Polycystic Ovary Syndrome (PCOS) or Hypothyroidism?

Polycystic Ovary Syndrome (PCOS) or Hypothyroidism?

With a Hypothyroid Mom following of over 1.2 million people, I hear stories all the time. Common threads emerge and particular symptoms show up in story after story. One thing is absolutely clear. Every woman with PCOS should have her thyroid health fully evaluated. I haven’t forgotten all the adolescent girls that present with what look like PCOS symptoms. I created Hypothyroid Mom for adults but I know that there are many parents visiting my site with teen girls struggling with undiagnosed hypothyroidism. I know because I was one of those teens.

Written by Amy Medling

Hypothyroid and Polycystic Ovary Syndrome (PCOS) share many symptoms. Unfortunately, this overlap is the cause of many women being misdiagnosed by a physician considering and treating symptoms and not looking for a root cause. An accurate diagnosis of one or both can mean the difference between years of struggle and the start of healing. Women with PCOS should advocate to be screened for hypothyroidism and Hashimoto’s and visa-versa.

What is PCOS?

Polycystic Ovarian Syndrome (PCOS) is one of the most common endocrine disorders found in women, affecting approximately 8-20% of women worldwide, with less than 50% of them diagnosed.[i] The syndrome is present throughout a woman’s life from puberty through post-menopause and affects women of all races and ethnic groups.[ii]  Women with PCOS wrestle with an array of possible symptoms including obesity, insulin resistance, irregular menstrual cycles, infertility, anxiety, depression, acne, hair loss, brain fog, fatigue, and more.  27% of women with PCOS also have hypothyroid disorders and 8% have Hashimoto’s Thyroiditis.[iii]  It is unusual to exhibit every symptom of PCOS.  Most women living with PCOS have some combination of symptoms. Practically speaking, PCOS has three main hallmarks: obesity, irregular menstruation/fertility issues, and hair/skin problems.

In an effort to better define PCOS and facilitate diagnosis and treatment, a definition was agreed upon between the European Society for Human Reproduction and the American Society for Reproductive Medicine. Diagnosis is now largely based upon these new symptoms dubbed the “Rotterdam” criteria.[iv]  To be diagnosed with PCOS, a woman must present two out of the three criteria:

1)    Oligo (anovulation or irregular periods)

2)    Hyperandrogenism (elevated male hormones often resulting in acne, hirsutism, or hair loss)

3)    Polycystic Ovaries (on an ultra sound)

Even with these criteria in place, diagnosis can be tricky. Symptoms can vary widely based on life stage, genotype, ethnicity, and environmental and lifestyle factors such as body weight and eating habits. Birth control pills may also interfere with test results because they lower androgens. With this in mind, physicians must eliminate other possible causes of a woman’s symptoms such as hypothyroidism.

Why are women misdiagnosed?

There are three main reasons for misdiagnosis of PCOS as thyroid disorder or visa-versa. First, the overlap in symptoms, plus the resulting conditions such as insulin resistance, may lead a doctor to make a blanket diagnosis of PCOS. Overlapping symptoms include:

·      Hair loss

·      Fatigue

·      Slow metabolism

·      Infertility

·      Depression/mood disorder

·      Elevated androgens

Second, if a doctor is looking simply at symptoms, the thyroid induced increase in the number of androgens in a woman’s body looks like PCOS associated hormone imbalance. Third, thyroid testing may be incomplete or the reference ranges inaccurate.

How can a woman be certain of their diagnosis?

I encourage all women with a PCOS diagnosis to have their thyroid checked to be sure it is not the root cause. Do not settle for the simple Thyroid Stimulating Hormone (TSH) test. It is not necessarily accurate, in part because inflammatory conditions (such as PCOS) reduce the action of your body’s TSH, which means that even if your levels are in the “normal” range, you may not be producing enough to be effective. Request a full thyroid panel including TSH, FT4, FT3, RT3, TPOAb, and TgAb.

What’s next?

Once your diagnosis is certain and your labs are complete, it is time to begin healing. In fact, you can begin even before diagnosis since many of the diet and lifestyle changes that benefit hypothyroidism also benefit PCOS. I suggest beginning in three broad areas.

