Polycystic ovarian syndrome, often called PCOS, is a complex hormonal disorder that impacts about 8–13% of women during their childbearing years. It involves elevated insulin and androgen levels, which can trigger a variety of symptoms and often lead to infertility.
PCOS symptoms
The signs of PCOS can differ from person to person and may fluctuate over time. Common features include:2
- Irregular or absent menstrual cycles
- Excessive facial and body hair (hirsutism)
- Hair thinning or loss (alopecia)
- Skin issues such as acne, skin tags, or darkened patches (acanthosis nigricans)
- Psychological effects like stress, anxiety, or depression
- Difficulty controlling body weight
- Challenges with conception
What causes PCOS?
Although the term “polycystic” suggests ovarian cysts, ultrasounds typically reveal multiple underdeveloped follicles rather than true cysts. The precise origin of PCOS is still undetermined, but genetic factors and family history play substantial roles, around one in three affected women has a close relative with the condition.2 Hormonal imbalances also drive PCOS: high insulin levels prompt excess production of male hormones (androgens), disrupting normal ovarian function and menstrual regularity. Roughly 85% of women with PCOS experience insulin resistance, meaning their bodies cannot effectively use blood glucose for energy, causing further insulin overproduction.3
Diagnosing PCOS
Because PCOS can present in varied ways, evaluation by an endocrinologist or gynecologist is often needed for confirmation and to reduce long-term health risks. Assessment may include:4
- Detailed review of symptoms and medical history
- Blood tests to measure hormone levels
- Ultrasound imaging of the ovaries
A diagnosis of PCOS is established when at least two of the following criteria are met:
- Absent or irregular menstrual periods
- Evidence of elevated androgens (e.g. acne, hirsutism, or high blood androgen measurements)
- Polycystic ovarian morphology on ultrasound
Potential health issues linked to PCOS
Women with PCOS face an increased likelihood of developing other chronic conditions. These may include:5
- High cholesterol
- Heart disease
- Type 2 or gestational diabetes
- Endometrial cancer
- Sleep apnoea
Impact on fertility
Elevated androgen levels in PCOS can block normal follicle growth and egg release, leading to irregular or absent ovulation. While many people with PCOS conceive without assistance, some will require medical support, such as ovulation-inducing drugs or surgery to enhance ovarian function.6 PCOS also raises the risk of certain pregnancy complications, including:6
- Miscarriage
- Gestational diabetes
- High blood pressure and preeclampsia
- Preterm birth
- Caesarean delivery
Approaches to manage PCOS
There’s currently no cure for PCOS, but its symptoms can be effectively controlled. Adopting a healthy lifestyle is one of the most powerful ways to manage this condition.1 Recommended steps include:7
- Eating a balanced, nutrient-dense diet
- Avoiding smoking and limiting alcohol
- Staying physically active
- Maintaining a healthy body weight
Even a modest weight reduction (5–10% of total body weight) can:
- Reduce insulin resistance by about 50%
- Restore regular ovulation
- Regulate menstrual cycles
- Improve fertility
- Decrease pregnancy risks
- Enhance maternal and child health during pregnancy
- Boost emotional well-being (self-esteem, anxiety, depression)
- Lower the future risk of diabetes and heart disease
Other treatment options may include:8
- Medications (e.g. hormonal contraceptives to normalise periods, lower testosterone, protect hair, aid weight loss, and ease mood symptoms)
- Dermatology therapies for skin concerns
- Hair removal procedures
- Counselling and other support for emotional health
Next steps
If you suspect you have PCOS, consult your doctor for a thorough evaluation. Early diagnosis allows for timely collaboration with specialists and the prompt start of an individualized treatment plan.