PCOS Explained: What It Is, How It's Diagnosed, and What You Can Do

What Is PCOS?

PCOS is a hormonal condition that affects around one in ten women. The ovaries produce higher than normal levels of androgens, which are often thought of as "male" hormones, though women produce them too. This hormonal imbalance disrupts the normal process of ovulation, which leads to irregular periods and, in some women, small fluid-filled follicles on the ovaries.

The name is a bit misleading. "Polycystic" suggests the problem is cysts, but the ovarian appearance is actually just one piece of the picture, and not every woman with PCOS has it. The real issue is the hormonal imbalance and what that leads to.

What Are the Symptoms?

PCOS looks different from woman to woman, which is part of why it can take so long to diagnose. The most common things I see are:

Irregular periods. Cycles that are very long (more than 35 days), unpredictable, or absent altogether. Some women have only a handful of periods a year. Others bleed frequently and heavily.

Excess hair growth, particularly on the face, chest, or stomach. This is caused by the higher androgen levels and is one of the more distressing symptoms for many of my patients.

Acne, especially along the jawline and chin. Adult acne that doesn't respond well to standard treatment is often hormonal.

Hair thinning on the scalp. This follows a female pattern of hair loss that can start as early as the mid-20s.

Weight changes. PCOS is closely linked with insulin resistance, which makes weight management harder. Not all women with PCOS carry excess weight, but many find it easier to gain and harder to lose than their peers.

Difficulty conceiving. Because PCOS affects ovulation, it's one of the leading causes of fertility problems in women. That said, most women with PCOS can conceive, often with some support.

Fatigue, low mood, and anxiety are also common, and I think these get underattributed to PCOS when they should be taken seriously as part of the condition's impact.

How Is It Diagnosed?

There's no single test that confirms PCOS. We use what's called the Rotterdam criteria, which requires at least two of the following three features: irregular or absent ovulation, elevated androgen levels (either on a blood test or based on symptoms), and a polycystic-looking ovary on ultrasound.

I'll typically organise blood tests to check your hormone levels, including LH, FSH, testosterone, and AMH, as well as a fasting glucose and insulin to assess for insulin resistance. An ultrasound of the ovaries is often useful, though it's not essential for a diagnosis. I'll also want to rule out other conditions like thyroid dysfunction that can look similar.

It's worth noting that oral contraceptive pills suppress many of the hormonal markers, so if you're on the pill and we want an accurate picture, we may need to revisit testing a few months after stopping.

What Can Be Done About It?

There's no cure for PCOS, but it's very manageable. Treatment depends on which symptoms are bothering you most and whether you're trying to conceive.

For cycle regulation and contraception: The combined oral contraceptive pill is often the first option. It regulates bleeding, reduces androgen levels, and helps with acne and hair growth. It's a reasonable choice for women who are not currently trying to fall pregnant.

For insulin resistance: Metformin, a medication originally developed for type 2 diabetes, is commonly used in PCOS. It helps with insulin sensitivity, can assist with weight, and in some women helps restore more regular ovulation.

For fertility: We have good options. Letrozole is now the preferred first-line treatment for inducing ovulation in PCOS and has a better success rate than the older drug clomiphene. If that's not sufficient, referral to a specialist for further fertility support is straightforward.

For hair and skin: Anti-androgen medications like spironolactone can be very effective for excess hair growth and acne that hasn't responded to other treatments. These need to be managed carefully, particularly if pregnancy is a possibility, but they can make a significant difference to quality of life.

Lifestyle and What It Actually Changes

I want to be honest here, because I think women with PCOS sometimes feel like they've been told to just "eat better and exercise" and sent on their way. Lifestyle genuinely matters in PCOS, more than in most conditions I treat, but that's because of the underlying insulin resistance, not because you need to be thinner.

A diet lower in refined carbohydrates and higher in fibre and protein helps stabilise blood sugar and insulin levels, which in turn can improve ovulation regularity, reduce androgen levels, and help with energy. Regular exercise, particularly strength training, has a similar effect. Even modest improvements in insulin sensitivity can make a noticeable difference to symptoms.

But I also know that weight management is genuinely harder with PCOS, and I'd rather help you work with your body than give you a target number on a scale. The goal is metabolic health and symptom management, not a particular dress size.

Long-Term Health and PCOS

Because of the insulin resistance component, women with PCOS are at higher risk of developing type 2 diabetes and should have their blood sugar checked regularly. I'd suggest at least every two years. There's also a somewhat higher risk of cardiovascular disease over time, which is another reason why managing the insulin resistance side of things matters beyond just the immediate symptoms.

Endometrial health is something I keep an eye on too. If periods are very infrequent, the endometrium can build up over time without being shed. I generally recommend at least four periods a year, either naturally or hormonally induced, to protect the uterine lining.

You Deserve a Proper Explanation

If you think you might have PCOS, or you've been told you have it and feel like you never fully understood what that means, please come in. It's one of those conditions where the conversation really matters. We can go through your specific symptoms, what's actually driving them, and build a plan around what's most important to you right now, whether that's getting your periods under control, managing your skin, or thinking about your options for having a family.