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PCOS

What is Polycystic Ovarian Syndrome (PCOS)?

Elinor Hills
Elinor Hills

PCOS (polycystic ovarian syndrome) is a condition that causes hormone level imbalances that can affect ovarian function. It's a leading cause of infertility, but other symptoms of PCOS are less commonly discussed.

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PCOS (polycystic ovarian syndrome) is a condition that causes hormone level imbalances that can affect ovarian function. It's a leading cause of infertility, but other symptoms of PCOS are less commonly discussed.

PCOS
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PCOS (polycystic ovarian syndrome) is a condition that causes hormone level imbalances that can affect ovarian function. It's a leading cause of infertility, but other symptoms of PCOS are less commonly discussed.

Polycystic ovarian syndrome (PCOS) is a condition that causes hormone level imbalances that can affect ovarian function. PCOS is a leading cause of infertility, but it comes with other symptoms that are less commonly discussed. In this guide, we’ll cover:

PCOS defined

Polycystic ovary syndrome, commonly abbreviated as PCOS, is a condition that causes an imbalance in hormone levels that can affect ovarian function.

>>MORE: 8 Signs Your Hormones May Be Out of Balance – And What to Do Next.

PCOS can affect anyone with ovaries and is one of the leading causes of infertility. There are three main factors associated with PCOS:

  • Menstrual cycle irregularities like irregular periods or anovulatory cycles (when your ovaries do not release an egg)
  • High levels of androgen, a hormone that is typically more abundant in biologically male bodies
  • Polycystic ovaries

Generally, doctors look for two of these three features to diagnose someone with PCOS, but the condition can also cause many other symptoms.

Having PCOS and not getting proper diagnosis or treatment may also lead to an increased risk of conditions like type 2 diabetes, high cholesterol, heart disease, and endometrial cancer. PCOS can also contribute to your mental health and has been linked to increased levels of anxiety and depression.

>>Oova insight: Women with PCOS may be up to four times likely than people without PCOS to develop type 2 diabetes.

PCOS causes

Doctors and researchers still aren’t sure exactly what causes someone to have polycystic ovary syndrome. However, a high level of androgens is a key characteristic of PCOS. Factors like inflammation, genes, and insulin resistance, have been linked to higher levels of androgen.

Genetic causes

PCOS tends to run in families, which suggests that there may be a genetic component to the condition. Research suggests that multiple genes may contribute to your likelihood of developing PCOS.

Insulin resistance

Studies suggest that as many as seven in ten people with PCOS have insulin resistance. Insulin resistance means your cells cannot properly process insulin. Extra insulin in the body can contribute to an increase in androgen production.

Inflammation

Some research suggests that inflammation may play a role in PCOS because it is associated with excess androgen levels.

PCOS symptoms

The most common symptoms of PCOS include:

  • Irregular periods: People with PCOS often have irregular periods or may not have periods at all.
  • Excess body hair growth: Excess androgens cause excess hair growth on the face, chest, stomach, and back.
  • Thinning hair: PCOS can cause hair loss and thinning hair on the scalp.
  • Acne: PCOS most commonly causes acne on the face, chest, and upper back.
  • Weight gain: Many people with PCOS have difficulty losing weight or may gain weight quickly.
  • Infertility: PCOS can make it more challenging to get pregnant due to hormonal imbalances and irregular ovulation.
  • Oily skin: Excess androgen in the body can cause oily skin and dandruff.
  • Darkened skin: PCOS can cause dark patches of skin, particularly on the neck, groin, and underarms. This is due to an excess of insulin in the body, which can be a symptom of PCOS.
  • Mood changes: Some people with PCOS may experience mood changes, including anxiety and depression.
  • Sleep problems: PCOS can cause sleep problems like insomnia.

It is important to note that PCOS is a complex condition and everyone with PCOS is different. It’s even possible to have PCOS and no symptoms at all.

PCOS and fertility

PCOS is a common cause of infertility, with a few aspects of PCOS can make it more difficult for someone to conceive.

