PCOS symptoms screening test preparation

Overview

Polycystic ovary syndrome (PCOS) is a common hormone condition that affects how a woman's ovaries work. The term 'polycystic' means 'many cysts' – small fluid-filled sacs in the ovaries. But having these cysts doesn't mean you have a serious disease. PCOS can cause irregular periods, excess hair growth, and fertility problems.

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

PCOS most often affects women and people assigned female at birth during their reproductive years, typically from the teenage years through their 40s. It can run in families.

Symptoms

Common symptoms

• Irregular periods – fewer than 8 periods in a year, or no periods at all.
• Too much hair on the face, chest, back, or belly (hirsutism).
• Acne, especially on the face, chest, and upper back.
• Thinning hair or hair loss on the scalp.
• Weight gain or trouble losing weight.
• Dark, thick skin patches on the neck, armpits, or groin (acanthosis nigricans).
• Skin tags in the armpits or neck area.
• Mood changes, anxiety, or depression.

Symptoms in children

• In teenage girls, PCOS may cause irregular periods from the start, but it's normal to have irregular periods for the first few years after getting your first period. Other signs include severe acne, excess hair growth, and weight gain.

Symptoms in older adults

• In older women, PCOS symptoms may change. Periods may become more regular as you approach menopause, but other symptoms like hair growth and insulin resistance may persist. The risk of diabetes and heart disease increases.

Causes

Main causes

• The exact cause is not fully understood. It likely involves a combination of genetic, hormone, and environmental factors.
• Insulin resistance – your body's cells don't respond well to insulin, causing the body to produce more insulin. High insulin can increase testosterone levels.
• Hormone imbalance – higher-than-normal levels of androgens (male hormones) like testosterone.
• Inflammation – low-grade inflammation in the ovaries and other tissues may play a role.

Risk factors

• Family history – if your mother or sister has PCOS, you are more likely to have it.
• Obesity or being overweight increases the risk, especially if you have insulin resistance.
• Certain ethnic backgrounds – women of South Asian, Middle Eastern, and Hispanic descent have higher rates.

When to see a doctor

See a doctor urgently if:

• Severe pelvic pain or heavy bleeding (see emergency symptoms above).

Book a routine appointment if:

• You have irregular periods – fewer than 8 periods a year, or you haven't had a period for 3 months without being pregnant.
• You have excess hair growth, severe acne, or hair thinning that bothers you.
• You are having trouble getting pregnant.
• You notice weight gain that is hard to control, especially around your belly.

Diagnosis

PCOS is usually diagnosed based on a combination of symptoms, a physical exam, and test results. There is no single test for PCOS. Your doctor will use what's called the Rotterdam criteria: you need to have at least two of these three: irregular or no ovulation (shown by irregular periods), signs of high androgens (by blood test or physical signs like excess hair), and polycystic ovaries on an ultrasound.

Tests that may be done

• Blood tests to check hormone levels (like testosterone, LH, FSH) and to rule out other conditions.
• Blood glucose (sugar) and insulin tests to check for insulin resistance or diabetes.
• Pelvic ultrasound to look at your ovaries and the lining of your uterus. This is usually done with a small probe inserted into the vagina (transvaginal ultrasound) for a better view.
• Blood tests for thyroid function and prolactin levels to rule out other causes of irregular periods.

What to expect at your appointment

For the ultrasound, you will be asked to empty your bladder and then lie on an exam table. The ultrasound technician or doctor will gently insert a small, lubricated probe into your vagina. This may feel a little uncomfortable but should not be painful. The whole scan takes about 15–20 minutes. For blood tests, you may be asked to fast (not eat or drink for 8–12 hours) if they are checking your glucose and insulin levels. Your doctor will explain what you need to do before your tests. Preparation is minimal – just follow the instructions you are given.

