How to Know If You Have PCOS: A Guide to Symptoms and Testing

Polycystic ovary syndrome (PCOS) is one of the most common conditions women of reproductive age face. However, medical experts estimate that up to 70% of cases could be going undiagnosed. That’s a heartbreaking statistic! Luckily, as awareness about PCOS spreads, women can better understand their symptoms, diagnose the problem, and advocate for their healing journey. 

If you think you may have PCOS, you’ve come to the right place. I am a Cyster myself, as well as a PCOS dietitian that’s here to help you figure out if you have PCOS—and how to reverse it if you do. In this post, I’ll break down common symptoms, similar medical conditions, and trusted diagnostic methods. Ready to jump in? Here’s how to know if you have PCOS:

How to Know If You Have PCOS: A Guide to Symptoms and Testing

There are a lot of reasons PCOS often goes undiagnosed. Symptoms vary widely from Cyster to Cyster, and many of them can be treated individually rather than holistically, making it difficult to see connections between side effects. Plus, many doctors aren’t well educated on the condition, and no single test can definitively detect PCOS.

That may all sound bleak, but you’re in the right place! You can be sure whether or not you have PCOS with a little research, some symptom tracking, a few strategic tests, and a knowledgeable healthcare professional. 

What Is PCOS? 

Polycystic ovary syndrome (PCOS) is an endocrine and metabolic condition that affects women of reproductive age. While the exact cause of PCOS is still unknown, it’s driven by insulin resistance, hormonal imbalances, and chronic inflammation. Research is now also examining whether there could be a genetic component, meaning it may run in families.

PCOS affects far more than just the ovaries. (In fact, many women with PCOS don’t have cystic ovaries at all.) It impacts how the body produces and responds to hormones, regulates blood sugar, and functions over all. Because these systems are so closely connected, PCOS can influence long-term metabolic health, fertility, and hormone balance throughout different stages of life. Additionally, there’s a lengthy list of common chronic symptoms that many Cysters manage daily. Some of them are:

Common Symptoms of PCOS

• Irregular, missed, very heavy, or very light periods
• Difficulty getting pregnant
• Sugar or carbohydrate cravings
• Difficulty losing weight or stubborn weight gain
• Excess facial and body hair (hirsutism)
• Thinning scalp hair or hair loss
• Persistent adult acne
• Darkened skin patches (acanthosis nigricans)
• Skin tags
• Chronic fatigue or low energy
• Brain fog and lack of focus
• Mood swings, anxiety, or depression (Learn more here about the connection between PCOS and mental health!)
• Bloating or digestive discomfort
• Joint or muscle aches
• Polycytic ovaries 

Can PCOS Be Misdiagnosed? 

Yes! PCOS is often misdiagnosed. I’ve already touched on a few reasons, but here’s a full list:

• Symptoms vary from person to person 
• Doctors often treat symptoms individually instead of looking at the full pattern
• No single test can definitively diagnose PCOS
• Standard hormone panels may appear “normal”
• Insulin resistance is frequently under-tested or missed
• Ultrasounds don’t always show ovarian cysts (or you may not have any) 
• Birth control pills can mask underlying hormone imbalances
• Physicians often blame symptoms on stress, lifestyle, weight, or aging
• Many patients don’t know which symptoms are relevant to report

Other Conditions Similar to PCOS

Thyroid Disorders (Hypothyroidism or Hyperthyroidism)

Thyroid disorders affect how the body regulates metabolism, energy, and hormones. They’re often mistaken for PCOS because they can cause irregular periods, weight changes, fatigue, hair loss, and fertility issues.

You can learn more about the connection in my post, “PCOS and Thyroid: Symptoms, Connections, and Solutions.”

Hypothalamic Amenorrhea (HA)

HA occurs when the brain suppresses ovulation due to stress, under-eating, excessive exercise, or extreme weight loss. It’s often confused with PCOS because both can involve missing periods and disrupted ovulation. That said, HA stems from low hormone signaling rather than excess hormone activity.

Hyperprolactinemia

This condition involves elevated prolactin levels, which interfere with ovulation and menstrual cycles. It’s mistaken for PCOS because it can cause excessive hair growth, acne, irregular periods, and trouble getting pregnant.

Congenital Adrenal Hyperplasia (Non-Classic CAH)

Non-classic CAH is a genetic condition that affects adrenal hormone production and can increase male sex hormone levels. It closely mimics PCOS due to shared symptoms like excess hair growth, acne, and irregular cycles.

Cushing’s Syndrome

Cushing’s Syndrome results from chronically elevated cortisol levels and affects metabolism, weight distribution, and hormone levels. It’s often confused with PCOS because both can cause weight gain, insulin resistance, irregular periods, and mood changes.

Primary Ovarian Insufficiency (POI)

POI occurs when the ovaries stop functioning normally before age 40. It can resemble PCOS early on because of irregular or missing periods. However, POI involves low estrogen rather than hormone excess.

