PCOS symptoms follow up care

Overview

Polycystic ovary syndrome, usually called PCOS, is a common hormonal condition that affects how a person's ovaries and body work. It can cause irregular periods, high levels of certain hormones called androgens, and small harmless collections of fluid (follicles) in the ovaries. PCOS affects hormones, periods, and often how the body uses sugar (insulin).

Yes. PCOS is very common. Around 1 in 10 women and people with ovaries of reproductive age have PCOS, but it affects everyone differently, and many people don't realize they have it.

PCOS mainly affects people with ovaries, usually starting in their teenage years or early 20s. It can happen at any age after puberty and continues after menopause, although symptoms may change over time. It affects people of all ethnicities and backgrounds.

Symptoms

Common symptoms

• Irregular, infrequent, or missed periods – often needing hormonal treatment to bring on a bleed
• Heavy bleeding or surprise bleeding after a long gap between periods
• Excess facial or body hair (hirsutism), usually on the face, chest, stomach or back
• Acne, oily skin, or dandruff
• Thinning hair or hair loss from the scalp
• Weight gain or difficulty losing weight, especially around the abdomen
• Dark, velvety patches of skin – often in the neck folds, groin or under the breasts

Symptoms in children

• In teenagers, the classic signs are irregular periods that stay irregular for more than two years after the first period.
• Severe acne, excess hair growth, or rapid weight gain in the teen years can also be early clues.
• If you are a parent or caregiver, seek advice early – don't assume very heavy or unpredictable periods are part of 'growing up'.

Symptoms in older adults

• After menopause, PCOS symptoms often improve – periods stop naturally, and hormone levels settle down.
• However, the metabolic features of PCOS, such as insulin resistance, high blood pressure and high cholesterol, can continue, so ongoing check-ups are important.
• Signs to watch for include new difficulty managing weight, increased blood sugar, or high blood pressure.

Causes

Main causes

• The exact cause of PCOS is not fully understood. It is thought to involve genetics – if someone in your family has it, you are more likely to have it.
• Most people with PCOS have insulin resistance. This means the body's cells do not respond normally to insulin, so the pancreas makes more. Extra insulin can cause the ovaries to make more androgen (male-type hormones).
• High androgen levels can stop the ovaries from ovulating regularly, which leads to irregular periods and the typical skin and hair symptoms.

Risk factors

• Family history – a parent or sibling with PCOS
• Carrying extra weight, especially around the middle, which increases insulin resistance
• Having had early puberty or very irregular periods from a young age
• Being inactive and having a diet high in processed or high-sugar foods – although these alone do not cause PCOS, they can make symptoms worse

When to see a doctor

See a doctor urgently if:

• See a doctor within a day or two if you have new or unusual pelvic pain that isn't severe, bleeding that is heavier or more irregular than usual, or a fever.

Book a routine appointment if:

• Routine check-ups with your doctor are important if you have PCOS, even if you feel fine. Ask for a review of your symptoms, blood pressure, blood glucose and cholesterol levels at least once a year.
• If you are trying to conceive, get advice early – many people with PCOS need a little help, and in most cases fertility can be improved with lifestyle changes and medicines.

Diagnosis

To diagnose PCOS, a doctor will ask about your symptoms, periods, and family history. There is no single blood test or scan that proves PCOS. In the UK, doctors usually use the Rotterdam criteria – you need to have two of the following three things: symptoms of high androgens (such as acne or hair growth) or high androgen levels on a blood test; irregular or absent periods (which suggests ovulation problems); and polycystic ovaries seen on an ultrasound scan.

Tests that may be done

• Blood tests to check hormone levels – including androgens (such as testosterone), and sometimes other hormones like thyroid or prolactin to rule out other causes
• Blood sugar tests – to check for insulin resistance or diabetes, because PCOS is linked to these
• Cholesterol and blood pressure checks – because PCOS increases cardiovascular risk
• Pelvic ultrasound scan – to look at the ovaries and the lining of the womb (although not everyone with PCOS has polycystic ovaries on a scan)

What to expect at your appointment

At your first appointment, the doctor will listen to your story and examine you gently (sometimes this is not needed). They may offer a blood test and an ultrasound. A full assessment can take a couple of visits. Do not worry – the tests are common and not painful. The ultrasound may be an external scan (over the tummy) or an internal scan (a small probe in the vagina); you can also ask for a reliable relative or friend to be present.

Treatment

There is currently no cure for PCOS, but the symptoms can be managed very well. Treatment focuses on what matters most to you – whether that is getting regular periods, improving skin and hair symptoms, improving fertility, or reducing your long-term risk of diabetes and heart disease. Many people need a combination of lifestyle changes and medicines, and these should be reviewed regularly.

