screening for PCOS symptoms

Overview

Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects people with ovaries. It can cause irregular periods, excess hair growth, acne, and problems with metabolism, such as being resistant to insulin (when the body doesn't use insulin well). The name 'polycystic' refers to many small, fluid-filled packs (follicles) that can appear on the ovaries, but it doesn't mean you have harmful cysts.

Yes. PCOS affects about 8 to 13 in every 100 people who have ovaries during their childbearing years. It is the leading cause of irregular periods and ovulation problems.

PCOS can start in the teenage years and continue through life. It affects people of all ethnicities, though some groups, such as South Asian, Black, and Hispanic people, may have more severe symptoms.

Symptoms

Common symptoms

• Irregular, missed, or very light periods
• Excess hair growth on the face, chest, back, or buttocks
• Acne or oily skin
• Weight gain or difficulty losing weight
• Thinning hair on the head
• Difficulty getting pregnant (because ovulation is irregular)
• Mood changes, anxiety, or depression

Symptoms in children

• Irregular periods beginning around puberty (though some irregularity is normal in the first few years)
• Acne and oily skin
• Unexpected weight gain, especially around the middle
• Excess hair growth on the face or body
• Mood swings

Symptoms in older adults

• After menopause, symptoms like irregular periods no longer occur, but you may still have metabolic issues
• Excess hair growth and hair thinning can continue
• Higher risk of type 2 diabetes, high blood pressure, and cardiovascular disease
• Persistent acne may improve, but some people still experience it

Causes

Main causes

• The exact cause of PCOS is not fully understood. It is thought to involve a combination of genetics and environment.
• Insulin resistance: The body's cells don't respond well to insulin, so the pancreas makes more, leading to higher insulin levels. High insulin can increase androgen ('male-type' hormone) production.
• Excess androgens: People with PCOS often produce higher levels of androgen hormones, which can disrupt ovulation and cause symptoms like hair growth and acne.

Risk factors

• Family history: A mother, sister, or daughter with PCOS increases your risk.
• Obesity or being overweight, particularly if weight is around the waist.
• Insulin resistance or a personal or family history of type 2 diabetes.
• Being born to a mother who had PCOS or gestational diabetes.

When to see a doctor

See a doctor urgently if:

• Sudden severe pelvic or abdominal pain
• Heavy bleeding with dizziness or weakness

Book a routine appointment if:

• Your periods are consistently irregular (fewer than 8 periods per year, or cycles shorter than 21 days or longer than 35 days)
• You notice new acne, excess hair growth, or thinning scalp hair
• You are under 30 and have been trying to get pregnant for a year without success
• You are gaining weight without a clear reason
• You feel overly tired, anxious, or depressed

Diagnosis

A doctor will diagnose PCOS based on your symptoms, medical history, blood tests, and possibly an ultrasound. They will also rule out other conditions like thyroid problems, high prolactin, or congenital adrenal hyperplasia. You don't need to have all the features – diagnosis usually requires at least two out of three criteria: irregular ovulation or periods, high androgen levels, or polycystic ovaries on ultrasound.

Tests that may be done

• Blood tests to measure hormone levels, including androgens (testosterone), thyroid-stimulating hormone (TSH), prolactin, and sometimes fasting blood sugar and insulin.
• A pelvic ultrasound to check the size of your ovaries, the appearance of follicles, and the thickness of the uterine lining.
• A physical exam to look for signs of excess hair growth, acne, and weight distribution.

What to expect at your appointment

You may be asked to track your periods for a few months. The appointment may include a discussion about your family history. Remember that diagnosis is not a rush – sometimes you need more than one visit. Your doctor may refer you to a gynecologist, endocrinologist, or a fertility specialist depending on your needs.

Treatment

Treatment for PCOS focuses on managing symptoms and lowering your risk of long-term health problems. Your plan will depend on your symptoms and whether you want to become pregnant. Lifestyle changes are the first line, and medicines can help when needed. There's no permanent cure, but many people find their symptoms are well controlled.

Self-care at home

• Regular physical activity – aim for at least 150 minutes of moderate exercise per week.
• Following a balanced eating plan with vegetables, whole grains, and lean proteins.
• Maintaining a healthy weight – losing even 5% of your body weight can improve symptoms.
• Managing stress with mindfulness, yoga, or talking to a friend.
• Getting enough sleep (7–9 hours a night).

Medical treatments

Medical treatment depends on your specific symptoms. Common approaches include hormonal birth control (the pill, patch, or ring) to regulate cycles, reduce androgen-related symptoms, and protect the uterine lining. If you are trying to conceive, your doctor may recommend medication to stimulate ovulation, usually in the form of a pill that blocks estrogen effects. For insulin resistance, medicines that improve insulin sensitivity may be used, but these are not first-line for everyone. There are also medicines that limit the effect of androgens on hair growth and skin. Any medicine must be prescribed and monitored by a healthcare professional.

When is surgery considered?

Surgery is rarely needed. In some cases, a procedure called laparoscopic ovarian drilling may be offered – where small holes are made in the ovary to lower androgen production and restore ovulation. It is usually considered when medication hasn't helped and fertility is desired.

Living with this condition

Living with PCOS is a marathon, not a sprint. Focus on small, consistent steps: follow your treatment plan, keep up with regular appointments, and monitor any changes in your body. Don't try to change everything at once – set realistic goals.

Lifestyle tips

• Exercise regularly – even brisk walking counts.
• Try to avoid sugary drinks and highly processed foods.
• Limit alcohol and avoid smoking.
• Build a support network of people who understand.
• Take time to relax – stress can worsen symptoms.

Diet and exercise

A balanced diet is important because PCOS often goes hand in hand with insulin resistance. Try to fill half your plate with non-starchy vegetables, a quarter with lean protein, and a quarter with whole grains. Include sources of healthy fats like nuts and olive oil. Keep sugary snacks and processed carbs modest. Regular exercise, such as brisk walking, cycling, or swimming, helps your body use insulin better and improves heart health.

Mental health and emotional wellbeing

PCOS can feel overwhelming, especially when it affects your appearance or your ability to become pregnant. Many people with PCOS experience anxiety, depression, and body image struggles. It's important to acknowledge these feelings and ask for help. A counselor or therapist can support you, and talking with others who have PCOS can reduce isolation.

Prevention

Because PCOS is largely genetic, it can't be 'caught' or prevented. However, you can reduce your risk of developing complications by staying active, eating well, and maintaining a healthy weight. If you have a family history, it's wise to mention it to your doctor and monitor your health.

Screening programmes

There is no routine screening test for PCOS in the general population. Instead, doctors use a 'screening' approach by asking about your symptoms and risk factors during routine check-ups. If you have symptoms like irregular periods, unwanted hair growth, or infertility, it's important to raise them. Evaluation typically involves blood tests and an ultrasound to confirm or rule out PCOS.

Complications

If left untreated

• Higher risk of type 2 diabetes and prediabetes
• High blood pressure and unhealthy lipid levels (cholesterol)
• Endometrial (uterus lining) cancer risk, especially if periods are infrequent for a long time
• Infertility or difficulty getting pregnant
• Anxiety, depression, and low self-esteem

Long-term outlook

With good medical care and lifestyle changes, most people with PCOS can successfully manage their symptoms, reduce complications, and many can become pregnant with fertility assistance. PCOS does not go away, but it doesn't have to control your life. Your outlook improves with early and consistent care.

Find support

Local organisations

• NHS – Polycystic Ovary Syndrome ↗ · United Kingdom

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