PCOS Infertility Factors

Irregular periods

One of the most common symptoms of PCOS is menstrual cycle irregularity, which can make it more difficult to predict ovulation and time intercourse. People with PCOS may also have anovulatory cycles where ovulation doesn’t occur. Ovulation is the process of the ovary releasing an egg, an essential function that needs to take place to get pregnant.

Hormonal imbalances

People with PCOS can have hormonal imbalances, including an excess of androgens. These imbalances can disrupt the functioning of the ovaries and lead to the development of small cysts on the ovaries.

Insulin resistance

Many people with PCOS have insulin resistance, which means their bodies cannot use insulin to regulate blood sugar levels effectively. This can lead to high insulin levels, stimulating the ovaries to produce more androgens.

Inflammation

Some research suggests that inflammation may play a role in PCOS’s impact on fertility. If the ovaries are inflamed, they may not function correctly and may not release eggs regularly. Inflammation in the ovaries can also lead to the development of small cysts that disrupt the standard hormonal signals that regulate the menstrual cycle and ovulation.

Is it possible to conceive if I live with PCOS

Yes! Many people with polycystic ovary syndrome do get pregnant. Some people with PCOS even get pregnant without treatment or intervention.

While PCOS can make getting pregnant challenging, it is not impossible. Many people with PCOS can get pregnant with the help of fertility treatments such as medication or assisted reproductive techniques.

It’s important to note that everyone is different, and not everyone with PCOS will have difficulty getting pregnant.  

Working with a healthcare provider can help you determine the best treatment plan for you if you’re trying to conceive with PCOS and are having difficulty.

What are the risks of getting pregnant if I have PCOS?

There are several risks associated with getting pregnant when you have PCOS. The most common risks are:

  • Miscarriage
  • Gestational diabetes
  • High blood pressure
  • Preterm delivery (before 37 weeks of pregnancy).
  • Large babies and associated delivery risks

It’s important to remember that if you are pregnant and have PCOS, your doctor will monitor these risks closely so that any potential issues are addressed quickly.

PCOS treatment

Treatments for PCOS can include medications, lifestyle changes, or a combination. These options vary based on whether you are trying to get pregnant.

If you are not actively trying to get pregnant, treatment options include hormonal birth control, medication to manage symptoms, and lifestyle changes.

If you are trying to get pregnant, treatment will focus more on helping you improve fertility by increasing your progesterone levels and stimulating ovulation. Your doctor may recommend supplements and medication. If you don’t respond to drug treatments, you can also try assisted reproductive techniques like in vitro fertilization (IVF) and intrauterine insemination (IUI).

>>MORE: PCOS Treatments: Helping the Whole Person, Not Just Their Symptoms

How can Oova help someone living with PCOS?

Because many people with PCOS do not have regular cycles, or experience anovulatory cycles, relying on traditional ovulation test kits just doesn’t cut it when it comes to tracking your cycle and hormone levels. Oova was designed to work for anyone with a menstrual cycle, not just people with "perfect" 28-day cycles. This makes Oova a great option for people with PCOS.

Oova allows you to track your unique hormone patterns and delivers lab-quality results in real time.

Tracking both luteinizing hormone (LH) and progesterone can give you a better sense of your menstrual cycle and predict when you are most likely to ovulate. This information can be game-changing if you live with PCOS and are trying to get pregnant.

Measuring your hormones at home can help you manage your health even if you are not trying to conceive. While you view your results in the Oova App, your healthcare provider can see them instantly on our Clinician Dashboard. This allows you and your doctor to work together to monitor your symptoms and response to treatments or lifestyle changes.

PCOS: Takeaways

PCOS is a condition that causes hormone level imbalances that can then affect your ovarian function. The main characteristics of PCOS include menstrual cycle irregularities, high levels of androgen, and polycsyctic ovaries, with symptoms ranging from acne and oily skin to sleep problems and mood changes.

While we still don’t know what exactly causes PCOS, factors like genetics, inflammation, and insulin resistance have been linked with higher levels of androgen.

PCOS is one of the leading causes of infertility, and while there is no cure for the condition, there are various treatment options if you’re trying to conceive — or if you aren’t! Oova’s test kit can be instrumental in helping you track your unique menstrual cycle and hormone levels to help you manage symptoms as you navigate PCOS.