Insulin Resistance

Insulin resistance affects how the body handles blood sugar and is a major driver of PCOS—but it can also exist on its own. When present without other diagnostic criteria, it may be mistaken for PCOS due to shared metabolic symptoms.

Endometriosis 

Endometriosis happens when tissue similar to the uterine lining grows outside the uterus, leading to inflammation and pain. It’s often confused with PCOS because both conditions can cause irregular or painful periods, fertility challenges, and chronic pelvic pain. Ultimately, however, endometriosis is a result of tissue overgrowth and inflammation, not hormone-driven ovulation or androgen imbalance.

Here’s more on PCOS vs. endometriosis. 

Androgen-Secreting Ovarian or Adrenal Tumors (Rare)

These rare tumors produce excess testosterone and other androgens, which can trigger a rapid onset of PCOS-like symptoms. They’re mistaken for PCOS because of sudden hair growth, acne, and cycle disruption, though symptoms usually appear more aggressively.

How to Know If You Have PCOS at Home

Step One: Track your menstrual cycle. 

A vast majority of people with PCOS have irregular periods. This is largely due to high levels of a hormone called androgen (male sex hormones), which are common with PCOS. They disrupt or even stop ovulation, which throws off the whole menstrual cycle. 

So, one of the first ways to determine if you have PCOS is to examine your periods. Track the start date, duration, and any notable symptoms. If your periods are longer than 35 days apart or you only experience periods every 2-6 months, you may have PCOS. Periods with PCOS can also be heavy and painful. 

Step Two: Check for common PCOS symptoms. 

Next, look for common signs and symptoms of PCOS. Review the list above and identify which symptoms you experience regularly. The more that applies to you, the more likely you are to have PCOS. 

Step Three: Look for signs of insulin resistance. 

Insulin resistance is present in up to 80% of Cysters, which is when your body doesn’t respond to glucose properly. Instead of turning the sugar into energy, it’s stored as fat and absorbed into the bloodstream. This increases your risk of high blood pressure, heart disease, and type 2 diabetes, while contributing to these common PCOS symptoms:

Step Four: Get home hormone testing. 

One of the best ways to detect PCOS at home is by using a hormone test kit like this one from EquiLife. It’s comprehensive and sensitive enough to measure a variety of hormone levels that contribute to PCOS symptoms. Here’s what you need to test for:

• Thyroid Deficiency 
• Estrogen Dominance
• Androgen Imbalance 
• Vitamin D Deficiency 
• Insulin Resistance/Metabolic Syndrome

Here’s more on how to get your hormone levels tested for PCOS. 

Step Five: Review results for PCOS patterns. 

Review all the information you’ve collected on your symptoms, periods, metabolic situation, and hormone levels. Then determine whether there’s enough evidence to support PCOS. If you think there is, the next step is to seek professional help.  

Step Six: Follow up with a healthcare provider. 

You can’t definitively determine whether or not you have PCOS on your own. However, with the information you’ve gathered and the right doctor, you can work toward an official diagnosis. There are a variety of healthcare professionals who can accurately detect PCOS and help you manage your symptoms. Here are the best types of doctors to see for PCOS:

• OB-GYN 
• Endocrinologist
• Reproductive Endocrinologist
• Functional Medicine Doctor
• Integrative or Holistic Physician
• Fertility Specialist 

Step Seven: Start PCOS-healing lifestyle habits. 

Whether you’ve received a PCOS diagnosis or are still waiting on results, it’s time to start making simple lifestyle changes to reverse your symptoms. Many of these new healthy habits support hormone and metabolic health for anyone, not just Cysters! So, adopting these new routines won’t hurt you if PCOS turns out to be the wrong diagnosis. That said, focusing on a PCOS-friendly diet, slow-weighted movement, and other daily rituals that stabilize blood sugar and regulate hormones can help support healing and symptom improvement over time.

Here’s our essential guide to naturally managing PCOS. 

How Is PCOS Diagnosed? Understanding the Rotterdam Criteria

PCOS is typically diagnosed using something called the Rotterdam Criteria, the most widely accepted diagnostic framework. Instead of relying on one single test, doctors look at the bigger picture and evaluate a combination of symptoms, lab work, blood tests, and imaging. 

Under the Rotterdam Criteria, clinicians diagnose PCOS after confirming specific criteria and ruling out other conditions. To get diagnosed with PCOS, you must have two of the following: irregular or absent ovulation, elevated androgen levels, and polycystic ovaries. This approach helps account for how differently PCOS can show up from person to person! 

PCOS is a unique condition, but it can be clearly diagnosed with the right criteria and testing.

If PCOS has been on your radar, trust that curiosity. It’s often the first step toward clarity! Understanding your symptoms, getting the right tests, and working with a knowledgeable provider can make a huge difference in how you confidently and strategically move forward. PCOS may be complex, but with the right information and support, it’s absolutely something you can manage and improve.
For more guidance on naturally healing PCOS and reversing symptoms, explore the PCOS Weight Loss blog and listen to the A Cyster and Her Mister Podcast.