PCOS or Something Else? How to Tell the Difference - and Why It Matters

Untangling period problems with compassion, nuance, and evidence-based naturopathic care

If you’ve ever Googled your symptoms and landed on a PCOS diagnosis - you’re not alone. Irregular periods, acne, hair growth, fatigue, and missing ovulation often get lumped together under the PCOS umbrella. But here’s the truth: not every hormonal imbalance is PCOS, and getting the right diagnosis matters more than you think.

Let’s explore what PCOS actually is, how it’s diagnosed, and how to tell it apart from other conditions that can look really similar.

Why PCOS Is So Commonly Misunderstood

Polycystic ovary syndrome (PCOS) is a syndrome, not a single disease. That means it’s diagnosed based on a constellation of symptoms, not one definitive test, nor one single symptom.

To meet the Rotterdam criteria (the current diagnostic standard), someone must have any two of the following three criteria:

  1. Irregular or absent ovulation

  2. Signs of excess androgens (like acne or facial hair OR blood work that shows elevated testosterone, DHEAs, or androstenedione)

  3. Polycystic-appearing ovaries on ultrasound

And perhaps even more importantly: other possible causes of these symptoms/signs must be ruled out.

What Conditions Look Like PCOS?

Many conditions present with similar symptoms - and misdiagnosis can lead to frustration, ineffective treatment, or even harm. Here are a few key lookalikes:

Hypothalamic Amenorrhea

  • Often occurs with under-eating, overexercising, or chronic stress

  • Periods stop due to suppressed ovulation, but androgens are typically low, not high

  • Treatment: nourishment, rest, and nervous system support - not restriction

Thyroid Dysfunction

  • Both hypothyroidism and hyperthyroidism can cause irregular cycles

  • May also lead to fatigue, hair changes, and mood shifts

  • A simple blood test (TSH, Free T4, sometimes T3) can help clarify

Perimenopause

  • For folks in their late 30s and 40s, perimenopause can cause irregular ovulation, mood swings, and hormonal chaos

  • PCOS and perimenopause can overlap - but the approach will be different

Non-classic Congenital Adrenal Hyperplasia (NCCAH)

  • A rare genetic condition that can mimic PCOS with elevated androgens and irregular periods

  • Requires specific hormone testing (17-OHP) to differentiate

Gentle, Personalized Support for Hormonal Health

Getting clear on what’s actually going on in your body is essential for creating a plan that works - especially if you’re:

  • Trying to regulate cycles

  • Supporting your mental health

  • Managing energy, inflammation, or fertility

  • Avoiding unnecessary supplements, diets, or meds

In my practice, I work with folks to take a whole-body, individualized approach - one that includes:

  • Full cycle + symptom tracking

  • Lab testing that makes sense for your body

  • Nutrition and lifestyle support that’s gentle and sustainable

  • Evidence-informed supplements - only where they make sense

  • Nervous system care and intuitive strategies, especially for Hypothalamic amenorrhea or burnout

Ready to Feel Clearer in Your Care?

PCOS symptoms can overlap with thyroid imbalances, insulin resistance, or hypothalamic amenorrhea, and figuring out what’s actually going on can feel overwhelming. But it doesn’t have to be.

💻 I offer virtual care that unpacks your symptoms and your story. Book a free consult here and let’s start with what’s true for you.

Dr. Jennah Miller, ND is a Naturopathic Doctor who provides holistic hormonal care for all bodies - offered virtually in Ontario & Nova Scotia

Jennah Miller