PCOS symptoms risks and benefits for patients

Overview

Polycystic ovary syndrome (PCOS) is a common hormonal condition that affects how the ovaries work. It is called 'polycystic' because many people with the condition have a large number of small fluid-filled sacs (follicles) in the ovaries, which are not actually cysts. The condition causes irregular periods, excess male hormones (androgens), and can affect the whole body's metabolism.

Yes. About 1 in 10 women and people assigned female at birth of childbearing age have PCOS. It is the most common hormonal disorder of this age group.

PCOS usually starts during the teen years or early twenties. It affects anyone with ovaries, including transgender men and non-binary people. This article uses 'women' for convenience, but the information applies to anyone born with ovaries. PCOS occurs across all ethnic groups and body sizes.

Symptoms

Common symptoms

• Irregular, missed, or very heavy periods
• Excess facial or body hair (often on the chin, chest, or back)
• Acne, oily skin, or dandruff
• Weight gain or difficulty losing weight
• Thinning hair on the scalp
• Dark, velvety patches of skin, often on the neck or under the breasts

Symptoms in children

• In teenagers, PCOS can look like the normal changes of puberty — irregular periods, acne, and body changes. This can make it hard to diagnose. Key warning signs include periods that never become regular within two years of starting, severe acne, or weight gain that never improves.

Symptoms in older adults

• After menopause, periods stop, but many of the hormonal and metabolic issues continue. Older adults with PCOS face a higher long-term risk of type 2 diabetes, high blood pressure, and heart disease. Excess hair growth and scalp thinning may also persist.

Causes

Main causes

• The exact cause is not fully understood, but PCOS often runs in families, suggesting a genetic link.
• Most people with PCOS have higher-than-normal levels of androgens (male-type hormones), which interfere with ovulation and cause skin and hair symptoms.
• Insulin resistance is common in PCOS: the body needs more insulin to manage sugar, and the extra insulin can prompt the ovaries to make more androgens.

Risk factors

• Family history of PCOS (mother, sister, or aunt)
• Obesity — although people at a healthy weight can also have PCOS
• Certain genetic variations and possibly environmental factors, though these are still being studied

When to see a doctor

See a doctor urgently if:

• Severe pelvic pain or pain that comes on suddenly
• Very heavy bleeding that soaks through a pad or tampon every hour
• Signs of diabetes such as extreme thirst, frequent urination, or unexplained weight loss

Book a routine appointment if:

• Periods that are irregular, two or more months apart, or absent for several months
• Trouble getting pregnant
• Persistent acne or unwanted hair growth
• Weight gain that is difficult to control, especially if you also have other symptoms

Diagnosis

Doctors diagnose PCOS based on three possible features: irregular ovulation or no ovulation (leading to irregular periods), higher-than-normal androgen levels (either symptoms or blood tests), and polycystic ovaries seen on ultrasound. You need at least two of these three, after other conditions such as thyroid problems or raised prolactin have been ruled out.

Tests that may be done

• Blood tests to check hormone levels, including testosterone, LH and FSH, thyroid function, and prolactin
• Blood sugar and insulin tests to check for insulin resistance or diabetes
• A pelvic ultrasound to look at the size and structure of your ovaries
• Blood pressure check and a lipid (cholesterol) panel

What to expect at your appointment

The diagnostic process may involve your GP, a gynaecologist, or an endocrinologist. Be ready to talk about your periods, weight changes, skin issues, and any pregnancy plans. Write down your symptoms beforehand — this makes it easier for the doctor to help. You may also be asked about your emotional health, as PCOS can affect mood.

Treatment

Treatment for PCOS is based on your personal goals. If you want to regulate periods and improve skin or hair symptoms, hormonal contraceptives are often the first choice. If you are trying to conceive, different medicines are used to encourage ovulation. If you have insulin resistance, medicines that help the body use insulin better can be added. Lifestyle change — especially weight loss and exercise — helps every type of PCOS. There is no single cure, but most symptoms can be managed well.

