PCOS Affects 1 in 8 Women Globally—But Most Don't Know They Have It

Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting an estimated 10-13% of women globally, yet up to 70% of those with the condition don't realize they have it. PCOS occurs when hormonal imbalances lead to higher than normal androgen levels, causing irregular periods, fertility challenges, and other symptoms that can significantly impact quality of life.

What Exactly Is PCOS and Why Does It Matter?

PCOS is a chronic metabolic condition that persists throughout a woman's life, often starting as early as adolescence but most commonly detected when women struggle to become pregnant. The condition happens when inappropriate hormonal signaling disrupts normal ovulation and creates a cascade of symptoms that vary widely from person to person.

The stakes are real: PCOS is the most common cause of anovulation (failure to ovulate) among women globally and a leading cause of infertility. Beyond fertility challenges, women with PCOS face significantly elevated risks for serious long-term health problems, including insulin resistance, type 2 diabetes, obesity, high blood pressure, high cholesterol, cardiovascular disease, sleep apnea, and even endometrial cancer.

What Are the Signs You Might Have PCOS?

PCOS symptoms can look different in every woman, and they may change over time. Some women experience obvious signs, while others have subtle indicators that get overlooked for years. Here are the most common warning signs:

• Menstrual Irregularities: Intermittent, unpredictable, or absent periods; or for some women, heavy, long, and/or painful periods that disrupt daily life
• Fertility Challenges: Difficulty conceiving or infertility, which is often what prompts women to seek diagnosis
• Unwanted Hair Growth: Excessive hair on the face or body (hirsutism) due to elevated androgen levels
• Hair Loss: Female-pattern baldness or thinning hair on the scalp, which can be emotionally distressing
• Skin Issues: Acne or oily skin that may not respond well to standard treatments

The emotional toll of PCOS symptoms shouldn't be underestimated. Women with PCOS often experience anxiety, depression, eating disorders, and negative body image, particularly because symptoms like infertility, weight gain, and unwanted hair growth carry social stigma in many communities.

Why Is PCOS So Often Missed?

The diagnostic challenge is part of the problem. PCOS is diagnosed when a woman has at least two of three criteria: signs of high androgens (excess facial or body hair, head hair loss, acne, or oily skin), irregular or absent menstrual periods, or polycystic ovaries visible on ultrasound. Interestingly, some women with PCOS don't actually have polycystic ovaries, and ovarian cysts alone aren't required for diagnosis—a fact that confuses many patients and healthcare providers alike.

The underdiagnosis problem is staggering: up to 70% of women with PCOS worldwide don't know they have the condition. This gap exists partly because symptoms overlap with other conditions, partly because irregular periods are sometimes dismissed as normal, and partly because structural racism and social determinants of health affect who gets screened and receives quality care. The prevalence of PCOS also varies among different racial and ethnic groups, and some women have higher genetic risk for metabolic complications.

What Treatment Options Actually Work?

Here's the important truth: there is currently no cure for PCOS, but multiple treatment approaches can significantly improve symptoms, increase fertility rates, and protect long-term health. The right approach depends on your individual priorities and values.

For managing menstrual cycles and cosmetic concerns, combined oral contraceptive pills can help regulate periods and may reduce acne or excess facial and body hair. Androgen receptor blockers may also be used specifically to treat excess hair or acne. Treatment choices should be based on shared decision-making between you and your healthcare provider, taking your unique values and preferences into account.

Lifestyle changes form the foundation of PCOS management. Healthy eating and physical activity are important for all women with PCOS, even if they don't lead to weight loss—the metabolic benefits occur regardless. For women trying to conceive, treatment options include lifestyle modifications, medicines to stimulate ovulation, or surgery in some cases. In-vitro fertilization (IVF) and other assisted reproductive technologies may also be used when other approaches haven't worked.

Women with PCOS can successfully become pregnant, but they generally face higher risk of pregnancy complications like gestational diabetes or high blood pressure, which warrants additional monitoring throughout pregnancy.

The Family Connection and Early Detection

PCOS runs in families, which means if your mother or sister has it, your risk is higher. Women with a family history of PCOS or type 2 diabetes are at significantly elevated risk. This genetic component makes family screening particularly valuable—if you have relatives with PCOS, discussing your own risk with a healthcare provider is worthwhile, even if you don't currently have obvious symptoms.

Early detection and management matter tremendously. Seeking healthcare early to manage PCOS symptoms helps women protect their health and well-being during and beyond their reproductive years. If you're newly diagnosed, additional blood testing should evaluate your insulin resistance and assess your overall cardiovascular risk, since these are major long-term health concerns for women with PCOS.

The bottom line: if you experience irregular periods, fertility challenges, excess hair growth, hair loss, or persistent acne—especially if these symptoms run in your family—it's worth discussing PCOS screening with your doctor. With proper diagnosis and management, women with PCOS can take control of their health and improve their quality of life significantly.