How to Tell If I Have PCOS

Dec 10

A coffee shop conversation about your cycle, hormones, and what your body might be trying to tell you:

Imagine we are sitting together at our local coffee shop, sipping on our favorite lattes (iced oatmeal latte for me), and you lean in and say, “Okay… how do I tell if I have PCOS”

PCOS, or polycystic ovarian syndrome, is a metabolic endocrine syndrome that is quite under diagnosed. And honestly, it makes sense. Most young girls who deal with menstrual cycle irregularities are put on birth control in their teen years instead of actually getting to a diagnosis. The symptoms get masked, the deeper issues are never explored, and years later women come off birth control and realize they have no idea what their natural cycle looks like or whether their symptoms point to something like PCOS.

So today, consider this your coffee shop conversation where I am going to walk you through everything you need to know about PCOS, the diagnostic criteria, and a few treatments. Let us dive in.

Early Signs of PCOS

When someone is trying to figure out if they have PCOS, the early signs usually fall into a few patterns. These are the symptoms I see most often in the clinic and the ones that tend to show up long before anyone actually gets a diagnosis.

Hyperandrogenism
Higher testosterone levels may show up as unwanted hair growth, especially facial hair or more male pattern characteristics that do not feel typical for you. This is one of the classic signs of PCOS and often gets brushed off.

Difficulty losing weight
You can exercise, eat healthy, and genuinely put in the effort, yet the scale does not move. That feeling of doing everything right and nothing working is incredibly common with PCOS.

Irregular cycles
Very long cycles or cycles that show up whenever they want are another major sign. If your period is unpredictable or consistently very long, that is a big clue that ovulation might not be happening.

PCOS Versus Normal Cycle Irregularities

Understanding what a normal cycle should look like is incredibly important when you are trying to figure out how to tell if you have PCOS.

What a normal cycle looks like
A normal cycle is anywhere from 21 days to 35 days in duration, although ideally at least 24 to 25 days. This is counted from the first day of your period to the first day of your next period.

Bleeding usually lasts 2 to 6 or 7 days. Day 1 is typically the heaviest, and mild cramps are normal as long as they do not keep you from your daily activities.

Ovulation should happen between day 12 and day 20. If ovulation happens past day 20, this can be a sign of a luteal phase deficit or some type of luteal phase dysfunction.

What cycles often look like with PCOS
Cycles are usually much longer than 35 days, or ovulation may not be occurring at all. This lack of ovulation is one of the biggest indicators that PCOS may be present.

Diagnosis and Testing for PCOS

When you are trying to figure out if you have PCOS, labs and imaging help fill in the picture, but it is important to understand what is truly diagnostic.

Helpful lab work
There is no single blood test that diagnoses PCOS. However, AMH, also known as anti-Mullerian hormone, can be helpful. AMH gives you a general idea of ovarian reserve. It is not diagnostic for PCOS but provides useful information about ovarian function.

Ultrasound findings
The official diagnosis of PCOS is based on the Rotterdam criteria. You need two out of the three criteria to be diagnosed:

Irregular cycles
hyperandrogenism
The string of pearls appearance on ultrasound

The string of pearls refers to the pattern of follicles on the ovary.

PCOS versus thyroid dysfunction
If someone does not meet the Rotterdam criteria, thyroid function is the next thing I suggest to have worked up. Hypothyroidism can look very similar to PCOS, especially regarding cycle irregularity and ovulation issues.

Can you diagnose PCOS without an ultrasound
Yes. If you meet two of the Rotterdam criteria, you do not need an ultrasound to receive the diagnosis.

Fertility and Menstrual Health with PCOS

Ovulation is the queen of your menstrual cycle, and PCOS changes the ovulation process in a specific way. Understanding this helps you communicate your body’s data with your provider in order to receive an accurate diagnosis and quicker treatment.

How ovulation normally works
In a normal cycle, one follicle matures and produces estradiol, which is estrogen. As estrogen rises and reaches a peak, it signals the brain, specifically the pituitary gland, to release LH. That LH surge triggers ovulation.

