PCOS, body image and confidence (hair, skin, weight)

Body changes

Body image

The international PCOS guideline says PCOS features can harm body image. A 2023 review found women with PCOS felt worse about their appearance and weight than women without it.

The WHO notes that unwanted hair, higher weight and infertility are stigmatised in many places. It is not vanity to be hurt by that. It is a normal reaction to real pressure.

Extra hair on the chin, upper lip, chest, belly or back is one of the most common PCOS signs. The guideline says unwanted hair should be taken seriously however mild it looks, and that your own report is valid even if a clinician cannot see it.

Thinning hair on the scalp is a known PCOS sign. The guideline says female pattern hair loss should be taken seriously because of its effect on how people feel.

In many cultures hair is tied to beauty, identity and faith. It makes sense if changes to your hair feel very personal.

PCOS can cause acne on the face, chest and upper back, darker skin in body creases, and skin tags.

The American Academy of Dermatology says acne can lead to low self-esteem, poor self-image, anxiety, depression and feeling alone. The longer acne lasts, the more likely it is to affect emotions.

Weight gain and finding weight hard to change are common in PCOS. The guideline says many women with PCOS face weight stigma in health care and elsewhere, and that this causes real harm.

The guideline says eating disorders and disordered eating should be considered in PCOS at any weight, especially during weight programmes. The WHO lists eating disorders among conditions linked with PCOS.

Signs food may be taking over

• Cycles of strict dieting and then eating a lot
• Feeling guilty or anxious after most meals
• Food rules that keep getting stricter
• Thinking about food, weight or your body much of the day

ANAD Eating Disorders Helpline (U.S.): call 1-888-375-7767, Monday to Friday, 9am–9pm Central Time. It offers free support and referrals. It is not a crisis line.

PCOS is common in every ethnic group and region, but how it shows can differ. The guideline asks for care and information that respects your culture, and for families to learn about weight stigma.

Every culture has its own ideals: slim, curvy, smooth-skinned, long-haired. Comments from relatives often come from care or habit, but they can still sting.

The guideline notes that weight, unwanted hair and mood can all affect sexual wellbeing in PCOS. Providers should ask permission before raising it, so you stay in control.

Things that may help

• Decide what you want to share, and when
• Remember a caring partner is interested in you, not a “perfect” body
• Start with closeness that feels safe, like holding hands or talking
• Talk with a therapist if worry about being seen stops you dating

The guideline recommends therapy such as CBT for body image distress and low self-esteem in PCOS. Small daily habits can help too.

Reach out if…

• Body worries take up much of your day
• Food feels out of control or full of rules
• Low mood lasts more than two weeks
• You avoid people, photos or places because of how you look
• You have thoughts of harming yourself

Your primary care provider, gynaecologist, dermatologist or a therapist can help. PCOS Challenge (pcoschallenge.org) is a U.S. nonprofit with an online support network.

Outside the U.S.: Find A Helpline (findahelpline.com) lists free, confidential helplines in many countries. In the UK, the charity Verity supports people with PCOS (PMOS).