PCOS can also change how your period looks and feels. If you haven’t had one in several months, then suddenly it arrives, there might be a big buildup of endometrial tissue (a.k.a. the uterine lining) and, as a result, the bleeding might be “heavy, long, and painful,” says Dr. Vash-Margita. Adeeyo, who’s now a Los Angeles-based mental health therapist and author, recalls that her month-long period was pretty heavy with a dark red color. “I felt as if someone cut me up on the inside,” she says. “It would be lighter in the mornings, but for the most part, it was constant bleeding and I justified it because I hadn’t had a period for months prior so I was like, ‘Oh this is just built-up blood.’ Girl, please.”
2. You have (or once had) deep cystic acne on your jawline, face, chest, or arms.
Acne can show up in a ton of ways—and for a boatload of reasons. But PCOS pimples tend to look and feel a lot different than, say, a random cluster of whiteheads, Gil Weiss, MD, an ob-gyn and assistant professor of clinical medicine at Northwestern Memorial Hospital, tells SELF: You’ll typically see large, deep cysts, rather than small, superficial pimples, Dr. Weiss says. (They may or may not appear red, depending on your skin tone.) For Dr. Vash-Margita, where acne shows up also factors into her PCOS suspicions. “It’s usually severe, inflammatory acne on the face, upper chest, upper back, upper arms.”
So why might PCOS trigger these types of breakouts? It comes back to those excess androgens, which can stimulate your oil glands and make an ideal environment for acne-causing bacteria to thrive. (Still, acne alone wouldn’t constitute a diagnosis, Dr. Vash-Margita reiterates—it’s just one potential indicator.)
Perhaps a bit more subtle sign of PCOS? Even if cystic acne faded long ago (say, you exited your tumultuous teen years and the hormonal pandemonium that went with it—thank god), Dr. Vash-Margita says that the skin condition can sometimes lead to a lot of scarring—and a doc might note that when considering a diagnosis.
3. You have more—or less—hair in places that aren’t your usual.
It’s not uncommon to get a few stray strands on your chin every now and then, or some growth on your upper lip. Still, if you’re dealing with hair in places that aren’t typical for you, Dr. Vash-Margita says it could be something to pay attention to because excess androgens cause it to sprout in unexpected spots.
Still, she rarely makes a PCOS diagnosis based on this alone—rather, she asks the person how they feel about it. “Some people are okay with facial hair, and some people are bothered by it. You can never assume,” she explains, noting that the upper lip, chin, sideburns, lower abdomen, or lower back can be growth areas. Hair loss can also be a potential sign that something’s up because androgens can cause thinning, particularly at the top of your head, and widening down your middle part, which is known as androgenetic alopecia.
4. Your insulin levels are off.
A lot of people with PCOS have a higher risk of insulin resistance, meaning the body loses its sensitivity to the hormone, Dr. Klein says. People who have PCOS tend to have, on average, elevated levels of blood sugar and insulin, he explains, which can lead to more serious health problems like heart disease and type 2 diabetes. Scientists aren’t exactly sure why, but “we do know that the reproductive hormonal imbalance and metabolic disruption that is common in PCOS is involved,” Dr. Klein says. This can—but not in all cases—be accompanied by more body fat than is normal for you, particularly around your waist. Nearly half of all people with PCOS also have metabolic syndrome, a cluster of health markers—including high blood pressure, blood sugar, and a type of fat in the blood called triglycerides—that can absolutely mess with your health, Dr. Vash-Margita says.
5. You’re feeling depressed and out-of-sorts.
According to Dr. Klein, there’s no question that PCOS and mental health are intertwined—people with the condition are at a higher risk for things like depression, anxiety, and eating disorders. As for whether living with PCOS causes those things to happen, that’s scientifically TBD, he notes: “It’s a little messy. It’s not a very straight-line type of relationship.”