Self-care at home

• Eat regular, balanced meals – focus on whole foods, vegetables, fruit, lean protein and fibre, with fewer sugary snacks and processed carbs.
• Move your body daily – even a 30-minute walk can help your body use insulin better.
• Aim for a healthy weight – losing just 5% of your body weight can improve periods and insulin resistance.
• Get enough sleep and find ways to manage stress – stress hormones can make PCOS symptoms worse.
• Check your period patterns with an app or diary – this is useful for your healthcare team.

Medical treatments

Medical treatment for PCOS is tailored to you. Options include combined hormonal contraceptives (like 'the pill' – a tablet that you take to regulate periods and reduce acne and hair growth) but note that these are not suitable for everyone. Other approaches include progestogen-based treatments to help you have a withdrawal bleed, medicines that help the body respond better to insulin (commonly prescribed for diabetes but used for PCOS), and skincare or hair treatments prescribed by a doctor. There are also treatments to stimulate ovulation (cause an egg to be released) if you are trying to conceive. Your doctor will only recommend medicines that are safe and appropriate for you.

When is surgery considered?

Surgery is rarely needed for PCOS. The most common exception is a small operation called 'ovarian drilling', where tiny holes are made in the ovary surface to encourage ovulation in some women who have not responded to medicines. Weight-loss (bariatric) surgery may be considered for some people with severe obesity to help improve PCOS symptoms and fertility, but this is only after other options have been tried.

Living with this condition

Living with PCOS means building a routine that supports your hormones. You will have good days and bad days – and that's normal. Managing it is not about being perfect. Small, consistent steps with your eating, activity, sleep and stress will help you feel better and keep long-term risks low.

Lifestyle tips

• Keep a period diary or app to help you spot when cycles go wrong – share it with your doctor.
• Make active time non-negotiable – find movement you enjoy, whether it's dancing, swimming, walking or strength training.
• Plan meals ahead so it's easier to choose healthy options.
• Look after your skin and hair with gentle care – and ask for dermatology advice if acne or excessive hair is affecting your mood.
• Learn to manage stress with breathing exercises, mindfulness, or just time outdoors – stress can trigger insulin resistance.

Diet and exercise

There is no special 'PCOS diet', but eating to keep your blood sugar stable can help. The key principles are: base meals on vegetables and whole grains, include protein and healthy fat with every meal, and limit ultra-processed foods and sugary drinks. For exercise, aim for at least 150 minutes of moderate activity a week – such as brisk walking – plus strength training twice a week. This improves insulin sensitivity and many PCOS symptoms.

Mental health and emotional wellbeing

PCOS can affect your mood, confidence and body image. Excess hair, acne, irregular periods and fertility worries can weigh on anyone. Depression and anxiety are more common in people with PCOS. It is important to be honest with your healthcare team about how you are feeling – they can help you access talking therapies or peer support. You are not alone, and feeling low does not mean you are 'not coping'.

Prevention

You cannot prevent PCOS itself – it runs in families and involves your genetics. However, you can take steps to prevent or delay complications. The same healthy habits that manage PCOS – a balanced diet, regular movement, and a healthy weight – can reduce your risk of diabetes, high blood pressure and womb lining problems.

Vaccines

There is no vaccine to prevent PCOS, but staying up to date with routine vaccines (such as flu and COVID-19, if recommended) is still important because PCOS can be linked to metabolic health. Ask your pharmacist or clinic about what vaccines apply to you.

Screening programmes

If you have PCOS, you are more likely to develop insulin resistance, type 2 diabetes, high blood pressure and high cholesterol. That is why it is important to have regular screening: your doctor typically checks your blood pressure, blood glucose and cholesterol at least once a year. If you have very infrequent periods (fewer than 4 a year), you may also need regular ultrasound checks of the womb lining because unopposed estrogen can make it thicken. Ask your care team about what checks are right for you.

Complications

If left untreated

• Type 2 diabetes – because insulin resistance is common with PCOS
• High blood pressure and unhealthy cholesterol levels, which raise the risk of heart disease and stroke
• Endometrial (womb lining) thickening – because irregular periods mean the lining is not shed regularly, which can increase the risk of womb cancer later in life
• Fertility difficulties – because irregular ovulation makes it harder to get pregnant naturally
• Sleep apnoea – a condition where breathing stops briefly during sleep, linked with excess weight and insulin resistance

Long-term outlook

The outlook for PCOS is generally positive. With the right follow-up and care, most people manage their symptoms well, reduce their long-term risks, and go on to have successful pregnancies if they choose. PCOS is a lifelong condition, but it is one you can live well with. Many people find they cope better over time as they learn what works for their body. There is a lot of hope – and you deserve, and should ask for, high-quality support at every stage.

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