PCOS: What PCOS Actually Is — And What I Wish I Had Understood Sooner

When I first heard the words “you have PCOS,” I nodded, maybe half-listening, and mentally filed it under “another confusing health thing I’ll figure out later.” It turns out, that’s exactly the part I wish I had understood sooner: PCOS isn’t a simple condition with one clear cause or one obvious symptom — it’s a syndrome, meaning a collection of symptoms that show up because hormones aren’t quite balanced. (NIH)

So what is PCOS?

Polycystic Ovary Syndrome (PCOS) is defined by a hormonal imbalance that can affect reproductive health, metabolism, inflammation, and more. It’s common — affecting an estimated 6–13% of people with ovaries of reproductive age worldwide — but often goes undiagnosed or misunderstood. (World Health Organization)

Doctors typically diagnose PCOS when you have at least two of the following:

1. Irregular or absent ovulation, like skipped periods or very unpredictable cycles.

2. Elevated male-type hormones (androgens), which can show up as excess facial/body hair or stubborn acne.

3. Polycystic-appearing ovaries on ultrasound — clusters of immature follicles that haven’t released eggs.

But here’s the thing I wish I had understood:

• You don’t have to have “cysts” on your ovaries to have PCOS. Those follicles aren’t actually painful or dangerous cysts in most cases — they’re a sign that ovulation isn’t happening regularly.

• It’s not just about periods. PCOS can affect your skin, hair, weight regulation, energy levels, insulin sensitivity, and even long-term heart and metabolic health.

• The causes are still not fully understood. Genetics and environment both likely play a role, and symptoms can look very different from person to person.

That means PCOS can feel invisible at first — people often chalk symptoms up to stress, weight changes, mood swings, or just adult life until something clicks.

What I wish I knew earlier:

Realizing it’s okay for PCOS to look different in every body. For some, irregular periods are the biggest clue. For others it’s acne or unexplained weight changes. For others still, it shows up as fatigue and difficulty with blood sugar. There’s no single experience, and that’s normal.

PCOS isn’t something you just fix or outgrow, but it is something you can understand and manage in partnership with the right care and reliable information.

Next up in this series: who I’m learning from and the conversations that have helped me make sense of all this along the way.

This is not medical advice — talk with your healthcare provider about diagnosis or treatment