PCOS: changes to periods, skin and hair

Extra hair on your face and thinning hair on your scalp can both happen with the same condition. PCOS can also bring acne and periods that are hard to predict. These changes can seem unrelated. But higher androgen activity (androgens are hormones such as testosterone) can lead to hair and skin symptoms and get in the way of ovulation.

PCOS now has a new name: polyendocrine metabolic ovarian syndrome (PMOS). Both names mean the same condition. This article uses PCOS because it’s the name you may already know.

When periods are hard to predict

PCOS can make periods come and go, stop, or arrive unpredictably. Some people have heavy or long periods instead. The pattern can change over time, so no single bleeding pattern shows that you have PCOS. A clinician needs to think about other causes too.

Talk to your clinician about long gaps between periods, even if the bleeding itself doesn’t bother you. With PCOS, going a long time without periods, without treatment, adds to the risk of thickening and cancer of the womb lining. The overall chance of womb (endometrial) cancer is still low, and routine screening for everyone with PCOS isn’t recommended.

A clinician can talk about ways to make your cycles more regular, and give progestogen treatment to protect the lining. For irregular periods, the NHS lists options including the combined pill, the progestogen-only pill and the hormonal coil (IUS). Which one suits you depends on your health and what you want, including any plans for pregnancy.

Facial hair, acne and scalp thinning

Extra hair growth on the face or body is called hirsutism. Acne and thinning hair on the scalp can also happen. But the international guideline says acne or scalp hair loss on their own are fairly weak signs of higher androgen levels. They can’t confirm PCOS on their own.

Tell the clinician if hair growth is new, severe or getting worse. The guideline recommends more tests for that pattern, to check for causes other than PCOS. A big new change needs checking, even if you already have a PCOS diagnosis.

If you remove unwanted hair, say so at the appointment. As the guideline recognises, hair removal can hide how much hair grows. What you tell them still matters, even if the clinician can’t see the full amount that day.

Choosing what you want treated

Whether to remove hair is your choice. NHS options include shaving, waxing and hair-removal creams, as well as electrolysis or laser treatment. A prescription cream called eflornithine can slow new hair growth. Your GP or doctor can tell you whether it suits you.

For laser treatment, the guideline recommends going to an experienced provider with the right qualifications. The colour of your skin and hair affects the approach, and laser works less well on blond, grey or white hair. Ask how much it’s likely to help your hair and skin before you commit.

The combined pill may help with irregular cycles, acne and extra hair growth. Anti-androgen medicines, which block the effects of androgens, can be considered for some people when other options haven’t helped enough. If you could get pregnant, you need reliable contraception, because anti-androgens can harm a developing baby. Talk about this with your prescriber.

Acne treatments can include creams, gels or tablets, chosen by how severe the acne is. Some treatments, including retinoids, aren’t suitable during pregnancy or when trying to get pregnant. Ask a pharmacist, GP or doctor before using a treatment, and talk about pregnancy plans at the same time.

There’s little evidence on treating scalp hair loss in PCOS specifically. The guideline says anti-androgens with the combined pill can be considered, while accepting this uncertainty. Ask how much improvement you can realistically expect, and about the risks. Agree how the treatment will be reviewed.

When symptoms affect daily life

Contact your GP urgently today (UK), or your doctor or urgent care service (US or elsewhere), if thick, dark hair suddenly appears on your face or body, or your voice gets deeper or your muscles get bigger for no clear reason.

Book a GP appointment in the UK, or see your doctor in the US or elsewhere, if changes to your cycle, skin or hair keep affecting daily life.

The emotional effect of visible symptoms matters, however mild they might look to someone else. WHO describes effects on body image, work and relationships. The guideline asks clinicians to take your own worries seriously.

Pick a real example for the appointment. It might be avoiding photos, spending time removing hair, or changing plans because of unpredictable bleeding. You can ask for a plan that deals with the symptom and how it affects you. Tell the clinician which worry you most want help with, even if they bring up something else first.