PCOS (Polycystic Ovary Syndrome): Symptoms, Diagnosis and Treatment

Polycystic ovary syndrome (PCOS) affects many women of reproductive age. It is a hormonal and metabolic condition, which means it involves the ovaries as well as how the body handles insulin. Despite the name, it is not simply about cysts, and many women with PCOS have no visible symptoms other than irregular periods.

Common symptoms of PCOS

• Irregular, infrequent or absent periods
• Excess hair on the face, chest or abdomen (hirsutism)
• Acne that is persistent or severe
• Thinning hair on the scalp
• Weight gain, especially around the waist
• Darkened, velvety skin on the neck or armpits (acanthosis nigricans)
• Difficulty getting pregnant

How is PCOS diagnosed?

Doctors generally diagnose PCOS when at least two of these three features are present, after other conditions have been ruled out:

1. Irregular or absent ovulation, usually seen as irregular periods
2. Signs of high male hormones, either symptoms such as excess hair and acne, or raised levels on blood tests
3. Polycystic-appearing ovaries on ultrasound

Because other conditions can look similar, your doctor will usually check thyroid function (see our thyroid guide), prolactin and other hormones. Blood sugar, cholesterol and blood pressure are often checked as well.

Why PCOS matters beyond periods

Many women with PCOS have insulin resistance, which raises the risk of prediabetes and type 2 diabetes. Read about the warning signs in our diabetes guide. PCOS is also linked to weight gain, high cholesterol, fatty liver and sleep apnoea. If periods are very infrequent, the lining of the womb can thicken over time, so this should be discussed with a doctor.

PCOS and fertility

PCOS is one of the most common reasons for irregular ovulation, but most women with PCOS can become pregnant. Treatment to trigger ovulation, and lifestyle changes, often help. If you have been trying for a year without success (or six months if you are over 35), it is sensible to get advice.

Treatment options

Treatment depends on your symptoms and whether you want to become pregnant.

• Lifestyle changes: losing even 5% to 10% of body weight can restore regular periods and improve hormones. See our guide to medical weight management.
• Cycle control: hormonal tablets may be used to regulate periods and protect the womb lining.
• Insulin resistance: medicines such as metformin may be prescribed when appropriate.
• Acne and hair growth: specific medicines and cosmetic treatments can help; these usually take several months to work.
• Fertility treatment: ovulation-inducing medicines are used under specialist supervision.

When to see an endocrinologist

See a specialist if your periods are irregular or missing for more than three months, you have excess hair or severe acne, you are struggling to lose weight, you are trying to conceive, or you have a family history of diabetes.

Frequently asked questions

This article is for general information only and is not a substitute for personal medical advice, diagnosis or treatment. Always speak to a qualified doctor about your own health.