What is PCOS?

Polycystic ovary syndrome (PCOS) is a hormonal condition affecting people with ovaries, usually during their reproductive years. It typically involves a combination of androgen excess (higher male‑type hormones), ovulatory dysfunction, and characteristic ovarian changes. PCOS presents across a spectrum — some people have mild symptoms while others face metabolic, reproductive and psychological impacts.

Common symptoms

• Irregular or absent periods (oligo‑ or amenorrhoea)
• Excess facial or body hair (hirsutism) and persistent acne
• Weight gain or difficulty losing weight, especially around the abdomen
• Thinning scalp hair (androgenic alopecia)
• Difficulty conceiving due to irregular ovulation
• Fatigue, mood changes and increased risk of sleep apnoea

Who is at higher risk?

PCOS often starts around puberty, though it may be diagnosed later. Risk factors include a family history of PCOS or type 2 diabetes, early puberty and obesity. Because PCOS is linked with insulin resistance, early recognition helps reduce long‑term metabolic risks such as type 2 diabetes and cardiovascular disease.

Tests and diagnosis

Diagnosis is clinical and typically uses a combination of history, examination and targeted tests. Common investigations:

• Blood tests: testosterone (total/free), SHBG, LH/FSH ratio, fasting glucose or HbA1c, and lipid profile. Thyroid and prolactin are checked to exclude other causes.
• Anti‑Müllerian hormone (AMH): may be elevated in PCOS but is not diagnostic alone.
• Pelvic ultrasound: assesses ovarian morphology (multiple small follicles) and rules out other pelvic pathology.
• Metabolic screening: fasting glucose/OGTT and lipids, especially if overweight or with a family history of diabetes.

Many clinicians use recognised criteria (e.g., Rotterdam) — at least two of: oligo/anovulation, clinical/biochemical hyperandrogenism, or polycystic ovarian morphology — after excluding other causes.

Treatment goals

PCOS management is personalised and targets symptom relief, metabolic health and fertility when desired. Typical goals include restoring menstrual regularity, reducing androgenic symptoms (hirsutism/acne), improving insulin sensitivity and supporting reproductive plans.

First‑line: lifestyle measures

For many people, lifestyle change is the foundation of care:

• Modest weight loss (5–10% if overweight) often improves ovulation and metabolic markers.
• Regular physical activity improves insulin sensitivity and mood.
• A balanced, lower‑GI carbohydrate diet helps metabolic control.

Medical treatments

• Combined oral contraceptives (COCs): regulate cycles and reduce acne/hirsutism.
• Antiandrogens (e.g., spironolactone): reduce unwanted hair and acne (use with reliable contraception).
• Metformin: improves insulin sensitivity and can help with weight and menstrual regularity, particularly when glucose intolerance is present.
• Ovulation induction: Letrozole is often first‑line for fertility; alternatives include clomiphene or gonadotrophins under specialist care.

Other options and long‑term care

Cosmetic treatments (laser hair removal), dermatology referrals, and psychological support are often helpful. Regular monitoring for glucose intolerance, dyslipidaemia, blood pressure and mental health is recommended.

When to see a doctor

Make an appointment if you have:

• Irregular, absent or very heavy periods
• New or worsening acne or excess hair growth
• Difficulty conceiving after 6–12 months (earlier if over 35)
• Significant weight gain or symptoms suggesting insulin resistance
• Mood changes that affect daily life

Your GP can start initial testing and refer to specialist services. For structured assessment and ongoing care, consider clinical services offering comprehensive PCOS pathways — for example, PCOS diagnosis and management.

Practical tips

• Track your menstrual cycles and symptoms to discuss with your clinician.
• Focus on sustainable lifestyle changes over time.
• Check family history of diabetes or PCOS to inform risk discussions.
• Seek support for mental health concerns — PCOS can impact body image and wellbeing.