Self-care at home

• Aim for at least 150 minutes of moderate exercise per week, like brisk walking or cycling
• Eat a balanced diet with plenty of vegetables, whole grains, legumes, and lean protein; reduce sugary drinks and refined carbohydrates
• If you are overweight, try to lose 5–10% of your starting weight over 6 months — this can bring back regular periods
• Get enough sleep — poor sleep worsens insulin resistance
• Reduce stress with mindfulness, meditation, or time with friends and family

Medical treatments

Your doctor may offer a hormonal contraceptive (the pill, patch, or vaginal ring) to regulate periods and reduce androgen effects. Medications that improve insulin sensitivity are sometimes prescribed, especially when blood sugar is affected. If you are trying to get pregnant, ovulation-inducing medicines are available. Certain treatments are not suitable during pregnancy, so always tell your doctor if you are planning a baby. Your healthcare team will explain all options in detail.

When is surgery considered?

Surgery is rarely needed. A procedure called laparoscopic ovarian drilling — where small holes are made in the ovary to reduce androgen levels — is occasionally used if ovulation medicines do not work. It is much less common than in the past and is not a first-line treatment.

Living with this condition

Living with PCOS is a marathon, not a sprint. Build a routine around healthy eating, regular movement, and good sleep. Keep track of your periods and any symptoms in a diary — it helps when you see your doctor. Be patient: improvements often take weeks or months, not days.

Lifestyle tips

• Set small, realistic goals — like walking 10 minutes after dinner or replacing one sugary drink with water
• Join a PCOS support group to share experiences with others who truly understand
• Have regular check-ups for blood pressure, cholesterol, and blood sugar (even if you feel fine)
• Protect your mental health — consider talking to a counsellor if you feel overwhelmed

Diet and exercise

A PCOS-friendly diet is not a strict 'diet' — it is simply a balanced way of eating. Fill half your plate with vegetables, a quarter with whole grains, and a quarter with lean protein. Swap sweetened drinks for water or unsweetened tea. Include both cardio and strength training. Strength training (with light weights or resistance bands) improves insulin sensitivity and helps with weight loss. Even 30 minutes a day, five days a week, makes a difference.

Mental health and emotional wellbeing

PCOS can make you feel you are not in control of your own body. Symptoms like unwanted hair, acne, and weight gain can lower self-esteem. Fertility worries can add stress and sadness. It is completely normal to feel angry, anxious, or low at times. Please talk to your doctor if these feelings last more than a couple of weeks. Help is available. If you are ever having thoughts of harming yourself, call your local emergency number or a crisis line immediately.

Prevention

PCOS itself cannot be prevented — it develops due to a mix of genes and hormones. But you can prevent, delay, or reduce the severity of many complications by keeping an eye on your health. The earlier you know you have PCOS, the sooner you can take steps such as weight management and regular screening to protect your long-term health.

Screening programmes

If you have PCOS, your doctor may recommend regular check-ups for type 2 diabetes, high blood pressure, cholesterol, and endometrial health. This usually means blood tests every 1–2 years, depending on your risk. If you have very few periods (fewer than 4 per year), your doctor may suggest using a hormonal method to shed the uterine lining and lower the risk of endometrial changes.

Complications

If left untreated

• Type 2 diabetes and pre-diabetes — 70–80% of people with PCOS have some insulin resistance
• High blood pressure and unhealthy cholesterol levels, raising heart attack and stroke risk
• Sleep apnoea — where breathing pauses during sleep — which is more common even at similar body weight
• Difficulty getting pregnant (infertility) due to irregular ovulation
• Endometrial cancer — the risk is higher if the womb lining builds up without regular shedding, which happens when periods are very absent or infrequent
• Depression and anxiety, affecting about 1 in 3 people with PCOS

Long-term outlook

A diagnosis of PCOS is not a life sentence. With the right care — mostly lifestyle support, and treatment when needed — most people manage their symptoms successfully. Fertility can be improved in the majority of cases. Long-term risks can be caught early by simple screening. Many people with PCOS go on to have healthy pregnancies, satisfying careers, and make peace with their bodies. PCOS is a challenge, but it is a manageable one.

Find support

International organisations

• Verity (PCOS support) ↗
• PCOS Challenge ↗

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