PCOS symptoms treatment options overview

Overview

Polycystic ovary syndrome (PCOS) is a common hormone problem that affects people who have ovaries. It happens when the body makes slightly higher levels of androgens (often called 'male' hormones, though everyone has them) and when ovulation — the release of an egg each month — becomes irregular. The name is a little misleading: you do not need to have ovarian cysts to have PCOS. PCOS affects periods, skin, body hair, energy and often metabolism.

Yes. Around 1 in 10 people with ovaries has PCOS, making it one of the most common hormonal conditions worldwide.

PCOS mainly affects people with ovaries during their reproductive years, usually beginning in their teens or twenties. It can affect people of every weight, background and body type, although it is more likely in people with a family history of PCOS, type 2 diabetes or metabolic syndrome.

Symptoms

Common symptoms

• Irregular, missed or very light periods
• Difficulty getting pregnant because ovulation is irregular
• Acne on the face, chest or back
• Extra coarse hair on the face, chin, chest, belly or thighs
• Thinning hair on the scalp
• Weight gain or difficulty losing weight
• Dark, velvety skin patches on the neck, groin or under the breasts
• Mood changes, including anxiety and low mood

Symptoms in children

• PCOS is rarely diagnosed before puberty. In teenagers, symptoms can include periods that stay irregular well after the first few years.
• New or worsening acne during adolescence may sometimes be related to hormonal imbalance.
• Weight gain, excess hair on the face or body, and a family history of PCOS can also be early clues.

Symptoms in older adults

• After menopause, periods stop, but PCOS-related metabolic risks continue.
• Excess hair and thinning scalp hair may remain, though some symptoms may soften with age.
• The risk of type 2 diabetes, high blood pressure and unhealthy cholesterol stays higher than average, so regular check-ups are important.

Causes

Main causes

• The exact cause is not fully understood.
• Small imbalances in hormones can disrupt regular egg release.
• Insulin resistance makes the body produce extra insulin, which can push the ovaries to make more androgens.
• Low-level inflammation is more common in PCOS and may worsen insulin resistance.
• Genetics play a role, since PCOS often runs in families.

Risk factors

• Having a mother, sister or grandmother with PCOS or type 2 diabetes
• Carrying excess weight, especially around the waist
• An inactive lifestyle
• Having had gestational diabetes during pregnancy
• Early puberty in childhood or a history of rapid weight gain

When to see a doctor

See a doctor urgently if:

• If you have serious symptoms listed under 'Emergency' — do not wait.
• If pelvic pain suddenly becomes severe.
• If bleeding is unusually heavy or you feel weak and dizzy.

Book a routine appointment if:

• If your periods have been irregular for several months.
• If you have unwanted facial or body hair, or acne that is new or worsening.
• If you have been trying to get pregnant for a year (or six months if you are over 35) without success.
• If you have been gaining weight without a clear reason.
• If you feel depressed, anxious or constantly overwhelmed.

Diagnosis

A doctor usually diagnoses PCOS by combining your medical history, physical examination, blood tests and sometimes a pelvic ultrasound. Most guidelines say a diagnosis is confirmed when you have at least two of these three features: irregular or absent ovulation, blood or physical signs of high androgens, and ovarian changes that look like polycystic ovaries on ultrasound. The doctor will also rule out thyroid disease, high prolactin and other causes of irregular periods.

Tests that may be done

• Medical history, including periods, skin and hair changes, weight and family history
• Physical examination: height, weight, blood pressure and look at skin and hair
• Blood tests for reproductive hormones and other hormones, such as thyroid hormone and prolactin
• Blood sugar check (fasting glucose or HbA1c)
• Cholesterol and triglyceride blood test
• Pelvic ultrasound to look at the ovaries and womb lining

What to expect at your appointment

The appointment may take longer than a usual check-up. You might need a second visit to review results. A pelvic ultrasound is usually either a scan over the lower belly or a small vaginal probe; it may be a little uncomfortable but is not painful. The doctor should explain what everything means and help you make a plan that fits your needs and goals.

