If you’ve recently been diagnosed with polycystic ovary syndrome (PCOS), or you’re wondering whether your symptoms could be linked to it, the amount of information online can feel overwhelming. PCOS is a common hormonal condition that can affect periods, fertility, hair growth, skin, weight and emotional wellbeing, but the symptoms and their severity can vary considerably from person to person.
You may also start seeing a different name for the condition. The NHS now uses polyendocrine metabolic ovarian syndrome (PMOS), explaining that this was previously known as polycystic ovary syndrome (PCOS). Because PCOS remains the name most people recognise and search for, I’ve used PCOS throughout this guide while reflecting the latest NHS information.
The reassuring thing to know is that having PCOS doesn’t mean you will experience every possible symptom or complication. Although there is currently no cure, treatment and lifestyle support can help manage symptoms, protect long-term health and support fertility where needed.
What is PCOS?
PCOS is a hormonal condition that affects how the ovaries work, but its name can be confusing. The “polycystic” appearance sometimes seen on an ultrasound refers to an increased number of small follicles in the ovaries rather than the type of ovarian cyst you might normally associate with the word “cyst”. Having polycystic-looking ovaries alone also doesn’t necessarily mean that you have PCOS.
PCOS is associated with changes in hormone levels and, for some people, insulin resistance. Higher levels of androgens such as testosterone can contribute to symptoms including excess facial or body hair, acne and changes to ovulation, while insulin resistance can affect blood glucose and may contribute to some of the longer-term health risks associated with the condition.
What are the symptoms of PCOS?
PCOS can affect people differently. Some have only mild symptoms, while others experience several symptoms that have a significant impact on their everyday life. Symptoms often begin around puberty, although they may not be recognised as PCOS until later.
Common symptoms can include:
- irregular periods, long gaps between periods or no periods
- excess facial or body hair (hirsutism)
- thinning hair or hair loss from the scalp
- oily skin or acne
- weight gain or difficulty losing weight
- difficulty becoming pregnant because ovulation may be irregular
- tiredness
- dark, thickened patches of skin, particularly around the neck or armpits
- mental health difficulties such as anxiety or depression.
Having one or more of these symptoms doesn’t necessarily mean that you have PCOS. Irregular periods, acne, changes in weight and hair growth can have other causes, which is why it’s important to speak to your GP rather than trying to diagnose PCOS yourself.
How is PCOS diagnosed?
There isn’t one single test that can confirm PCOS. Your GP will usually discuss your symptoms and medical history and may arrange blood tests to look at hormone levels and other possible causes of your symptoms. You may also be referred to a gynaecologist or endocrinologist for further assessment.
Traditionally, PCOS has been diagnosed when at least two of three features are present:
- irregular, infrequent or absent periods, suggesting irregular ovulation
- signs of higher androgen levels, such as excess facial or body hair, or blood tests showing raised testosterone
- an ultrasound showing polycystic ovaries.
This means you do not necessarily need to have polycystic ovaries on an ultrasound to be diagnosed with PCOS.
The NHS currently states that ultrasound for PMOS is only carried out in people over 18. Blood tests may be used to check hormone levels and insulin resistance, and your healthcare professional may need to rule out other conditions that could be causing similar symptoms.
How is PCOS treated?
There is currently no cure for PCOS, but treatment can help manage individual symptoms and reduce some of the longer-term health risks associated with the condition. The right approach will depend on your symptoms, your general health and whether you’re trying to become pregnant.
This is why treatment can look quite different from one person to another. Your GP may manage some symptoms or refer you to a gynaecologist, endocrinologist or fertility specialist where appropriate.
Managing irregular periods
Hormonal contraception, including the combined pill, progestogen-only pill or an intrauterine system (IUS), may be recommended to help manage irregular periods. For people who have very infrequent periods, treatment can also help protect the lining of the womb from becoming excessively thick.
Treating excess hair growth, hair loss and acne
Treatments are available for some of the skin and hair symptoms associated with PCOS. Depending on your circumstances, these may include hormonal contraception or medicines such as spironolactone or eflornithine for unwanted facial or body hair. Acne can also be treated with creams or tablets. Your doctor can advise which options are suitable for you, as some medicines aren’t appropriate when trying for a baby or during pregnancy.