About the author

Elinor Hills
Elinor Hills has a Master in Science degree in Medical Anthropology and leads brand strategy and content at Oova. She is passionate about reproductive health research and finding ways to make medical research more accessible. When she's not working, she's either training for a marathon or taking photographs. You can see her work at elinorhills.com.

Sources

perimenopause-periods
Should I still see my gynecologist if my periods are just "weird" but not painful?
Yes. Annual visits remain important during perimenopause. Your provider can help determine if your "weird" periods are typical perimenopause changes or something requiring attention. They can also discuss management options to improve your quality of life.
perimenopause-periods
How long do irregular periods last before menopause?
Irregular perimenopause periods typically last 4 to 8 years before your final period, though this varies greatly. Some women experience irregularity for just a few months, while others have irregular periods for over a decade before reaching menopause.
perimenopause-periods
Is it normal to have two periods in one month during perimenopause?
Yes, this can happen, especially in early perimenopause when cycles shorten. You might have a 21 day cycle, meaning you could have a period at the beginning and end of the same calendar month. Track these patterns to distinguish between short cycles and abnormal bleeding.
perimenopause-periods
Why are my periods suddenly so heavy in my 40s?
Heavy perimenopause periods often result from estrogen dominance. When progesterone drops but estrogen remains high, your uterine lining builds up more than usual, causing heavier bleeding when it sheds. This is common in perimenopause but should be evaluated if it affects your daily life.
perimenopause-periods
Can I still get pregnant if my periods are irregular during perimenopause?
Yes. As long as you're having periods, even irregular ones, you may still be ovulating. Pregnancy is possible until you've gone 12 full months without any period. If you don't want to become pregnant, continue using contraception throughout perimenopause.
perimenopause-and-weight-gain
Can you prevent perimenopause weight gain completely?
While you may not prevent all weight changes during perimenopause, you can minimize gain through proactive strategies. Starting strength training before perimenopause, maintaining consistent sleep habits, and managing stress can help your body adapt to hormonal changes more smoothly. Remember, some body changes during this transition are normal and healthy.
perimenopause-and-weight-gain
At what age does perimenopause weight gain typically start?
Perimenopause weight gain can begin in your late 30s or early 40s, often coinciding with the first hormonal changes. Many women notice gradual changes starting 5 to 10 years before their final period. The timing varies greatly based on genetics, lifestyle, and overall health.
perimenopause-and-weight-gain
Does everyone gain the same amount during perimenopause?
No. Perimenopause weight gain varies significantly. Some women gain 5 pounds, others 20 or more, and some maintain their weight. Factors include genetics, starting weight, activity level, stress, sleep quality, and how dramatically hormones fluctuate. Your experience is unique to your body.
Is perimenopause weight gain different from regular aging weight gain?
Yes. While metabolism naturally slows with age, perimenopause weight gain has distinct characteristics. The hormonal shifts cause fat redistribution to the midsection, even if overall weight doesn't change dramatically. This abdominal weight gain pattern is specifically linked to declining estrogen and progesterone, not just aging.
perimenopause-and-weight-gain
Will the weight come off after menopause?
Perimenopause weight gain often stabilizes after menopause when hormones level out, but the weight doesn't automatically disappear. The metabolic and body composition changes that occur during perimenopause tend to persist. However, with consistent healthy habits, weight management becomes more predictable post menopause than during the fluctuating perimenopause years.
https://www.oova.life/blog/progesterone-supplementation-guide
Can I take progesterone if I'm breastfeeding?
Yes, progesterone is generally safe while breastfeeding and doesn't significantly affect milk supply. However, always discuss with your healthcare provider before starting any hormone supplementation while nursing.
https://www.oova.life/blog/progesterone-supplementation-guide
Is it safe to take progesterone throughout pregnancy?
Yes, when prescribed by your healthcare provider. Progesterone supplementation in early pregnancy is safe and can reduce miscarriage risk in women with low progesterone or a history of pregnancy loss. Most providers continue supplementation through the first trimester (weeks 10-12) when the placenta takes over.