Treatment

There is no single treatment that works for everyone with PCOS. The aim is to manage your symptoms, reduce long-term health risks, and support whatever matters most to you — like regular periods, clearer skin, better energy, weight management or pregnancy. Most plans start with lifestyle support and add medication when needed.

Self-care at home

• Eat in a regular rhythm with vegetables, whole grains, lean proteins and healthy fats.
• Move more in ways you enjoy — walking, cycling, swimming, dancing — with a target of about 150 minutes of moderate activity per week.
• Add some strength training two or more days per week.
• Try to improve sleep and reduce stress gradually.
• Limit sugary drinks and very processed snacks.
• Seek support from a dietitian or diabetes educator for personalised meal planning.

Medical treatments

Medical treatment depends on your symptoms and whether you are planning pregnancy. Hormonal contraception, often called the combined pill, is sometimes prescribed to make periods regular and improve acne and excess hair; it is not safe or appropriate for everyone, and your clinician will discuss the benefits, risks and alternatives. Other treatments include medicines that improve insulin resistance, treatments that block the effects of androgens on hair and skin, and medicines that help a person ovulate when trying to become pregnant. These are prescription-only and are chosen after a full assessment. Always speak to your healthcare provider about the expected benefits, possible side effects and how long to use a treatment.

When is surgery considered?

Surgery is rarely the first option. For some people with severe obesity, bariatric (weight-loss) surgery may be considered after specialist assessment. For a small number of people trying to conceive who do not respond to ovulation medicines, a keyhole procedure called laparoscopic ovarian drilling may be offered. Surgery is not a routine or quick fix for PCOS.

Living with this condition

Living with PCOS is about steady habits, not perfection. Regular meals, daily activity, enough sleep and a healthcare team that listens all matter. Some symptoms improve slowly, so give your body time and celebrate small wins.

Lifestyle tips

• Set a regular sleep and wake time.
• Find stress-relief strategies you actually enjoy.
• Keep a simple symptom diary to spot patterns and share them with your clinician.
• Go to follow-up appointments for blood pressure, blood sugar, cholesterol and mental health.
• Talk about your feelings with someone you trust so you do not carry everything alone.

Diet and exercise

There is no special 'PCOS diet'. A high-fibre eating pattern with protein and healthy fats at each meal helps steady blood sugar and hunger. Include carbohydrates in sensible portions rather than cutting them out. Combine aerobic activity and resistance exercise, as both help your body use insulin better. Choose changes you can keep up for life, not a short-term plan.

Mental health and emotional wellbeing

PCOS can affect self-esteem, body image, mood, and feelings about fertility. Depression and anxiety are more common in people with PCOS. This is a real part of the condition, not a personal failing. Talking to a counsellor, psychologist or mental health nurse can help. If you are in crisis or having thoughts of harming yourself, call your local emergency number or go to an emergency department right away.

Prevention

PCOS itself cannot be completely prevented because genetics and hormones play a large part. But you can reduce how severe the symptoms become and lower the risk of diabetes, high blood pressure and womb problems by keeping active, eating well, managing weight and asking for help early.

Screening programmes

If you have PCOS, ask your healthcare team about regular screening for blood pressure, cholesterol, HbA1c (blood sugar over recent months) and mood. If you have a close relative with PCOS or type 2 diabetes, mention it at your next check-up so your doctor can monitor early warning signs.

Complications

If left untreated

• Type 2 diabetes
• High blood pressure and unhealthy cholesterol levels
• Sleep apnoea, which disturbs sleep and breathing
• Non-alcoholic fatty liver disease
• Thickening of the womb lining (endometrial hyperplasia) and, in rarer cases, womb cancer
• Difficulty getting pregnant without support
• Depression and anxiety

Long-term outlook

Most people with PCOS can live full, healthy lives. Symptoms often improve with insulin resistance reduction, and fertility treatments help many people to become parents. PCOS is a long-term condition, not a life sentence. The earlier you seek support, the better your chance of protecting your health and feeling more in control.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.