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Symptom checklist for PCOS

I'm posting inCYST's symptom checklist, developed by Mia Elwood, LCSW, of Healthy Futures in Scottsdale, Arizona. Mia's lecture on mood disorders and PCOS is part of the inCYST professional training. I like Mia's list because it addresses many of the food and mood aspects of PCOS that are not often written about. And in my opinion, when moods are not taken into consideration, their imbalances can generate many of the behaviors that make it hard to manage PCOS.

If you're new to this blog, or if you haven't seen this, take a moment and run through the symptoms. If this sounds like you, one of our inCYST providers is happy to help you figure out your personal action plan. You can also print this out and show your medical caregiver to give them a more complete picture of the issues you need help with.

If you wish to duplicate this for any reason, please include the copyright information at the bottom as Mia deserves credit for her original work. Thanks!

If you feel this profile describes you, stick around and read more! Pay particular attention to Ellen Reiss Goldfarb's post on lab tests you can get to monitor how your diet, exercise, sleep, and lifestyle changes are helping you to get back into balance.

Screening for Polycystic Ovary Syndrome and Other Hormonal Contributors
Name ________________________ Date _______________ Current Age _____


Sometimes, hormones contribute to our symptoms. These questions help to explore whether hormones may be contributing to any of your symptoms.

When was your first period? Age ___ When was your last menstrual period? ___ What is your current height? ___ What is your current weight? ___

___Do you believe that you are perimenopausal or in menopause? If so, what symptoms are you experiencing that lead you to believe this?

___Have you had regular periods consistently throughout your life? Explain:

___Do your symptoms (that you are here for) change in any way according to your cycle? If yes, how do they change and when in your cycle do you notice a change?

___Has your menstrual flow become lighter/much heavier than usual for you?

___Have you ever gone more than two months without a period?

___Do you have skin that is dark or thick, especially on the neck, groin, underarms, or skin folds? ________

___Has your menstrual flow become lighter/much heavier than usual for you?

___Do you have any skin tags, teardrop-sized pieces of skin usually found in the neck area and/or armpits?

___Have you or any family members had bipolar disorder, an eating disorder, epilepsy, or migraines?

___Do you take any psychotropic medications? (antidepressants, mood stabilizers, etc.)

___Have you ever had trouble getting pregnant?

___Has your sex drive decreased?

___Do you feel you have excess hair growth? ___ Where? ___face ___back ___chest ___other____________

___Do you feel more irritable than usual?

___Have you lost/gained weight recently without your eating/exercise habits changing? _________________

___Is it hard for you to lose weight or maintain a genetically healthy weight?

___Do you have more mood swings than you used to?

___Do you have severe acne? (if adolescent) or adult acne?

___Is your waist to hip ratio greater than 0.8? Ratio _________

___Have you noticed your hair thinning or hair loss?

___Do you have strong cravings for sweets or carbohydrates?

___Do you or any family members have a history of PCOS, insulin resistance, diabetes, hypoglycemia, gestational diabetes? Who?

___Are you experiencing any other symptoms (emotional,physical, cognitive) that you feel may be related to hormones or your cycle (or lack of one)? Describe

Created by Mia Elwood, MSW/Healthy Futures-MSE, LLC, 2004/