https://www.oova.life/blog/progesterone-supplementation-guide
Can progesterone supplementation cause weight gain?
Progesterone can cause temporary water retention and bloating, which may show up as a few pounds on the scale, but it doesn't cause true fat weight gain. Most women don't experience significant weight changes from progesterone supplementation.
https://www.oova.life/blog/progesterone-supplementation-guide
Can I switch from pills to suppositories or vice versa?
Yes, but only under your doctor's guidance. The dosing and timing may need adjustment when switching between forms since they're absorbed differently. Never switch on your own, especially if you're pregnant or undergoing fertility treatment.
https://www.oova.life/blog/progesterone-supplementation-guide
Will progesterone supplementation delay my period?
Yes, progesterone keeps the uterine lining intact, so if you're not pregnant and continue taking progesterone, your period will be delayed. Once you stop taking it, your period should start within 2-10 days. If you are pregnant, progesterone helps maintain the pregnancy and you won't get a period.
https://www.oova.life/blog/progesterone-supplementation-guide
Should I take progesterone pills orally or vaginally?
For fertility and pregnancy support, vaginal progesterone is usually preferred because it delivers higher concentrations directly to the uterus. For perimenopause or general hormone balance, oral progesterone often works well and is more convenient. Your doctor will recommend the best route based on your specific needs.
https://www.oova.life/blog/progesterone-supplementation-guide
When should I start taking progesterone after ovulation?
Typically, progesterone supplementation for luteal phase support starts 2-3 days after ovulation (confirmed by LH surge or temperature rise). Your doctor will give you specific timing based on your protocol. Some women start immediately after a positive ovulation test.
https://www.oova.life/blog/progesterone-supplementation-guide
What's better: progesterone cream or pills?
Pills (oral micronized progesterone) are generally more effective and reliable than creams because absorption from creams is inconsistent. For medical conditions like fertility issues, low progesterone, or HRT, prescription pills or suppositories are strongly recommended over over-the-counter creams.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
How can I tell if I have low or high progesterone?
The only definitive way to know is through hormone testing via blood tests or at-home urine tests that measure progesterone metabolites. However, symptom patterns can provide clues: anxiety and irregular periods suggest low progesterone, while bloating and extreme fatigue suggest high progesterone.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
When during my cycle should I test progesterone levels?
Test progesterone levels during the luteal phase, typically 7 days after ovulation or around day 21 of a 28-day cycle. This is when progesterone should be at its peak, making it easier to identify if levels are too low or too high.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
What are the main differences between low and high progesterone symptoms?
Low progesterone typically causes irregular or heavy periods, anxiety, hot flashes, and sleep issues. High progesterone causes bloating, fatigue, intense breast tenderness, and depression-like mood changes. Low progesterone symptoms persist throughout your cycle, while high progesterone symptoms are most intense during the luteal phase.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
Can you have symptoms of both low and high progesterone?
Some symptoms like breast tenderness and mood changes can occur with both low and high progesterone, making it confusing. However, the timing, intensity, and accompanying symptoms differ. Hormone testing is the best way to determine which imbalance you're experiencing.
https://www.oova.life/blog/10-dpo
Can stress affect 10 DPO symptoms?
Yes, stress can worsen or mimic 10 DPO symptoms. Stress increases cortisol, which can cause cramping, fatigue, and mood changes similar to both PMS and early pregnancy. During the two-week wait, try stress-reduction techniques like gentle exercise, meditation, or spending time with loved ones.
https://www.oova.life/blog/10-dpo
Is it better to test at 10 DPO or wait?
It's better to wait until 12–14 DPO for more accurate results. Testing at 10 DPO often leads to false negatives because hCG levels may still be too low. If you absolutely can't wait, use a sensitive early detection test with first morning urine, and be prepared to retest in 2–3 days if negative.
https://www.oova.life/blog/10-dpo
What does implantation bleeding look like at 10 DPO?
