As is the case with many health concerns, how to know if you polycystic ovary syndrome (PCOS) can be difficult to tell on your own, unless you know exactly what to look for. And even then, signs of this hormonal and reproductive disorder can be easy to miss. In fact, "half of the 10,000,000 women who have it are unaware of it," Sinem Karipcin, MD, a fertility specialist at Conceptions Florida, tells Bustle.
Partially to blame are the easy-to-miss symptoms, as well as the fact PCOS can be difficult for doctors to diagnose, due to all the factors involved. "The exact cause is multifactorial with multiple environmental and genetic factors fostering its development," Karipcin says. "PCOS is diagnosed based on your family and gynecological history, an ultrasound to count the baseline follicles on your ovaries, as well as a hormonal checkup to make sure there is not an underlying thyroid problem or another testosterone-related issue."
There is good news, though. According to Karipcin, there are several treatment options available, once you are diagnosed. Doctors often recommend maintaining a healthy lifestyle and birth control pills, in order to even out hormones. And some suggest certain medications that can help lower insulin levels. Here are a few lesser-known, super subtle signs of PCOS experts say all women should watch out for.
1. Darker Patches On Your Skin
If you notice rings around your neck that are darker than your usual skin tone, it may be a sign of a shift in your hormones. "They are called acanthosis nigricans, and are most common on the back of the neck and right above the elbows," Dr. Shaughanassee Williams, DNP, CNM, founder of HealthyHER Center for Women's Care, tells Bustle. "These patches are the result of insulin resistance meaning that the woman’s body has difficulty processing sugars." If you spot this change in skin tone, talk to your doctor to find out if PCOS is to blame.
2. Irregular Or Heavy Periods
"Regardless of the diagnostic criteria that are used, [PCOS] most commonly leads to irregular periods and difficulty ovulating on a regular basis," Maria Costantini-Ferrando, MD, PhD, FACOG, at Reproductive Medicine Associates of New Jersey (RMANJ) tells Bustle.
If your periods are often delayed or you have a heavy flow, talk with an OB/GYN. They can run a few tests, such as an ultrasound, to see if your irregular periods are due to PCOS.
3. Waking Up Feeling Tired
Do you tend to wake up feeling tired, despite getting those recommended seven to nine hours of shut eye? If so, it could mean you're struggling with PCOS-related symptoms during the night. As Williams says, "Sleep apnea and insomnia are two common side effects of PCOS," and both can leave you feeling exhausted.
Insomnia can make it difficult to fall asleep. And sleep apnea is a condition where your breathing is interrupted while you sleep, resulting in insufficient oxygen to your brain. Both issues have been linked to PCOS, and the resulting fatigue may help tip you off.
4. Cravings For Certain Foods
Sometimes, a craving for a certain food can be your body's way of telling you something. In the case of PCOS, you might notice that you're craving carbohydrates more often. As dietician Meghan Cichy, RDN, CEDRD, CSP, CD tells Bustle, this has a lot to do with how PCOS affects your insulin levels.
"Insulin is a hormone that acts like a key to unlock the cells of the body and enables the cells to take glucose from the bloodstream into the cell to be used as fuel," she says. "In insulin resistance, the cell 'doors' are not responding to the insulin 'key,' which leaves glucose in the blood and results in your cells starving for fuel. This can trigger cravings for carbohydrates in an attempt to take in glucose to fuel the cells." And it's why many doctors prescribe insulin medications to women who are struggling with PCOS.
5. Adult Acne
"While acne as a teen is [common], acne as an adult woman can be a sign of PCOS," Jenna McCarthy, MD, an IVFMD fertility specialist, tells Bustle. This is usually due to the hormonal changes associated with PCOS. But it can be treated, by getting to the root of the problem.
"A skin doctor or dermatologist may be the best way to avoid severe acne," Sherry Ross, MD, OB/GYN, Women’s Health Expert and author of She-ology: The Definitive Guide to Women's Intimate Health. Period, tells Bustle. "Anti-androgens [decreasing testosterone], antibiotics, and special medicated skin washes are also used to keep the acne under control."
6. Trouble Conceiving
Another subtle thing to watch out for? Unpredictable ovulation tests. If you're trying to become pregnant, and would like to map out your ovulation dates with an at-home kit, you might notice that you can't seem to get a positive result.
"If someone is trying to conceive, she may also have difficulties interpreting any ovulation prediction kits because sometimes, they never get a positive or every day says it’s positive," Dr. Erika Munch, a reproductive endocrinologist at Texas Fertility Center, tells Bustle. "And both outcomes are very frustrating."
If this is happening to you, PCOS may be what's messing up your hormones, and thus messing up your ovulation test results. And since experts have linked PCOS to infertility, speaking with a doctor ASAP will be in your best interest, if you're trying to conceive.
7. Thinning Hair
While it's common to lose up to 100 strands of hair a day, take note if it seems like your hair is thinning — especially if you can see more of your scalp than usual. As Williams says, thinning hair might be due to excess testosterone in the body, which "can cause women to have a condition similar to male-pattern baldness." But if this is happening to you, do not panic — talking with your OB/GYN about a potential PCOS diagnosis can help get to the root of this problem, and treat it.
8. Hair In New Places
While everyone has different levels of hair growth on their body, sometimes new patches of hair can be a sign of a hormonal imbalance. "Many women with PCOS have increased effects of the male hormones we all have, because the body hasn’t made enough protein to help bind these extra male hormones," says Munch. "For some women, that can mean hair in places ... like the lip, chin, sideburns ... or problems with acne."
The hair itself isn't the issue nor is it anything to be ashamed of, but the reason behind it can be cause for concern, in some instances. Since PCOS can affect your health, it's a good idea to pay attention to little clues like this from your body, and talk with a doctor to make sure your hormones are properly balanced.
9. Anxiety and Depression
According to Ross, anxiety and depression can be a sign of PCOS. So if you haven't been feeling like yourself and can't quite figure out why, a trip to an OB/GYN should be on your list of things to do.
Of course, there are many factors at play when it comes to mental health, but sometimes an underlying health issue, like PCOS can make you feel worse, especially since it can impact your hormones. If you feel that you are struggling with anxiety or depression, confiding in a doctor, therapist, or loved one can guide you toward the help you need to feel well again.
10. Unexplained Health Issues, Like High Blood Pressure
You might not immediately think of PCOS as the cause of your anxiety and depression, but both have be linked linked to the disorder. And so are many other health concerns. As Ross says, "The list is long and includes ... heart attacks, high blood pressure, high cholesterol ... endometrial cancer, and sleep apnea." Although some of these conditions are extreme, and represent worst case scenario situations, being mindful of your health and speaking with your doctor if you experience any changes can help treat the issue early.
If you've been diagnosed with pre-diabetes or diabetes, it may be a good idea to be checked for PCOS, too. "Women with PCOS may ... become less efficient at processing sugars (glucose and carbohydrates) from their diets. As a result, women can also develop glucose intolerance (pre diabetic state) or resistance to the insulin that their body makes," Dr. Aaron Styer, Medical Director with CCRM Boston tells Bustle. "This can result in ... the development of diabetes, increased cholesterol levels, and an increased risks of heart attack and stroke later in life. As a result, women with PCOS should be screened for diabetes and abnormal cholesterol levels during their initial evaluation to reduce the risk of complications later in life."
But there is no need to fret — if you think you might have polycystic ovary syndrome, check in with your doctor. They can check to see if the symptoms mentioned above are, in fact, due to PCOS. And then prescribe you a treatment plan, so you can start feeling better.