Too Old for Acne? Difficult-to-Diagnose PCOS May Be the Cause

Written by Julia Telfer, MPH
Reviewed by Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE

Though the exact cause of PCOS is unknown, many scientists believe that a combination of environmental and genetic factors are involved. Your risk may be higher if you are overweight or if your mother, aunt, or sister has PCOS.

As Andrea Dunaif, MD, Chief of the Division of Endocrinology, Diabetes, and Bone Disease at the Icahn School of Medicine at Mount Sinai points out, “The name can be confusing and misleading, because not all women with PCOS have cysts on their ovaries.” In fact, many experts and patient advocates are joining an international effort to change the name to something that is more reflective of what PCOS actually is – a metabolic issue. The hope is that having a more accurate name will help further research and improve treatment.

Signs and Symptoms

Most women are diagnosed in their twenties and thirties, but PCOS often starts in adolescents and can affect girls before they begin menstruating. The hormonal imbalance can interrupt the development and release of eggs from the ovaries. It often goes undiagnosed because many of the symptoms can be attributed to other causes. Common symptoms of PCOS include:

These symptoms are caused by hormonal imbalances including lower-than-average levels of the progesterone, higher-than-average levels of androgens, and decreased insulin sensitivity. This helps explain the PCOS-diabetes connection—in both conditions, the body isn’t as sensitive to insulin as it should be. This leads to high blood sugar levels, which in turn cause the body to produce more insulin. High levels of insulin in the body triggers the production of more androgens, contributing to additional symptoms.

When talking to patients, Dr. Dunaif tries to stress that although these symptoms can sound overwhelming and scary, with the right treatment plan, both PCOS and diabetes can be managed and women can live normal, healthy lives. Everyone is different, so it’s important to work with your healthcare team to come up with a treatment plan that works for you.

Diagnosis and Treatment

Getting diagnosed and properly treated is important because women with PCOS are often at risk for having co-occurring health problems such as diabetes, high blood pressure, and high cholesterol. Because there isn’t one specific test that is used to diagnose PCOS, your healthcare provider(s) might use a combination of the following to help rule out other causes for your symptoms and diagnose you:

Although there isn’t a cure for PCOS yet, there are a number of very effective treatments available to help decrease or completely eliminate your symptoms. Many of the treatment options are also used to treat type 2 diabetes. Unfortunately, due to a lack of funding for research, many haven’t been officially approved by the FDA for the treatment of PCOS. 

Some Good Options Not Approved for PCOS Treatment

Talk to your doctor about which options might benefit you. Here, some options that may be recommended:

How to Build the Best PCOS Treatment Team

Due to the less-than-accurate name, the lack of published research on PCOS, and the symptoms that mimic other conditions, a diagnosis is easy to miss. “Women usually have to go to a number of providers to get the right kind of tests and treatments underway,” says Dr. Dunaif.

If you think you may have PCOS, Dr. Dunaif recommends asking your doctor for a referral to an endocrinologist who specializes in reproductive disorders. These specialists can order and interpret the appropriate hormonal and glucose tests, and are well-versed in PCOS symptoms and treatments. Your care team might include a combination of the following providers: a primary care doctor, a gynecologist, an endocrinologist, a fertility specialist, a dermatologist, a certified diabetes educator, a registered dietitian, and a mental health provider.

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