Implantation bleeding at 10 DPO is typically light pink or brown, much lighter than a period, and lasts 1–2 days. It's often just spotting when you wipe or a few drops on a panty liner. However, only 15–20% of pregnant women experience implantation bleeding—most don't have any bleeding at all.
https://www.oova.life/blog/10-dpo
Why am I cramping at 10 DPO?
Cramping at 10 DPO can be caused by elevated progesterone (whether you're pregnant or not), implantation (if you're pregnant), or premenstrual cramping. Unfortunately, cramping alone can't tell you if you're pregnant since progesterone causes similar symptoms in both scenarios.
https://www.oova.life/blog/10-dpo
What are the chances of a BFP at 10 DPO?
If you're pregnant, you have about a 50–60% chance of getting a positive test at 10 DPO. This means there's a 40–50% chance of a false negative even if you conceived. Chances improve significantly by 12–14 DPO.
https://www.oova.life/blog/10-dpo
What DPO is most accurate for pregnancy testing?
14 DPO (the day of your missed period) is the most accurate time to test, with 99% accuracy. 12 DPO offers 80–90% accuracy. 10 DPO has only 50–60% accuracy. For best results, wait as long as you can—ideally until 12–14 DPO.
https://www.oova.life/blog/10-dpo
Is 10 DPO too early to test?
10 DPO is considered early for pregnancy testing. While some women get positives at 10 DPO, accuracy is only 50–60% if you're pregnant. For best results, wait until 12 DPO (80–90% accuracy) or 14 DPO/missed period (99% accuracy).
https://www.oova.life/blog/10-dpo
Can you have implantation at 10 DPO?
Yes, implantation can still occur at 10 DPO, though 84% of women have already implanted by this point. Late implantation at 10–12 DPO is normal. If implantation happens at 10 DPO, you won't get a positive pregnancy test for another 2–3 days.
https://www.oova.life/blog/10-dpo
What does a negative test at 10 DPO mean?
A negative test at 10 DPO does not mean you're not pregnant. It's very common to get negatives at 10 DPO even if you conceived. Your hCG levels may still be too low, or implantation may have occurred later. Wait until 12–14 DPO to retest for more accurate results.
https://www.oova.life/blog/10-dpo
Can you get a positive pregnancy test at 10 DPO?
Yes, but only about 50–60% of pregnant women will get a positive at 10 DPO. The other 40–50% have hCG levels that are still too low to detect. If you test negative at 10 DPO, wait 2–3 days and test again.
https://www.oova.life/blog/high-progesterone-symptoms
Can high progesterone cause weight gain?
Yes, elevated progesterone can cause temporary weight gain through water retention and bloating. This is a normal part of the luteal phase and early pregnancy.
https://www.oova.life/blog/how-to-increase-estrogen
Does stress affect estrogen levels?
Yes, chronic stress elevates cortisol, which can suppress estrogen production and disrupt hormonal balance. Stress reduction through meditation, yoga, adequate sleep, and self-care practices helps maintain optimal estrogen levels.
https://www.oova.life/blog/how-to-increase-estrogen
When should I consider medical treatment for low estrogen?
Consider medical intervention if natural methods don't improve symptoms after 3 months, if symptoms severely impact quality of life, if you're experiencing early menopause (before 40), or if you have fertility concerns. Hormone replacement therapy may be appropriate in these cases.
https://www.oova.life/blog/how-to-increase-estrogen
What are the signs that my estrogen is increasing?
Signs of rising estrogen include more regular menstrual cycles, reduced hot flashes, improved vaginal lubrication, better mood stability, increased energy, and improved skin elasticity. You may also notice reduced symptoms that originally indicated low estrogen.
https://www.oova.life/blog/how-to-increase-estrogen
Can exercise increase estrogen levels?
Yes, moderate exercise stimulates estrogen release and helps maintain hormonal balance. Aim for 150 minutes of moderate cardio weekly plus strength training twice per week. However, excessive exercise can actually lower estrogen, so balance is key.
https://www.oova.life/blog/how-to-increase-estrogen
How long does it take to increase estrogen naturally?
With consistent dietary and lifestyle changes, you may notice improvements in symptoms within 4-8 weeks. However, significant hormonal changes typically take 2-3 months. Tracking your cycle and symptoms can help you monitor progress.
https://www.oova.life/blog/how-to-increase-estrogen
What foods increase estrogen levels naturally?
Foods high in phytoestrogens can help increase estrogen naturally. The best options include flax seeds (high in lignans), soy products (tofu, tempeh, edamame), lentils, chickpeas, whole grains (oats, quinoa, brown rice), and garlic. These plant compounds mimic estrogen's effects in the body.
https://www.oova.life/blog/perimenopause
