AcnePCOSWomen's Health

5 Visual Signs of PCOS

5 visual signs of Pcos

Polycystic Ovarian Syndrome, otherwise known as PCOS affects around 15% of reproductive aged women. Many women have symptoms of PCOS such as irregular menstrual cycles or acne, but have not yet received a diagnosis or proper treatment options. If you are one of many women who think you may have PCOS but have not yet received blood work or ultrasounds, here are 5 visual signs of PCOS to look out for. If you decide to get checked for PCOS or any other illness, it would be wise to go to a medical facility that outsources CentralReach Managed Billing Services that will make billing and insurance processing more efficient.

1. Skin Tags

Skin tags are very small growths of skin that are common and harmless. They are often skin-coloured and appear on the neck, under the armpits or under the breasts. They may fall off on their own, but often do not detach if you pull on them. This is a sign of insulin resistance. 

What is insulin resistance?

Over 70% of women with PCOS have some level of insulin resistance. This occurs when the receptors for insulin are not as sensitive as they should be.

When we eat anything that contains carbohydrates or sugar, our body breaks it down into glucose molecules. We need to bring this glucose from the bloodstream into our cells in order to use it as energy. 

To do this, insulin must be present. You can think of insulin as the key in order to open the door for glucose. Insulin binds to its receptor, and a signal happens inside the cell to open the door for glucose to enter the cell. But, in insulin resistance these receptors aren’t really listening. The insulin key isn’t fitting the receptors lock. So, glucose can’t get in. 

We are left with high levels of glucose in the bloodstream, which leads to an increased risk of diabetes. Our body tells our pancreas to release more insulin to deal with this glucose. But, low insulin isn’t the problem. The issue is all in the receptors. So, now we have high glucose AND high insulin in the blood stream. This leads to high triglycerides, inflammation and directly inhibits ovulation. Other symptoms include skin tags, dark patches of skin behind the neck and under the arms or feeling “hangry” or lightheaded if you skip a meal.

2. Acanthosis nigricans

This is a fancy medical term for dark patches of skin. Often times, these darker patches appear on the back of the neck or under the armpits, and may have a leathery like appearance or texture. Again, this is a sign of insulin resistance.

3. Acne

Acne and oily skin are common concerns in PCOS. This is a complex condition, with so many potential internal and external factors. In the case of PCOS, acne is often caused by hormonal imbalance. Specifically, elevated androgens such as testosterone, DHEA and DHT (dihydrotestosterone). This often leads to acne along the chin or jaw line, and it may be cystic and painful.

Other factors to take into consideration with acne are dietary triggers or intolerances. Dairy and sugar are the main culprits here. These create inflammation in the body and stimulate insulin, which is often dysregulated in PCOS. Gut health, inflammation, skincare products, makeup and hygiene are other important factors to consider.

If you suffer from acne, it’s important to get a thorough workup to determine WHY you’re experiencing acne. When you treat the underlying causes, your acne will improve long term. The approach to acne is often a band-aid such as a prescription cream or the birth control pill. These may help reduce the appearance of acne in the moment, but it doesn’t address the underlying concerns. Once you stop that cream or pill, your acne will return. And, often a lot worse than it was before.

4. Hair loss

This is a common concern in PCOS. This pattern of hair loss is often thinning in the temporal regions or the midline. People may notice their part is getting wider, or their hairline is receding more. This is due to elevated androgens, particularly DHT (dihydrotestosterone). This potent form of testosterone binds to hair follicles and causes them to fall out. Around 35% of women with PCOS have elevated levels of DHT1. To learn more about hair loss, check out this blog post.

5. Hirsutism

Hirsutism is abnormal hair growth on the face and body. This is often thick, dark, course hair growth that is persistent. It often occurs on areas of the body such as the face or chin, between the breasts, abdomen and inner thighs. Again, hirsutism is a common sign of elevated androgens such has testosterone and DHT.

What to do if I think I have PCOS?

If you have one or more of the above visual signs of PCOS, you may want to get a proper workup. This includes a visit with your doctor or Naturopathic Doctor for thorough bloodwork, a health history and a transvaginal ultrasound to assess for the number of follicles on your ovaries.

There are so many treatment options to support PCOS and reduce symptoms. As a Naturopathic Doctor that focuses in this area, I do a thorough investigation and determine what the underlying factors are that are contributing to your symptoms. You will then receive a treatment protocol that is specific to supporting these areas of imbalance. When we treat the underlying causes of PCOS, we get long lasting results and reduction in symptoms. Birth control and metformin are NOT your only options, and these treatments only provide temporary relief of symptoms.

If you have any questions, or would like to book a free 15 minute consultation to determine how we can work together to treat your PCOS symptoms, click here.

Dr. Gina Neonakis, ND


  1. Urysiak-Czubatka, I., Kmieć, M. L., & Broniarczyk-Dyła, G. (2014). Assessment of the usefulness of dihydrotestosterone in the diagnostics of patients with androgenetic alopecia. Advances in Dermatology and Allergology, 4, 207–215.

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