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Most women with polycystic ovary syndrome (PCOS) usually present to a doctor with some or all of the following symptoms:

• Menstrual irregularities
• Infertility
• Cystic ovaries
• Obesity
• Hirsutism (excessive body and facial hair)
• Acne/Seborrhea
• Insulin resistance
• Alopecia (thinning hair or male-pattern baldness)
• Acanthosis nigricans (dark patches of skin)
• Dyslipidemia (abnormal lipid levels)
• Obstructive sleep apnea syndrome (OSAS)

Menstrual Irregularities

In the normal menstrual cycle, GnRH (Gonadotropin Releasing Hormone) is released by the hypothalamus and the hormone stimulates the pituitary gland to direct the release of FSH (follicle stimulating hormone) and LH (luteinizing hormone). The menstrual cycle begins when FSH rises as estrogen and progesterone fall at the end of the previous cycle. Follicles on the ovary begin to grow in response to FSH. The theca cells in the follicles produce androgens (male hormones, e.g. testosterone) in response the LH and these androgens are converted to estrogen in response to FSH.

As estrogen increases, one dominant follicle that grows up to 20 mm in size, emerges on the ovary. There is a surge of LH that results in ovulation, during which the follicle erupts and an egg is released. Additionally, in response to the rising estrogen, the endometrium (central lining of the uterus) thickens and becomes very vascular. If no pregnancy occurs, progesterone and estrogen levels fall and the endometrium is sloughed off in the form of menstrual flow and the next cycle begins.

In PCOS, multiple follicles form but none exceed 9 mm in size because the elevated FSH necessary to promote maturation is lacking. It is thought that there are other factors may be involved in the failure of a dominant follicle to develop and these factors may be related to an unknown "programming" problem within the ovary or somewhere in the endocrine system. Another theory is that high levels of insulin may somehow cause premature cessation of follicular development. Women who are hyperinsulinemic tend, in general, to have more menstrual abnormalities.

A woman with PCOS may experience heavy uterine bleeding at unpredictable times (dysfunctional bleeding). But this type of bleeding represents only the excretion of the top layers of endometrium and not the amount that should be eliminated in the course of a normal cycle.

Menstrual irregularities can normally occur during adolescence and can often be a confusing factor in the early diagnosis of PCOS. Whereas in non-PCOS adolescents cycles usually are regulated after a couple of years, in adolescent girls with PCOS:

• Over half of the menstrual cycles are anovulatory even three years after onset of menstruation
• They still experience dysfunctional bleeding
• Still may experience amenorrhea

Infertility

In addition to menstrual irregularities, PCOS is a major cause of anovulatory infertility. According to Resolve: National Infertility Association, infertility is considered to be the inability to become pregnant within 12 months of trying to conceive. In PCOS, infertility is usually due to problems with ovulation. When a woman with PCOS does become pregnant, there is an elevated risk of miscarriage. The International Council on Infertility Information Dissemination (NCIID) among others estimates that the risk of miscarriage is approximately 45%.