What is PCOS?

What Is PCOS? (Polycystic Ovary Syndrome)

Polycystic Ovary Syndrome (PCOS) is a common but complex hormonal and metabolic condition that affects how the ovaries function.

It’s estimated to affect 1 in 10 women and people assigned female at birth (AFAB) worldwide, though many remain undiagnosed or misdiagnosed for years.

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Core Features

PCOS is diagnosed when at least two of the following three criteria (known as the Rotterdam Criteria) are present:

1. Irregular or absent ovulation – leading to irregular, infrequent or absent periods.
2. Excess androgens (male-type hormones) – seen as elevated levels on blood tests or physical signs such as acne, excess hair growth (hirsutism), or scalp hair thinning.
3. Polycystic ovaries on ultrasound – showing many small follicles (immature eggs) around the edge of the ovary, giving a “string of pearls” appearance.

⚠️ Important: The presence of “cysts” on the ovaries does not mean you have cysts that need removal — they are actually small follicles that haven’t matured for ovulation.

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Underlying Causes

The exact cause of PCOS isn’t fully understood, but it’s thought to be multifactorial — involving genetics, hormones, and environment.

Common contributing factors include:

• Insulin resistance – where the body’s cells don’t respond properly to insulin, leading to higher insulin levels, which can trigger excess androgen production.
• Hormonal imbalance – elevated luteinising hormone (LH), low or normal follicle-stimulating hormone (FSH), and high androgens.
• Genetic predisposition – PCOS tends to run in families.
• Inflammation and metabolic factors – chronic low-grade inflammation may contribute to the hormonal disruption seen in PCOS.

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Symptoms and Signs

Symptoms can vary from person to person, but may include:

• Irregular, absent or heavy periods
• Difficulty conceiving (due to irregular ovulation)
• Acne and oily skin
• Excess facial or body hair (hirsutism)
• Hair thinning or loss on the scalp
• Weight gain, particularly around the abdomen
• Fatigue and low energy
• Mood changes or anxiety
• Darkened patches of skin (acanthosis nigricans), often around the neck or underarms

Not everyone with PCOS will have all symptoms — some may be lean, others overweight; some have irregular cycles, others don’t.

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Beyond Reproductive Health

PCOS is not just a reproductive condition — it affects overall health and wellbeing.

It is linked to several long-term risks, including:

• Type 2 diabetes or prediabetes (due to insulin resistance)
• High cholesterol and cardiovascular disease risk
• Sleep apnoea (especially in those with higher body weight)
• Endometrial (womb) cancer (from long-term unopposed oestrogen exposure if periods are infrequent)
• Mental health concerns, including anxiety, depression, and body image distress

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Diagnosis

Diagnosis is made through:

• Medical history and symptom assessment
• Physical examination (including signs of androgen excess)
• Blood tests to check hormone levels, glucose, and lipid profile
• Pelvic ultrasound to assess ovarian appearance

PCOS is a diagnosis of exclusion — other conditions (like thyroid disorders or high prolactin) should be ruled out first.

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Treatment and Management

There is no single cure, but PCOS can be managed effectively with a combination of lifestyle, medical, and supportive approaches, depending on symptoms and goals.

1. 

Lifestyle and Nutrition

• Balanced nutrition focused on blood sugar balance
• Regular physical activity
• Stress management and adequate sleep
• Addressing emotional wellbeing and self-image

2. 

Medical Management

Depending on the main symptoms:

• Combined oral contraceptive pill – to regulate periods and reduce androgen symptoms
• Metformin – helps with insulin resistance and cycle regulation
• Ovulation induction medications (e.g. letrozole, clomiphene) – for fertility
• Anti-androgen medications – for hair growth or acne (e.g. spironolactone)

3. 

Supportive Therapies

• Psychological or counselling support
• Specialist dietetic support
• Weight management or metabolic clinics if needed

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PCOS and Fertility

Many people with PCOS worry about infertility — but most can conceive, naturally or with help.

Ovulation issues are common, but with treatment and tailored support, outcomes are very good.

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Living with PCOS

PCOS is a lifelong condition, but symptoms can change over time and be influenced by weight, stress, pregnancy, and menopause.

Support, education, and advocacy — like through Cysterapp — are vital for improving quality of life and ensuring women are heard, believed, and empowered in their care journey.

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References (for credibility)

• NICE Guideline NG233: Polycystic Ovary Syndrome: Diagnosis and Management (2023)
• NHS UK – Polycystic Ovary Syndrome overview
• Teede HJ et al. (2018) International Evidence-Based Guideline for the Assessment and Management of PCOS
• Legro RS, et al. (2020) NEJM Review on PCOS Pathophysiology