Metformin and PCOS
Metformin is best known as a medicine for type 2 diabetes, but it can also be prescribed for PCOS. It works by helping to lower blood glucose levels and may be recommended for some people as part of managing their symptoms. Whether it’s appropriate will depend on your individual circumstances, so it should be discussed with your healthcare professional.
PCOS and fertility treatment
PCOS can make it more difficult to become pregnant if you’re not ovulating regularly, but having PCOS doesn’t mean that you cannot have a baby.
Medicines can be used to encourage ovulation when PCOS is affecting fertility. The NHS currently lists clomifene as one option, while fertility specialists may recommend other treatments depending on your circumstances. In some cases where other approaches haven’t worked, a procedure called laparoscopic ovarian drilling may be considered.
If you’re trying to conceive and have PCOS, speak to your GP rather than starting supplements or treatments based solely on advice you’ve found online. If you’re planning a pregnancy, you may also find our preconception health guide for women and men helpful, with practical steps to consider before you start trying to conceive. They can assess your individual circumstances and refer you for fertility support when appropriate.
Can lifestyle changes help PCOS?
Lifestyle forms an important part of PCOS management, but advice needs to be individual rather than assuming everyone with PCOS needs to lose weight.
A balanced diet, regular physical activity, adequate sleep and looking after your emotional wellbeing can all support general health. If you’re living with overweight or obesity, your healthcare professional may also discuss weight management with you. RCOG notes that for people with PCOS who are overweight, even a relatively small amount of weight loss can improve some symptoms and reduce certain long-term health risks.
It’s also worth remembering that PCOS can affect emotional as well as physical wellbeing. Symptoms such as acne, excess hair growth, changes in weight and fertility difficulties can affect confidence and mental health. If you’re struggling with anxiety, depression or the emotional impact of PCOS, that’s something you can discuss with your GP too.
What are the long-term health risks of PCOS?
Having PCOS doesn’t mean that you will develop other health conditions. However, it is associated with an increased risk of certain health problems, which is one reason why ongoing health checks and symptom management can be important.
People with PCOS may have an increased risk of developing type 2 diabetes, particularly where insulin resistance or other risk factors are present. Your GP may recommend checks for diabetes depending on your individual circumstances and risk factors.
PCOS can also be associated with risk factors for cardiovascular disease, including high blood pressure and changes in cholesterol levels. This doesn’t mean that having PCOS means you will develop heart disease, but looking after your wider health remains important.
PCOS and the lining of the womb
If you have very infrequent periods, the lining of the womb can become thicker because it isn’t being shed regularly. Over time, this can increase the risk of endometrial hyperplasia and endometrial cancer.
It’s important to put this risk into perspective: RCOG explains that although the risk of endometrial cancer is increased in women with PCOS, the overall chance of developing it remains small. Treatments that regulate periods or protect the lining of the womb can help reduce this risk.
PCOS and emotional wellbeing
The effects of PCOS aren’t limited to physical health. The condition is also associated with an increased risk of anxiety and depression, while symptoms such as unwanted hair growth, acne, hair loss, weight changes and fertility difficulties can have a significant emotional impact.
If PCOS is affecting your mood, confidence or quality of life, it’s worth discussing this with your GP rather than feeling that it’s simply something you have to cope with.
When should you speak to your GP?
Speak to your GP if you’re concerned that you may have PCOS, particularly if you have irregular or absent periods, increased facial or body hair, persistent acne, thinning hair or difficulty becoming pregnant.
You should also seek medical advice if you’ve already been diagnosed with PCOS and your symptoms change, you’re concerned about your periods or fertility, or you’re struggling with the emotional impact of the condition.
PCOS can affect people in very different ways, so there isn’t a single treatment or management plan that’s right for everyone. Getting an accurate diagnosis and discussing your individual symptoms and priorities with a healthcare professional can help you decide what support is appropriate for you.
About this article: This guide is intended to provide general information about PCOS and is not a substitute for individual medical advice. It has been updated using current information from the NHS and the Royal College of Obstetricians and Gynaecologists (RCOG). If you’re concerned about symptoms or your health, speak to your GP or another qualified healthcare professional.
A final note
Understanding PCOS can feel daunting, particularly when you’re first diagnosed or trying to make sense of symptoms you’ve experienced for some time. But a diagnosis doesn’t define what your health or fertility will look like in the future.
There are treatments and support available for many of the symptoms associated with PCOS, and understanding the condition is an important first step towards finding an approach that works for you.