Polycystic ovary syndrome is one of the most common hormonal conditions in women — and one of the most commonly missed. Many women spend years cycling through explanations that don’t quite fit: stress, diet, normal variation. By the time a diagnosis lands, the frustration is real. Understanding what PCOS actually is, and what evaluation and treatment look like, is the first step toward care that works.
At Anchor Health’s Women’s Health service, PCOS is treated as the complex metabolic and hormonal condition it is — not a collection of symptoms to suppress one at a time.
What PCOS Is — and Why It’s So Often Missed
PCOS is a hormonal disorder characterized by elevated androgen levels, disrupted ovulation, and often — but not always — small cysts on the ovaries. It affects an estimated 8–13% of reproductive-age women. Despite that prevalence, it’s underdiagnosed because it presents differently in different women. Some have obvious cycle irregularities. Others have normal periods but significant metabolic issues. Some have classic androgen symptoms like acne and hair changes. Others don’t.
The lack of a single defining symptom means women often get partial answers — or none at all — for years. And because the metabolic components of PCOS (insulin resistance, dyslipidemia, elevated cardiovascular risk) develop quietly, the downstream consequences of a missed or delayed diagnosis go well beyond menstrual irregularity.
Common Symptoms to Know
PCOS doesn’t look the same in every woman. The most frequent presentations include:
- Irregular or absent periods — cycles that vary significantly in length, or that stop altogether. This reflects disrupted ovulation.
- Weight changes — unexplained weight gain, particularly in the midsection, or significant difficulty losing weight despite genuine effort. This is driven by insulin resistance, which is present in most women with PCOS.
- Acne and oily skin — especially in adult women, acne that doesn’t respond to typical treatments is often androgen-driven.
- Hair thinning at the scalp — or excess hair growth on the face, chest, or abdomen (hirsutism) — both reflect elevated androgen activity.
- Fertility challenges — PCOS is one of the leading causes of ovulatory infertility. Irregular ovulation makes timing conception difficult.
- Mood changes — anxiety and depression are more prevalent in women with PCOS, likely due to a combination of hormonal dysregulation and the chronic stress of managing an underrecognized condition.
How PCOS Is Diagnosed
The clinical standard is the Rotterdam criteria, which requires at least two of three findings: irregular or infrequent ovulation, evidence of elevated androgens (either on labs or clinically — acne, hirsutism, hair thinning), and polycystic ovary morphology on pelvic ultrasound.
Lab work typically includes:
- Total and free testosterone, DHEA-S (androgen markers)
- LH and FSH (to assess ovulatory function)
- Fasting insulin and glucose, HbA1c (metabolic picture)
- Thyroid function (TSH) — to rule out thyroid disorders, which mimic PCOS symptoms
- Lipid panel — PCOS significantly elevates cardiovascular risk over time
- Prolactin — to rule out hyperprolactinemia as a cause of cycle irregularity
Diagnosis also requires ruling out other conditions that share symptoms with PCOS — including thyroid disease, congenital adrenal hyperplasia, and Cushing’s syndrome. Getting that differential right matters because the treatment paths are different.
On the Rotterdam criteria: PCOS can be diagnosed without cysts on ultrasound — two of the three criteria are sufficient. Women are often told they “don’t have PCOS” because their ultrasound was normal. That’s not accurate. If labs and clinical picture meet the threshold, the diagnosis stands.
Treatment Approaches
PCOS management is individualized because the condition expresses differently. Treatment targets the specific drivers — hormonal, metabolic, or both — rather than applying a single protocol to everyone.
- Hormonal management — Combined oral contraceptives are frequently used to regulate cycles and reduce androgen activity, which addresses acne, hirsutism, and cycle irregularity. They also protect against endometrial hyperplasia, a risk associated with chronic anovulation.
- Metabolic support — Metformin is the most studied medication for addressing the insulin resistance underlying most PCOS. It improves insulin sensitivity, often helps regulate cycles, and supports weight management without the risks of more aggressive interventions.
- GLP-1 medications — For women with significant metabolic dysfunction and weight concerns, GLP-1 receptor agonists like semaglutide may be appropriate. PCOS and metabolic health overlap significantly — the work at a telehealth weight management visit and a PCOS evaluation often cover the same ground.
- Lifestyle — Nutrition approaches that reduce glycemic load improve insulin sensitivity and can restore ovulation even without medication in some women. Movement, sleep, and stress reduction all affect cortisol and insulin dynamics in ways that directly influence PCOS symptoms.
