PCOS

Overview

Polycystic Ovary Syndrome, commonly called PCOS, is a condition that affects how a woman's ovaries work. It involves hormonal imbalances, irregular periods, and small fluid-filled sacs (cysts) on the ovaries. PCOS can affect fertility and other aspects of health.

Yes, PCOS is very common. It affects about 1 in 10 women of childbearing age worldwide.

PCOS can affect any woman or person with ovaries after puberty. It often starts in the teenage years or early 20s. It is more common in people who have a family history of PCOS, and it affects all ethnicities, though risk may be higher in certain groups.

Symptoms

Common symptoms

• Irregular or missed periods (fewer than 8 periods a year)
• Excess body or facial hair (hirsutism)
• Acne, especially on the face, chest, or back
• Thinning hair on the scalp or male-pattern baldness
• Weight gain or difficulty losing weight
• Dark, thick patches of skin on the neck, armpits, or groin (acanthosis nigricans)
• Ovaries with many small cysts seen on ultrasound

Symptoms in children

• PCOS usually develops after puberty, but early signs in teenagers can include irregular periods, severe acne, and excess hair growth. Teens with PCOS may also have weight gain and difficulty losing weight.

Symptoms in older adults

• As women approach menopause, PCOS symptoms may change. Irregular periods can become more regular, but risks of type 2 diabetes, high blood pressure, and heart disease remain. Hirsutism and hair thinning may persist.

Causes

Main causes

• The exact cause is not fully understood, but it is linked to an imbalance of hormones, particularly higher levels of androgens (male-like hormones) and insulin resistance (the body's cells do not respond well to insulin).
• Genetics plays a role: if your mother or sister has PCOS, you are more likely to develop it.

Risk factors

• Family history of PCOS
• Obesity or being overweight
• Insulin resistance and type 2 diabetes
• Having a mother or sibling with PCOS

When to see a doctor

See a doctor urgently if:

• If you have severe pelvic pain suddenly.
• If you experience heavy bleeding that lasts more than a week or soaks through pads quickly.

Book a routine appointment if:

• If you have irregular periods (fewer than 9 per year) and are concerned about fertility or other symptoms.
• If you have unwanted excess hair, severe acne, or hair thinning.
• If you have struggled with weight gain and suspect a hormone issue.

Diagnosis

Doctors diagnose PCOS based on a combination of symptoms, blood tests, and sometimes an ultrasound. A common set of criteria called the Rotterdam criteria requires at least 2 of 3: irregular ovulation (irregular periods), high androgen levels, and polycystic ovaries on ultrasound.

Tests that may be done

• Blood tests to check hormone levels (testosterone, LH, FSH, and others)
• Blood sugar and insulin tests to check for insulin resistance
• Pelvic ultrasound to look at the ovaries and check for cysts

What to expect at your appointment

Your doctor will ask about your symptoms, periods, and family history. They may do a physical exam to check for signs like excess hair or skin changes. The process may take a few visits. There is no single 'yes/no' test, so diagnosis is based on the overall picture.

Treatment

Treatment for PCOS focuses on managing symptoms, improving fertility if desired, and reducing long-term health risks. Options include lifestyle changes, medications (to regulate periods, lower androgen levels, or improve insulin sensitivity), and sometimes surgical procedures. No single treatment works for everyone, so you and your doctor will create a plan tailored to your needs.

Self-care at home

• Healthy diet: focus on whole grains, lean proteins, vegetables, and healthy fats. Limit sugar and processed foods.
• Regular physical activity: aim for at least 150 minutes of moderate exercise per week (like brisk walking, cycling, or swimming).
• Weight management: losing even 5% of your body weight can improve symptoms and insulin sensitivity.
• Stress reduction: try relaxation techniques like deep breathing, yoga, or meditation.
• Hair removal or acne treatments (over-the-counter creams or professional options) for cosmetic concerns.

Medical treatments

Doctors may prescribe hormone-regulating medications (such as the combined oral contraceptive pill) to help regulate periods, reduce androgen levels, and improve acne and hair growth. Other medications can help with insulin resistance, ovulation induction for fertility, or reduce hair growth. Always discuss the risks and benefits with your healthcare provider. Do not take any medication without a prescription and medical supervision.

When is surgery considered?

Surgery is rarely the first choice. A procedure called laparoscopic ovarian drilling (making tiny holes in the ovary) may be considered if medications for ovulation are not effective. This can temporarily lower androgen levels and help with ovulation, but it is not a cure.

Living with this condition

Living with PCOS can be challenging because symptoms affect appearance, mood, and fertility. Building a routine that includes healthy eating, regular physical activity, and self-care is key. Working with a healthcare team (doctor, dietitian, mental health professional) can help you manage the condition long-term.

Lifestyle tips

• Establish a consistent eating schedule with balanced meals.
• Incorporate both aerobic exercise and strength training into your week.
• Get enough sleep (7-9 hours per night).
• Limit stress through hobbies or relaxation practices.
• Track your menstrual cycle and symptoms to share with your doctor.

Diet and exercise

A diet low in high-glycemic foods (sugary snacks, white bread) can help manage insulin levels. Focus on high-fiber foods, lean protein, and healthy fats. Regular exercise helps improve insulin sensitivity and weight management. Even small changes can make a big difference.

Mental health and emotional wellbeing

PCOS can affect self-esteem, body image, and mood. Many women experience anxiety and depression. It's important to talk to your doctor if you are feeling low, anxious, or overwhelmed. Mental health support, including counselling or support groups, can be very helpful. If you are having thoughts of harming yourself, call your local emergency number or a crisis helpline immediately.

Prevention

PCOS cannot be prevented entirely because it is linked to genetics and hormones. However, maintaining a healthy weight, eating well, and staying active may reduce the risk of developing severe symptoms or associated conditions like diabetes.

Complications

If left untreated

• Type 2 diabetes or prediabetes due to insulin resistance
• High blood pressure and high cholesterol, increasing heart disease risk
• Infertility or difficulty getting pregnant
• Endometrial hyperplasia or uterine cancer (from infrequent periods causing buildup of uterine lining)
• Sleep apnea
• Depression and anxiety

Long-term outlook

With proper management, the outlook for PCOS is generally good. Most symptoms can be controlled, and long-term health risks can be reduced. Many women with PCOS can get pregnant with treatment. Although PCOS is a lifelong condition, it does not have to define your health or happiness. Regular check-ups and a healthy lifestyle are the best tools for a positive future.

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