Introduction
Polycystic ovary syndrome — PCOS — is one of the most common hormonal disorders affecting women and people with ovaries of reproductive age, with estimates suggesting it affects between 8% and 13% of this population globally. Despite its prevalence, PCOS is significantly underdiagnosed, often taking years to identify due to the variability of its presentation. Understanding PCOS symptoms and treatment options is essential for anyone experiencing irregular periods, unwanted hair growth, difficulty conceiving, or other common signs — and for healthcare providers who support them.
What Is PCOS and What Causes It?
PCOS is a complex endocrine and metabolic disorder characterised by hormonal imbalance, irregular or absent ovulation, and often (but not always) the presence of multiple small follicles on the ovaries visible on ultrasound. The exact cause is not fully understood, but insulin resistance plays a central role in most cases — the body’s cells do not respond effectively to insulin, causing the pancreas to produce more, and elevated insulin levels stimulate the ovaries to produce excess androgens (male hormones like testosterone). This androgen excess disrupts the normal ovulatory cycle and causes many of the visible symptoms associated with PCOS. Genetics also contribute significantly — PCOS runs strongly in families — and environmental factors including diet, physical activity, and weight can modulate how severely the condition expresses itself.
Common PCOS Symptoms to Know
PCOS presents differently in different individuals, which is one reason it can be difficult to diagnose. The most common symptoms include irregular or infrequent menstrual periods (oligomenorrhea) or complete absence of periods (amenorrhea), which occur because the hormonal imbalance prevents regular ovulation. Excess facial and body hair (hirsutism) — typically in an androgenic distribution including the chin, upper lip, chest, and abdomen — affects a significant proportion of those with PCOS and is caused by elevated androgen levels. Acne that is persistent, severe, and hormonally driven — particularly along the jawline, chin, and back — is another common presentation. Scalp hair thinning or loss in a male-pattern distribution can occur. Many individuals with PCOS experience weight gain and difficulty losing weight, particularly concentrated in the abdomen, reflecting the underlying insulin resistance. Darkened, thickened patches of skin (acanthosis nigricans) in skin folds like the neck, armpits, and groin are another marker of insulin resistance. Fertility challenges from anovulation are among the most distressing aspects for those wishing to conceive.
How PCOS Is Diagnosed
There is no single definitive test for PCOS. The most widely used diagnostic framework is the Rotterdam Criteria, which requires the presence of at least two of three features: irregular or absent ovulation, clinical or biochemical signs of excess androgens (hirsutism, acne, or elevated testosterone on blood tests), and polycystic ovarian morphology on ultrasound (12 or more follicles per ovary or increased ovarian volume). Blood tests help assess androgen levels, insulin and glucose metabolism, thyroid function (to rule out thyroid disease as an alternative cause), prolactin, and lipid profile. Pelvic ultrasound is used to visualise the ovaries. Importantly, diagnosing PCOS also requires ruling out other conditions that can cause similar symptoms — including congenital adrenal hyperplasia, thyroid disorders, hyperprolactinaemia, and androgen-secreting tumours — making a thorough medical evaluation by a gynaecologist or endocrinologist important.
Lifestyle Changes as PCOS Treatment
For women with PCOS who are overweight or obese, lifestyle modification is the most impactful first-line treatment. Even modest weight loss of 5% to 10% of body weight has been shown to meaningfully improve menstrual regularity, reduce androgen levels, improve insulin sensitivity, and restore ovulation — significantly improving both metabolic health and fertility prospects without medication. A low-glycaemic diet — emphasising whole grains, legumes, vegetables, lean proteins, and healthy fats while minimising refined carbohydrates and added sugars — directly addresses the insulin resistance at the core of PCOS pathophysiology. Regular physical activity, particularly a combination of aerobic exercise and resistance training, improves insulin sensitivity and reduces abdominal fat independently of weight change. These lifestyle measures are relevant and beneficial for all women with PCOS, regardless of weight.
Medical Treatments for PCOS
Medical management of PCOS is tailored to the individual’s primary concerns. For menstrual regulation and androgen reduction, combined oral contraceptive pills (OCP) are first-line — they suppress androgen production, regulate cycles, and reduce hirsutism and acne over time. For hirsutism specifically, antiandrogens like spironolactone or cyproterone acetate are often added. Metformin — an insulin-sensitising medication used in type 2 diabetes — is widely prescribed in PCOS to address insulin resistance, improve menstrual regularity, reduce androgen levels, and support weight management. For women with PCOS who wish to conceive, ovulation induction is the goal: letrozole (an aromatase inhibitor) has become the preferred first-line agent over the previously dominant clomiphene citrate. Injectable gonadotrophins and assisted reproduction (IVF) are options for those who do not respond to oral agents. Managing the long-term metabolic risks of PCOS — including type 2 diabetes, cardiovascular risk, and endometrial cancer risk from prolonged anovulation — is a critical and often underemphasised component of ongoing care.
Frequently Asked Questions
Can PCOS go away on its own? PCOS is a lifelong condition, but symptoms often improve with age and after menopause. Can I get pregnant with PCOS? Yes — most women with PCOS can conceive with appropriate management. Is PCOS the same as having cysts on the ovaries? No — the follicles seen on ultrasound in PCOS are not true cysts, and many women with PCOS do not have visible follicles at all.
Conclusion
PCOS is a complex condition with wide-ranging effects on reproductive health, metabolism, and quality of life — but it is highly manageable with the right combination of lifestyle changes and medical treatment tailored to individual goals and symptoms. Early diagnosis, regular monitoring of long-term metabolic risks, and a collaborative relationship with a gynaecologist and/or endocrinologist are the cornerstones of living well with PCOS.