis is all too often a long journey filled with trial and error and a multitude of symptoms that may come and go along the way. (It certainly doesn't help that the exact cause of PCOS is unknown, and thought to be a combination of genetic and environmental factors.)

The good news? There are meaningful steps you can take to land a diagnosis, balance your hormones and get your PCOS in check. We brought in OB/GYN and Perelel Medical co-Founder, Dr. Banafsheh Bayati, MD, OB/GYN, FACOG, to weigh in and break down exactly what to do next if you think you may have PCOS.

But first: What Is PCOS?

Polycystic ovary syndrome is a hormonal imbalance condition in women of reproductive age. A hallmark of PCOS is high levels of luteinizing hormone (a chemical that drives your reproductive system) and androgens (a group of sex hormones that includes testosterone). This sets off an imbalance that causes issues with ovulation, menstruation, and getting pregnant. 

Lots of people with PCOS have insulin resistance, meaning their bodies make this essential hormone but their cells don’t respond to it effectively. As a result, their insulin blood levels become higher than normal. Too much insulin can signal your body to create extra testosterone, which prevents normal ovulation.

As a result, symptoms of PCOS can include:

• Skipped or irregular periods
• Hormonal acne
• Weight gain
• Excessive body hair growth, often on the chin, back or stomach (also known as hirsutism)
• Ovarian cysts
• Infertility

Because increased male hormones like testosterone can suppress ovulation, PCOS can cause fertility challenges if left untreated.

It's also important to note that PCOS isn’t “just” a reproductive health issue. It’s associated with increased risk of: ¹

• Depression
• Sleep disorders
• Type 2 diabetes
• Heart disease
• High blood pressure

PCOS also increases the risk of endometrial hyperplasia, a condition where the lining of the uterus gets too thick, which can raise the risk of endometrial cancer.

The Stress Factor

When you’re stressed, your body releases a surge of the hormone cortisol. Extreme or long-term stress can disrupt bodily processes like ovulation and hormone production. Even past traumatic experiences from childhood might play a role in PCOS. 

There could also be a chicken-and-egg effect. The stresses of having PCOS—including struggling to get pregnant—might contribute to the hormone imbalance that amplifies PCOS in the first place. ²

Keep reading for Dr. Bayati's tips on treating PCOS.

Step 1: Build Your Support Team 

"First, discuss your symptoms with your primary care provider," says Dr. Bayati. Why? "PCOS is not uncommon and the evaluation and diagnosis are extremely helpful for fertility, cardiovascular health, cancer prevention and overall longevity."

"Most primary care providers, including nurse practitioners, can start the initial evaluation," she continues. "Then, they can refer you to a gynecologist or endocrinologist for further assistance."

A few things you might say to your doctor:

• “I've had irregular menstrual periods my whole life and I'm worried I might have something like PCOS. Could you do an exam, labs, or imaging to look into it?”
• “Are there any lifestyle changes you can recommend to help with my symptoms?”
• “I want to start birth control to help with my PCOS but I'm worried about trying to get pregnant in the future. What should I consider?”

Step 2: Diagnostic Testing 

Since PCOS is hallmarked by irregular menstrual cycles, Dr. Bayati notes that your first step should be to rule out an unsuspected pregnancy.

Next, complete testing with your primary care practitioner and inform them of any family medical history that may be relevant.

"A good history and physical, as always, is the place to start," says Dr. Bayati. From there, "laboratory blood testing is used to look for increased testosterone levels, glucose intolerance, and elevated lipid values."

Finally, your doctor may schedule "a transvaginal pelvic ultrasound to look for polycystic ovaries."

Tests for PCOS

• Laboratory blood work to screen for:
  • Testosterone Levels
  • Glucose Intolerance
  • Elevated Lipid Values
• Transvaginal pelvic ultrasound to screen for:
  • Polycystic Ovaries

Diagnosed with PCOS? Find the Treatment Plan That Works for You

"Most providers will start with education around the diagnosis as well as recommending lifestyle modifications including nutrition, supplements and exercise, along with the start of medications as needed," explains Dr. Bayati.

While your doctor is your best resource here, some ways to promote hormonal balance at home include:

• A blood sugar-balancing diet: Since insulin resistance is a common culprit with PCOS, be sure to counterbalance carbohydrates with protein and healthy fats. One of our resident dietitians, Stephanie Lauri, RD, shares her recommendations for a PCOS-friendly diet here.
• Regular exercise: Research suggests that individuals with PCOS should aim to for about 150 to 300 min of moderate-intensity activity per week.³
  
• Supplements with inositol, berberine and DIM: These ingredients have been shown to support symptoms related to hormonal imbalance. Let's take a closer look:
  • Myo-inositol is a compound that plays a role in insulin signaling and glucose metabolism which can help balance both insulin and the follicle stimulating hormone (FSH). ⁴
  • D-chiro-inositol can help balance hormones, blood sugar levels and blood pressure. ⁴
  • Berberine may support balanced blood glucose levels and reduced insulin resistance. ⁵
  • DIM is a compound found in cruciferous vegetables that has been shown to support healthy estrogen metabolism. ⁶

These are just a few reasons why our experts opted to include them in Perelel's doctor-backed, clinically-proven Hormonal Balance Support.

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Haven't Been Diagnosed with PCOS? Here's How To Take Care of Yourself in the Meantime

"Many patients with PCOS experience frustration with delayed diagnosis," says Dr. Bayati. But finding a doctor that you feel really listens and takes their time with their evaluation will go a long way. "I️ would recommend finding a primary care provider who takes their time with the basic tenant of healthcare: a thorough history and physical," she continues.

Nonetheless, Dr. Bayati reminds us of the importance of being your own health advocate. "I️ would recommend individual research to better educate oneself, most importantly through reliable sources of knowledge," she explains. "In all aspects of healthcare, recognizing the partnership of individual research, knowledge and advocacy along with the role of your provider is beneficial."

"I️ don’t think PCOS is black and white," she adds. "As a syndrome, it’s on a spectrum— and thus people with mild symptoms but without a diagnosis can definitely incorporate certain habits like supplementation to support their hormonal health.

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References:

1. Polycystic Ovary Syndrome (PCOS). (n.d.-c). ACOG. Retrieved October 24, 2022
2. Benjamin JJ, Kuppusamy M, Koshy T, Kalburgi Narayana M, Ramaswamy P. Cortisol and polycystic ovarian syndrome - a systematic search and meta-analysis of case-control studies. Gynecol Endocrinol. 2021.
3. Sabag A, Patten RK, Moreno-Asso A, Colombo GE, Dafauce Bouzo X, Moran LJ, Harrison C, Kazemi M, Mousa A, Tay CT, Hirschberg AL, Redman LM, Teede HJ. Exercise in the management of polycystic ovary syndrome: A position statement from Exercise and Sports Science Australia. J Sci Med Sport. 2024.
4. Unfer V, Facchinetti F, Orrù B, Giordani B, Nestler J. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocr Connect. 2017.
5. Mishra N, Verma R, Jadaun P. Study on the Effect of Berberine, Myoinositol, and Metformin in Women with Polycystic Ovary Syndrome: A Prospective Randomised Study. Cureus. 2022.
6. Alois M, Estores IM. Hormonal Regulation In PCOS Using Acupuncture And Herbal Supplements: A Case Report And Review Of The Literature. Integr Med (Encinitas). 2019

This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and we recommend that you always consult with your healthcare provider. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of Perelel.