1)  Mindset – Being diagnosed with PCOS can be an overwhelming experience. With the disorder affecting so many aspects of our lives, it can feel isolating and scary. It’s very easy to slip into a negative head space. Stay in a confident and productive mindset by seeking out support, being patient but persistent, caring for your emotional and mental health, practicing self-forgiveness, and practicing self-love. Decide that it is time to heal and that you must take charge of your health. The moment you decide that you are worth the time and effort it takes to heal, you have taken the most important step.

2)  Diet – Both hypothyroidism and PCOS involve a high level of systemic inflammation. This study demonstrated that an anti-inflammatory dietary combo achieved weight loss and signifiant improvements in body composition, menstrual cyclicity and spontaneous pregnancy rate in overweight and obese women with PCOS.[v] Upgrading to an anti-inflammatory diet can bring relief from many symptoms. Eliminating common inflammatory staples such as processed foods, gluten, and dairy takes work, but the positive results can manifest in as little as a few days. Supplements can help fill in dietary gaps and also relieve inflammation, regulate menstruation, and manage blood sugar. I suggest that almost all women take a high-quality multivitamin, vitamin D, and DHA (fish oil). Ovasitol Inositol Powder is also very popular due to its positive effect on blood sugar and menstrual regularity.

3)  Movement – It is important to get movement in every day, but try to avoid extreme exertion for extended periods. This sort of activity can further stress and inflame your system. Consider High-Intensity Interval Training (HIIT), yoga, walking, barre, or anything that you enjoy and leaves you feeling terrific instead of drained. HIIT has been shown to be particularly helpful in improving insulin resistance in women with PCOS.[vi]

Final Thoughts

I often hear from women with PCOS who are frustrated and have lost all hope because the only advice their doctors offer is to lose weight, take a pill, and live with their symptoms. For much of my life, I was one of these women. As early as age 14, I wrestled with a lot of the common PCOS symptoms. It seemed this was my fate. My mom dealt with this. My grandmother dealt with this. It was the genetic fate of women in my family.

One day in college, I found myself sitting in a cold exam room scared and confused, feeling lousy, not having had a period in months and months, and not understanding why. The doctor looked me in the eye and told me they would have to “jump through hoops” to get me pregnant one day. She renewed my prescription for the pill and sent me on my way. I felt helpless and hopeless. It was a dark moment.

Many years later, with the help of fertility drugs, I did have two sons. After the birth of my second son, I felt worse than ever. I had 2 beautiful children and a wonderful husband, but I was exhausted all the time, and my PCOS symptoms were at their worst. I wasn’t the wife or mother I wanted to be. After years of following mainstream advice from countless doctors, I realized that nothing was helping. The drugs they offered made me sicker and more miserable. I was way too young to feel so old and couldn’t go on living this way. It was then I realized that I had to empower myself and take control of my health. No one else could do it for me. My husband noticed the shift and declared me a “Diva.” At first, I was offended, until I realized that in order to be my best and give my best to my family, I DID have to be a Diva.

About Amy Medling

Amy Medling founded PCOS Diva where she helps women with Polycystic Ovary Syndrome (PCOS), who are frustrated and have lost all hope when the only solution their doctors offer is to lose weight, take a pill, and live with their symptoms.

[i] Sirmans, S. M., & Pate, K. A. (2014). Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical Epidemiology, 6, 1–13.

[ii] Thatcher, Samuel, PCOS: The Hidden Epidemic, Indianapolis, Perspectives Press, 2000, 320.

[iii] Kowalczyk, K, et al. “Thyroid Disorders in Polycystic Ovary Syndrome.” European Review, Eur Rev Med Pharmacol Sci, Jan. 2017, www.europeanreview.org/article/12104.

[iv] Rotterdam ESHRE/ASRM- Sponsored PCOS Consensus Workshop Group. Revised 2003 Consensus on diagnostic Criteria and Lon-Term Health Risks Related to Polycystic Ovarian Syndrome. Fertility and Sterility, 2004; 81, 19.

[v] Salama, A.A., et al. Anti-Inflammatory Dietary Como in Overweight and Obese Women with Polycystic Ovary Syndrome.

[vi] Allmenning, I., et al. Effects of High Intensity Interval Training and Strength Training on Metabolic, Cardiovascular and Hormonal Outcomes in Women with Polycystic Ovary Syndrome: A Pilot Study. PLoS One. 2015;10(9):e0138793.