What happens to ovulation in PCOS
With PCOS, multiple follicles grow, but none mature enough to create a strong estrogen peak. Without that peak, the brain never receives the message to release LH. Without an LH surge, ovulation does not occur.

These follicles do not necessarily suppress hormones, but they fail to produce enough estrogen. Instead, they produce more androgens like testosterone and DHEA. Higher androgens then interfere with normal follicle development.

If ovulation does not happen, a corpus luteum does not form. Without a corpus luteum, there is no progesterone. This is why PCOS patients often have low progesterone, irregular or absent periods, and no distinct luteal phase.

How to know if you are ovulating with PCOS
Ovulation predictor kits do not apply to PCOS. The only way to truly confirm ovulation is through ultrasound. You can also track basal body temperature or cervical mucus, but just know that LH kits will not give you reliable information if you have PCOS.

PCOS and trying to conceive
If you have been diagnosed with PCOS, or you were placed on birth control for symptoms that pointed toward PCOS, I recommend coming off birth control six months to one year before trying to conceive. This allows time for your natural cycle to reestablish so you know what your body is doing.

To support cycle regulation, I often recommend:

Blood sugar regulation
Strength training
Medications like Metformin or sometimes a GLP 1
Taking supplements like Berberine and inisitol daily

Conditions Commonly Related to PCOS

When you are trying to figure out if you have PCOS, it is really important to understand that PCOS rarely shows up alone. There are several conditions that commonly travel with it, either because they share similar root causes or because PCOS increases the likelihood of developing them.

Insulin resistance
This is one of the most common conditions that shows up alongside PCOS. It affects how your body processes blood sugar and can make weight regulation and energy levels harder to manage.

Thyroid dysfunction, especially hypothyroidism
Hypothyroidism can look very similar to PCOS, and it often appears right alongside it. Thyroid dysfunction can impact ovulation, cycle length, energy, mood, and metabolism, which is why it is always something I look at when PCOS is suspected.

Metabolic syndrome
Some patients with PCOS experience metabolic changes that fall under the umbrella of metabolic syndrome. This can include elevated blood pressure, changes in blood sugar regulation, and cholesterol abnormalities.

Endometrial hyperplasia
When ovulation does not occur regularly, the uterine lining can remain unopposed by progesterone for long stretches of time. This can lead to a buildup of the lining, called endometrial hyperplasia.

Sleep apnea
There is a higher rate of sleep apnea in patients with PCOS, and poor sleep can make hormone regulation even more challenging.

Depression and anxiety
Because PCOS impacts hormones, metabolism, and the menstrual cycle, it is very common for patients to also experience depression or anxiety. The emotional side of PCOS is often overlooked, but it is a real and significant part of the experience.

Non alcoholic fatty liver
This is another condition that can show up alongside PCOS due to changes in metabolic health and insulin resistance.

Infertility
PCOS is one of the leading causes of ovulatory infertility. When ovulation does not occur consistently, it is much harder to conceive, which is why understanding your menstrual cycle is such an important part of the journey.

Final Thoughts

If you are reading this and thinking, “Okay… some of this sounds a little too familiar,” just know you are not alone. PCOS is incredibly common, incredibly underdiagnosed, and incredibly misunderstood. And if no one ever taught you what a normal cycle should look like or what your hormones should be doing, of course it feels confusing to figure out how to tell if you have PCOS.

My hope is that this gives you a clearer starting point. Your cycle tells a story. Your symptoms tell a story. And none of this is about guessing or searching the internet or trying to piece it together on your own.

If you have questions about your cycle, your ovulation, or whether your symptoms may fall under PCOS, I do see patients in person in Sulphur Springs and Rockwall and virtually as well. You can reach out any time (or fill out a form here), and someone from my team will help you get scheduled.

And if you are on your trying to conceive journey, our Fertility Foundations email series is a really good place to start. We created it to help you understand your cycle, your hormones, and your overall fertility long before you begin trying. I believe education on the front end leads to less heartache later.

As always, learn to listen to your body. It is talking to you, even when your cycle feels chaotic or confusing. You are not broken. You just deserve more information and better support.