- Spironolactone — For women whose primary concern is androgen-driven symptoms (acne, hirsutism, hair thinning), spironolactone is an anti-androgen that works independently of cycle regulation.
Why Telehealth Is Ideal for PCOS Management
PCOS is not a condition you diagnose and walk away from. It requires monitoring — labs every 3–6 months to track insulin, androgens, and metabolic markers; medication titration based on response; and ongoing conversation as symptoms shift over time. Hormonal conditions change — what works at 28 may need adjustment at 35 or 42. PCOS that overlaps with perimenopause adds additional complexity that requires a provider who knows your full history.
Telehealth removes the friction that causes this kind of ongoing care to lapse. Lab orders go to a draw site near you. Results come back to your provider, who reviews them and follows up by video. Medication adjustments happen without a commute. The consistency that PCOS management requires becomes achievable in a way that in-person care, with its scheduling friction and waiting rooms, often isn’t.
Anchor Health serves PCOS patients across Maryland — Baltimore, Silver Spring, Rockville, Columbia, Annapolis, Frederick, and beyond — entirely via telehealth.
How Anchor Health Approaches PCOS
The Anchored Care™ model treats PCOS as a whole-person metabolic and hormonal condition — not a symptom list to suppress. That means evaluating the full clinical picture (labs, cycle history, metabolic function, body composition, fertility goals) before recommending treatment. It means adjusting the plan as your picture evolves. And it means understanding that PCOS management isn’t a prescription refilled annually — it’s an ongoing clinical relationship.
If you’ve been told your labs are “normal” but your symptoms don’t feel normal — or if you have a diagnosis but no clear treatment plan — that’s the conversation Anchor Health is set up to have.
Frequently Asked Questions
What are the main symptoms of PCOS?
PCOS presents differently in different women, but the most common symptoms include irregular or absent periods, excess androgen activity (acne, excess facial hair, or hair thinning at the scalp), difficulty losing weight or unexplained weight gain, and ovarian cysts visible on ultrasound. Fertility challenges are also common. Not every woman with PCOS has all of these — that variability is part of why PCOS is so often missed.
How is PCOS diagnosed?
PCOS is diagnosed using the Rotterdam criteria, which requires at least two of three findings: irregular or infrequent ovulation, clinical or lab evidence of elevated androgens, and polycystic ovaries on ultrasound. Labs typically include testosterone, DHEA-S, LH, FSH, fasting insulin, glucose, thyroid function, and a lipid panel. Diagnosis also requires ruling out other conditions that mimic PCOS — thyroid disorders, hyperprolactinemia, and late-onset congenital adrenal hyperplasia.
Can PCOS be treated with telehealth in Maryland?
Yes. PCOS management is well-suited to telehealth because it involves ongoing lab monitoring, medication adjustments, and follow-up conversations — none of which require an in-person exam. Lab orders are sent to a draw site near you. Anchor Health provides PCOS care to patients across Maryland, including Baltimore, Silver Spring, Rockville, Columbia, Annapolis, and Frederick.
What medications are used to treat PCOS?
Treatment depends on what’s driving your symptoms. Combined oral contraceptives regulate cycles and reduce androgen activity. Metformin addresses insulin resistance, which underlies PCOS in most women. GLP-1 receptor agonists may be appropriate when metabolic dysfunction is significant. Spironolactone reduces androgen-driven symptoms like acne and hair changes. Your plan depends on your lab results, symptoms, and goals — there’s no one-size-fits-all protocol.
Does PCOS affect fertility?
PCOS is one of the most common causes of ovulatory infertility. Irregular or absent ovulation makes conception more difficult — but it’s often treatable. For many women, addressing insulin resistance and regulating cycles through medication restores ovulation. Anchor Health manages PCOS comprehensively, including fertility-related conversations. Women actively trying to conceive may be referred to a reproductive endocrinologist depending on clinical complexity, but the foundational metabolic and hormonal work starts in primary care.
How is PCOS different from perimenopause?
Both involve hormonal disruption and irregular cycles, but the mechanisms are different. PCOS is driven by elevated androgens and insulin resistance — it typically begins in the teens or twenties. Perimenopause is driven by declining estrogen and progesterone as the ovaries wind down, usually beginning in the 40s. The two can overlap — a woman with PCOS entering her 40s faces a more complex hormonal picture. Getting the diagnosis right matters because the treatment approaches differ significantly.