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About Dana Trentini

Dana Trentini founded Hypothyroid Mom October 2012 in memory of the unborn baby she lost to hypothyroidism. This is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links including the Amazon Services LLC Associates Program.


  1. can someone who has lean pcos have hypothyroidism? People always talk about obese or overweight PCOS but there is not much information about the lean PCOS. It makes me think that maybe the lean category is actually misdiagonised. There is also another category who bleed often or have prolonged bleeding or have polymenorrhea. Or even someone has a combination of both- lean and prolonged bleeding.Do you think that there could be some kind of misdiagnosis?

  2. I recently read a post on HypothyroidMom.com by Amy Medling, author of “Healing PCOS: A 21-Plan for Reclaiming Your Health and Life with Polycystic Ovary Syndrome.” It stated Polycystic Ovarian Syndrome (PCOS) is one of the most common endocrine disorders found in women, affecting 8-20% of women worldwide, with less than 50% of them being diagnosed. Why is that? I don’t believe this is a health issue we should take lightly or treat before knowing all the potential issues involved. Her post encouraged all women with a PCOS diagnosis to have their thyroid checked and not by the simple Thyroid Stimulating Hormone (TSH) test. The TSH test can basically determine an over-active thyroid gland (hyperthyroidism) or under-active thyroid gland (hypothyroidism). Ask your primary care physician or endocrinologist to do the tests to determine the levels of antibodies that your immune system is producing such as the anti-TPO or anti-TG. These tests will help make sure the thyroid is not the root cause of your health concerns.
    This is where women get frustrated, including myself, after going to their doctors, and explaining the symptoms they are having. Many leave wondering if they got a correct diagnosis and treatment plan. The post included the definition defining the criteria for PCOS that was agreed upon between the American Society for Reproductive Medicine and the European Society for Human Reproduction. Even if doctors look at this stated criteria, immune system antibodies can attack the thyroid gland – producing symptoms like weight gain or loss, anxiety, depression, insomnia, headaches, constipation, rapid heart rate, infertility. It still makes diagnosis tricky because doctors don’t usually have the whole picture without full testing when giving a diagnosis out. Is it (PCOS) or Hypothyroidism? I think so many of the symptoms involving our hormones are not fully researched and medical personal don’t have or take the time to dig into what is really causing these issues. I feel most patients get a blanket diagnosis because our nations medical costs are so high to run the needed tests or lab work looking for each possible imbalance. Our health care system determines the level of the care we can receive from our doctors, clinics, and hospitals.
    How can women be certain they have received the correct diagnosis? I feel that following the mainstream advice from their doctors can still leave them feeling helpless and like nothing helps. Those affected by these symptoms need to insist their doctors take the time to listen to them. I would encourage everyone to be proactive in your own health care and also encourage others to push for better research, understandable solutions, treatment programs, etc. by the medical professionals so that we can get back control of our health care.

  3. Fran rizzo says

    Hi Dana…I am located in NJ and I am trying to find the best doctor for Hashimotos….Can you suggest ay? I was seeing a doctor here in MOnmouth county, but it’s too long a wait in her office..up to 4 hours…..and not much help at all…I will go into NYC also. Thanks and your website is awesome !! Fran Rizzo. [email protected]

  4. Thank you! I found a great NP who specializes in hormone therapy and I’m pinning my hopes on her.

  5. The reliance on lab values alone is noting short of malpractice by the medical community. I am losing my hair, my memory has evaporated, my bladder is damaged beyond repair, I have IBS, my iron is so low I can’t breathe properly. My TSH has gone from 1.4 to 2.3 in 2 years.
    I often project my options onto the doctors I’ve relied on and I ask, would they accept these symptoms and not look for the underlying cause? would they accept those TSH scores as normal and get on with their lives, esp if they physically and mentally could barely make it through the workday?

  6. Lakisha Johnson says

    Hello I am really looking for all donations and prayers, I’m getting ready to have my thyroids removed and I’m very scared due to I am going threw this by myself with no friends or family. Just wanted to reach out to the thyroid community to release what I’m about to face and go threw. Thank you for your time.

  7. Hi, I’d really appreciate it if you would share and donate to my GoFundMe campaign. https://www.gofundme.com/thyroidectomy-procedure?pc=em_co_flowinvite_a&rcid=25dc42a3803645f6a38089826f6794aa

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