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Beneath the Surface: Subclinical Symptoms of PCOS (Part 1/2)

The Journey Towards Diagnosis

- Dr Grove Higgins

I. A Serious Women's Health Issue

Women's Health - PCOS Focused article
Women's Health

Polycystic Ovary Syndrome (PCOS) is a common hormonal issue affecting about 1 in 10 women of childbearing age, equaling 5 million women in the United States. It is the most common cause of infertility and can seriously affect their health and day-to-day life (Burghen et al., 2022). PCOS can cause changes in menstrual cycles, increase male hormones, and lead to the growth of many small cysts on the ovaries. However, PCOS isn't just about these noticeable symptoms. There are also quieter, often missed signs that show up before the main symptoms. We call these subclinical symptoms.

Subclinical symptoms are like warning signs. They hint at a health issue like PCOS but aren't strong enough to confirm it (Dumesic et al., 2023). They can include minor hormonal changes, slight changes in periods, and mild skin issues or weight gain. While they might seem small, they're important. They can give us an early warning about PCOS, helping us to tackle the problem sooner.

Recent studies have highlighted the importance of spotting and acting on these early warning signs quickly. This could lead to an earlier diagnosis and early action to prevent the more severe symptoms of PCOS. Understanding these early warning signs is a crucial step in managing PCOS and improving the health of women dealing with this condition (Dumesic et al., 2023). In this article, we'll dig into these early warning signs of PCOS, how often they occur, and their role in diagnosing PCOS.

II. The Puzzle of Subclinical Symptoms

In the world of Polycystic Ovary Syndrome, or PCOS, there are certain signs or symptoms that are easy to miss but are really important. These are called subclinical symptoms. They aren't as loud as other symptoms, but they can be just as useful in figuring out if someone has PCOS.

The subclinical symptoms of PCOS are often about changes in periods, skin, and metabolism. These include minor changes in menstrual cycles like having longer cycles or missing periods sometimes, a little more body hair in places usually seen in men, small breakouts, and a bit of weight gain or trouble losing weight. Even though these symptoms might not seem like a big deal, they can be vital clues in diagnosing PCOS (Weinstein et al., 2023).


Menstrual Irregularities:

  • Longer Menstrual Cycles: This refers to cycles that are longer than the average 28-day cycle. 15% of women reported having experienced cycles longer than 35 days before being formally diagnosed.

  • Sporadic Missed Periods: 10% of women had instances of missed periods, which they initially attributed to stress or other non-medical factors.

  • Light or Heavy Menstrual Flow: 5% of women reported uncharacteristically light or heavy menstrual flow prior to their diagnosis.

It's important to note that while these irregularities can indicate the onset of PCOS, they are also associated with other medical conditions. Therefore, they should be evaluated in the context of other symptoms and a comprehensive clinical examination. (Yildiz et al, 2022)


In simple terms, a study by Yildiz and team (2022) showed that around 3 in 10 women with PCOS had noticed some changes in their periods before they were diagnosed. About a quarter of women saw a bit more body hair and minor skin breakouts, and 2 in 5 women struggled a bit with their weight, but not enough to worry them at the time.

Interestingly, these quieter symptoms can show up several years before PCOS is diagnosed. Yildiz and colleagues (2022) suggested that in some cases, these symptoms can appear as early as the teen years, often when puberty starts. However, these symptoms can easily be brushed off as just regular hormonal changes or blamed on lifestyle habits, which can delay the diagnosis of PCOS.

These findings highlight how important it is for everyone, both healthcare providers and women, to be aware and watchful of these early signs. Spotting these signs early can speed up the diagnosis of PCOS, allowing for quicker treatment and potentially stopping the condition from getting worse.

III. Journey Towards Clinical Diagnosis

Subclinical symptoms of PCOS may seem harmless or even normal, but they can actually be early signs of this condition. With time, these quiet signs might grow louder and start looking more like the usual symptoms of PCOS (Hickey et al., 2023).

To diagnose PCOS, doctors typically use the Rotterdam criteria, which were established in 2004. According to these rules, to be diagnosed with PCOS, a woman needs to have at least two out of these three issues: (1) irregular periods or no periods at all, (2) signs of having high levels of male hormones, like skin breakouts, unusual body hair growth, or high androgen levels found in blood tests, and (3) many small cysts on the ovaries, seen on ultrasound (Rotterdam, 2004).

These subclinical symptoms can often be the first signs of these issues. For example, minor changes in periods might become more noticeable, leading to very infrequent periods or no periods at all. This would meet the first rule of the Rotterdam criteria (Hart & Doherty, 2022). A bit of unusual body hair growth might get worse and join with other signs of high male hormones like severe skin breakouts or hair loss, meeting the second rule. Minor metabolism issues might progress and lead to the development of many small cysts on the ovaries, meeting the third rule.

So, the path to diagnosing PCOS often involves these quiet symptoms becoming louder and more noticeable. By being aware of this change and keeping an eye out for these early signs, healthcare providers and women can speed up the diagnosis of PCOS. This means they can start treatment earlier and potentially have better health results (Hart & Doherty, 2022).

Questions to ask your doctor if you suspect you might have early signs of PCOS

  • Could my irregular periods be a sign of PCOS?

  • Could my acne or hair growth pattern indicate higher levels of male hormones?

  • Are there other early signs of PCOS that I should be aware of?

  • What tests can be done to determine if I have PCOS?

  • What can I do to manage my symptoms and prevent PCOS from getting worse?

  • Could my weight changes be related to PCOS?

  • Are there lifestyle changes that can help manage these symptoms?

  • Should I consider seeing a specialist for my symptoms?

  • Is there a possibility my symptoms could be misinterpreted as another condition?

  • How often should I check in with you about my symptoms?

  • What resources or tools can help me track my menstrual cycles or other symptoms?

In part 2 we will discuss the problems with diagnosis and the benefit of early diagnosis.

Please share this article with other women. You can change their lives for the better!


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