An estimated one in 10 women have polycystic ovary syndrome (known as PCOS)—although half of those women don’t even know they have it, according to Sinem Karipcin, MD, and reproductive endocrinology and infertility specialist at Conceptions Florida.

Polycystic ovary syndrome is a hormonal disorder that affects women of childbearing age. There’s no one cause for PCOS, but according to the National Institutes of Health, most of the symptoms are triggered by higher-than-normal levels of androgens (hormones that typically control the male characteristics).

In women without PCOS, the ovaries make a balance of hormones—estrogen (sometimes called the female hormone) and androgen. Women’s bodies need both, but in PCOS, there’s an over-abundance of the latter.

What Are The Symptoms of PCOS?

The classic symptoms of PCOS include weight gain, irregular periods or no periods at all, hirsutism (unwanted hair growth, especially on the face), fatigue, mood swings, sleep issues (like sleep apnea, and polycystic (a.k.a. enlarged) ovaries and ovarian follicles that surround the egg. Yet despite all the symptoms associated with PCOS, they don’t always show up for every woman as expected—and in some cases they don’t show up at all.

“Not every women with PCOS has unwanted hair,” explains Karipcin. “And not everyone has irregular periods. In fact, some women with PCOS ovulate regularly.” So symptoms may differ wildly between women.

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Outside of keeping an eye out for the more classic symptoms, there are other more subtle ways to detect PCOS: “While weight gain is a classic sign, gaining weight in the abdominal area is a potential sign of PCOS,” says Karipcin. “Specifically, if your abdominal circumference is more than 88 centimeters, or 35 inches, then it could be a subtle sign you have may have PCOS.”

Additionally, women should watch for the development of something called acanthosis nigricans, which appears as a dark ring around the neck. This is caused by high insulin levels, which are known to cause dark skin patches. Acanthosis nigricans is commonly seen in people who are overweight, have darker skin, have diabetes, or are pre-diabetic—and PCOS is associated with high levels of insulin and type 2 diabetes.

Interestingly enough, male baldness on your mother’s side can also be an indicator. According to The Journal of Clinical Endocrinology and Metabolism, polycystic ovaries are inherited genetically as an autosomal dominant trait, which means you can inherit the disease from a single abnormal gene from just one parent. This gene also happens to dictate the baldness in males.

According to Mayo Clinic, having PCOS can lead to many complications, including infertility, metabolic syndrome (high blood pressure, high blood sugar, abnormal cholesterol levels—all of which increase your risk of heart disease), depression, uterine bleeding, uterine lining cancer, and more.

How PCOS Is Diagnosed

The diagnosis process for PCOS is tricky—which explains why so many women have undiagnosed PCOS.

“There is no one single test for PCOS,” said Karipcin. “This is why it is important to see a reproductive endocrinologist, also known as a fertility specialist, to rule out other causes and confirm your diagnosis.”

Specifically, a visit to a fertility specialist will mean a talk about both your family history and your personal gynecological history. He or she will perform a physical exam to rule out any abnormalities—as well as check for acne and hair growth.

They will likely also perform an ultrasound—intended to look at your uterus lining and provide a count of the follicles (to see if they’re surrounding your egg) found on your ovaries. To rule out underlying problems, you may also have your hormone levels checked, since thyroid or testosterone-related issues might cause symptoms similar to PCOS.

How PCOS Is Treated

Unfortunately, there is no cure for PCOS. However, there are multiple ways to treat and manage the symptoms. And it’s not uncommon to employ several treatment methods at one time.

“A healthy lifestyle that includes nutritious foods and daily exercise can have a positive effect on the endocrine system,” says Karipcin. “Birth control pills are often prescribed to correct the hormone imbalance.” This may also help correct the irregular periods and the hair growth.

Additionally, doctors might prescribe a drug to lower insulin levels, especially if pre-diabetes is a concern. Adding a blood sugar-supporting supplement to your routine could also be effective in supporting healthy insulin levels.

Related: 6 Period Symptoms That Warrant A Visit To The Doctor

In cases of PCOS and metabolic syndrome, there has been an improvement noted when women with PCOS supplemented with omega-3, according to Journal of Research in Medical Sciences.

Early diagnosis, treatment, and maintaining a healthy lifestyle are key in order to prevent down-the-line complications, like diabetes, stroke, infertility, and heart disease.