Treatment

Treatment for PCOS focuses on managing your symptoms and reducing your risk of long-term health problems. The right treatment depends on your symptoms and whether you are trying to get pregnant. A combination of lifestyle changes and medical treatments is often recommended.

Self-care at home

• Eating a balanced diet with plenty of fruits, vegetables, whole grains, and lean protein can help manage weight and insulin levels.
• Getting regular physical activity – aim for at least 150 minutes of moderate exercise each week (like brisk walking, cycling, or swimming).
• Maintaining a healthy weight – even losing 5–10% of your body weight can improve symptoms and increase chances of pregnancy.
• Managing stress through relaxation techniques, mindfulness, or talking with a counsellor.
• Getting enough sleep – aim for 7–9 hours per night.

Medical treatments

Doctors may prescribe medicines to help regulate your menstrual cycle, reduce excess hair growth, manage insulin resistance, or help with fertility. These treatments are chosen based on your individual needs and goals. For example, some medicines help your body use insulin better, which can lower testosterone. Others can help balance hormones or reduce androgen levels. Always talk to your healthcare provider about the benefits and possible side effects of any treatment.

When is surgery considered?

Surgery is rarely needed for PCOS. In some cases, a procedure called ovarian drilling (where small holes are made in the ovary using a keyhole surgery) may be considered to trigger ovulation if other treatments haven't worked and you want to get pregnant. This is not common and is only done after discussing all other options.

Living with this condition

Living with PCOS can be a challenge, but many women learn to manage their symptoms and feel well. Working with a healthcare team – your GP, a gynaecologist, a dietitian, and sometimes a mental health professional – can help you create a plan that works for you. Be patient with yourself; changes take time.

Lifestyle tips

• Establish a routine for meals and exercise to help manage weight and blood sugar levels.
• Track your periods and symptoms in a journal or app – this helps you notice patterns and share information with your doctor.
• Develop a support network – talk to friends, family, or join an online or local support group.
• Avoid smoking and limit alcohol, as these can worsen symptoms.

Diet and exercise

A healthy diet full of fibre, lean protein, and healthy fats can help control insulin levels. Try to include foods like oats, legumes, leafy greens, nuts, and fish. Limit sugary drinks, white bread, and processed snacks. Exercise is very important – it helps your body use insulin more efficiently. Even light activity like walking after meals can make a difference. Find an activity you enjoy so you'll stick with it.

Mental health and emotional wellbeing

PCOS can affect your mood and self-esteem. Many women experience anxiety, depression, or feel frustrated with their body image. It's normal to feel this way. Please know that you are not alone. Talking to a therapist or counsellor who understands PCOS can be very helpful. If you are having thoughts of harming yourself, please reach out to a crisis helpline or a trusted person immediately.

Prevention

PCOS cannot be prevented because the exact cause is not known. However, maintaining a healthy weight, eating a balanced diet, and staying active can reduce your risk of developing severe symptoms. Early diagnosis and treatment can help prevent complications.

Screening programmes

There is no routine screening test for PCOS in the general population. However, if you have symptoms, your doctor can assess you. Screening for related conditions like diabetes and high cholesterol is often recommended for women with PCOS.

Complications

If left untreated

• Long-term insulin resistance can lead to type 2 diabetes.
• High cholesterol and high blood pressure increase the risk of heart disease.
• Irregular periods or lack of ovulation can cause infertility.
• Endometrial (womb) cancer – a slightly higher risk because of irregular shedding of the womb lining.
• Sleep problems, including sleep apnoea.
• Poor mental health, including depression and anxiety.

Long-term outlook

With care and support, most women with PCOS lead healthy, fulfilling lives. Symptoms can be managed with lifestyle changes and medical treatment. Fertility treatments can help many women become pregnant. The key is to work with your healthcare provider to find a plan that fits your needs. You are not alone, and there is hope.

Find support

International organisations

• Office on Women's Health (U.S. Department of Health and Human Services) ↗
• NHS UK – Polycystic ovary syndrome ↗

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