What helps relieve hot flashes quickly?
Cool environments, layered clothing, herbal teas, and medical treatments like gabapentin or HRT may help—depending on severity. Lifestyle changes like reducing caffeine and alcohol can also provide relief.
https://www.oova.life/blog/perimenopause
Are there tests to confirm perimenopause?
Yes. Tests measuring estradiol, LH, and FSH levels can indicate hormonal shifts—but diagnosis is often symptom-based since hormone levels fluctuate widely during perimenopause.
https://www.oova.life/blog/perimenopause
How do I know it's perimenopause and not something else?
A doctor may recommend hormone testing (like LH, E3G, and PdG) and track symptom timing. Diagnosis is often based on symptoms combined with age and menstrual pattern changes.
https://www.oova.life/blog/perimenopause
What's the earliest age perimenopause can start?
Some women begin experiencing symptoms as early as their mid-30s, though perimenopause typically starts between ages 38-45.
https://www.oova.life/blog/perimenopause
Does perimenopause affect mental clarity?
Yes. Brain fog and difficulty concentrating are common during hormone fluctuations in perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What happens after the last sign of perimenopause?
After your final period, you enter postmenopause. You'll need 12 consecutive months without a period to confirm menopause. Many symptoms gradually improve, though some like vaginal dryness may persist without treatment.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
When do perimenopause symptoms finally stop?
Some symptoms like brain fog improve after menopause, while others like hot flashes may continue for up to 10 years post-menopause. Vaginal symptoms often persist or worsen without treatment. Each person's timeline is different.
https://www.oova.life/blog/high-progesterone-symptoms
Is high progesterone a sign of pregnancy?
Yes, high progesterone is one of the earliest indicators of pregnancy. Progesterone levels rise significantly after conception to support the developing embryo and reach their peak during the third trimester.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Can you still get pregnant in late perimenopause?
Yes, you can still get pregnant during perimenopause as long as you're having periods, even if they're infrequent. Continue using birth control until you've gone 12 consecutive months without a period and have officially reached menopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Do symptoms get worse before perimenopause ends?
Yes, most perimenopause symptoms intensify in the final 1-2 years before menopause. Hot flashes peak around your final period, vaginal symptoms worsen, and mood changes increase. However, brain fog typically improves in late perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
How long does late perimenopause last?
Late perimenopause typically lasts 1-3 years before your final period. However, the exact duration varies significantly from person to person. You've reached menopause after 12 consecutive months without a period.
https://www.oova.life/blog/high-progesterone-symptoms
What are the symptoms of high progesterone?
High progesterone symptoms include fatigue, bloating, breast tenderness, weight gain, anxiety, depression, headaches, and food cravings. During pregnancy, you may also experience increased nipple sensitivity and muscle aches.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What are the first signs that perimenopause is ending?
The earliest signs include longer gaps between periods (60+ days), intensifying hot flashes that peak around your final period, and worsening vaginal dryness. These symptoms typically increase in late perimenopause before you reach official menopause.
https://www.oova.life/blog/high-progesterone-symptoms
When should I be concerned about high progesterone?
Consult a healthcare provider if you experience high progesterone symptoms outside your luteal phase when not pregnant, or if symptoms include severe pelvic pain, abnormal vaginal bleeding, or rapid weight gain while on hormone therapy.
https://www.oova.life/blog/high-progesterone-symptoms
How do you test progesterone levels?
Progesterone can be measured through blood tests at your doctor's office or at-home urine tests that measure PdG (a progesterone metabolite). Testing is typically done during the luteal phase, about 7 days after ovulation.

About the Oova Blog:
‍Our content is developed with a commitment to high editorial standards and reliability. We prioritize referencing reputable sources and sharing where our insights come from. The Oova Blog is intended for informational purposes only and is never a substitute for professional medical advice. Always consult a healthcare provider before making any health decisions.

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