PCOS

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PCOS (Polycystic Ovary Syndrome): symptoms, diagnosis, and treatment (UK guide)

Polycystic ovary syndrome (PCOS) is a common hormonal condition that can affect your periods, skin, hair growth, weight, and fertility. The name is confusing: you can have PCOS **without** “cysts”, and the condition is bigger than what an ultrasound shows.

What PCOS is (and what it isn’t)

PCOS is usually a mix of:

*Irregular or absent ovulation* (which can cause irregular periods and difficulty conceiving)
*Higher androgen levels* (male-type hormones) leading to acne, unwanted hair growth, or scalp hair thinning
*Polycystic-appearing ovaries* on ultrasound (many small follicles)

It isn’t:

A single “cyst” that needs removing
Something that only happens to people who are overweight
A condition you can diagnose by symptoms alone (other causes need ruling out)

Common symptoms

Many people have only a few symptoms. Typical signs include:

Irregular periods (long gaps, missed periods, or unpredictable cycles)
Acne or oily skin that persists beyond the teenage years
Excess facial/body hair (hirsutism)
Thinning scalp hair (female-pattern hair loss)
Weight gain or difficulty losing weight (not everyone has this)
Darkened skin patches (often around the neck/armpits) which can suggest insulin resistance
Fertility issues related to irregular ovulation

*Less obvious signs*

Low mood, anxiety, or reduced self-esteem (often linked to symptoms and chronic stress)
Snoring or daytime sleepiness (possible sleep apnoea risk is higher in some people)
Pelvic discomfort is *not* a classic PCOS symptom—persistent pelvic pain needs a separate check-up

What causes PCOS?

There’s no single cause. Most evidence points to a combination of:

*Insulin resistance* (your body needs more insulin to manage blood sugar; higher insulin can drive higher androgens)
*Genetics/family history* (PCOS often runs in families)
*Body weight and fat distribution* can worsen insulin resistance for some people, but PCOS also affects people in smaller bodies

How PCOS is diagnosed in the UK

Diagnosis is usually based on symptoms, exam, and tests. Your clinician may check for:

*Menstrual pattern* (how often you bleed)
*Signs of high androgens* (acne, hirsutism, hair thinning)
*Blood tests* (often include androgens; and tests to rule out other causes)
*Ultrasound* (sometimes used, but not always necessary)

*What else should be ruled out?*

Because several conditions can mimic PCOS, clinicians may rule out things like thyroid disorders, high prolactin, and other hormonal conditions. This is one reason self-diagnosis isn’t enough.

Treatment: what actually helps

Treatment depends on your main goal: symptom control, cycle regulation, metabolic health, or pregnancy.

Lifestyle foundations (worth doing even if you use medication)

You do *not* need a perfect diet. Focus on changes you can sustain:

*Movement:* aim for a mix of cardio and strength training across the week
*Food:* prioritise fibre, protein, and minimally processed foods; reduce sugary drinks and ultra-processed snacks
*Sleep and stress:* poor sleep and chronic stress can worsen appetite regulation and insulin resistance
*Weight loss (if needed and desired):* even modest loss can help ovulation in some people, but weight is not the only target—symptom improvement matters too

Medications and medical options

If you’re not trying to get pregnant

Options are chosen based on symptoms:

*Combined hormonal contraception* (pill/patch/ring): helps regulate bleeding and reduces androgen-related symptoms for many
*Anti-androgen medicines* may be considered for troublesome hair growth/acne in some cases (usually alongside reliable contraception because of pregnancy risks)
*Acne treatments* (topical or prescription) may help; severe acne may need dermatology input

*Metformin*

Metformin can improve insulin resistance and may help with weight, cycle regularity, or ovulation for some people. In the UK it’s sometimes used for PCOS, but whether it’s “licensed” for PCOS can vary—your prescriber will explain why it’s recommended in your situation.
Woman discussing PCOS treatment plan with a GP in a UK clinic

PCOS and fertility: trying to conceive

Many people with PCOS conceive naturally, but it can take longer if you’re not ovulating regularly.

Practical steps:

Track cycles and ovulation (apps are imperfect; consider ovulation predictor kits, and discuss timing with a clinician)
Consider a preconception check (folic acid, weight, smoking, alcohol, long-term conditions)
Seek help sooner if you have very infrequent periods, are over 35, or have been trying for 6–12 months depending on age and history

Ovulation induction

If lifestyle measures aren’t enough, clinicians may suggest medicines to trigger ovulation.

**Letrozole** is commonly used for ovulation induction in PCOS (often considered first-line in many guidelines), but prescribing practices can vary by service.
**Clomifene citrate** may also be used in some pathways.

Your fertility team will decide what fits your situation and local guidance.

Long-term health risks (and how to lower them)

PCOS is linked with higher risk of:

Type 2 diabetes and gestational diabetes
Higher cholesterol and blood pressure in some people
Endometrial problems (risk can rise if you go long stretches without bleeding)

Ways to reduce risk:

Keep up regular activity and a balanced diet
Ask your GP about checks for blood pressure, cholesterol, and blood sugar based on your risk factors
If you have very infrequent periods, discuss safe ways to protect the lining of the womb (endometrium)

When to see a GP (and red flags)

Book a GP appointment if you have:

Irregular or absent periods for several months
New or worsening acne/hair growth, or scalp hair thinning
Difficulty conceiving
Rapid weight changes, symptoms of high blood sugar, or dark skin patches

Seek urgent medical advice if you have:

Very heavy bleeding (soaking pads every hour), dizziness/fainting, or severe pain
Sudden severe pelvic pain (especially with fever, vomiting, or feeling unwell)
Signs of pregnancy complications (severe one-sided pain, shoulder tip pain, heavy bleeding)

FAQs

1) Can you have PCOS without ovarian cysts?

Yes. Many people meet PCOS criteria based on ovulation problems and/or raised androgens even if the ovaries look normal on scan.

2) Can you have PCOS if you’re not overweight?

Yes. Weight can influence symptoms, but PCOS affects people across body sizes.

3) Does PCOS go away?

There isn’t a “cure”, but symptoms can improve a lot with the right combination of lifestyle changes and (if needed) medication.

4) Is “tired ovaries” the same thing as PCOS?

In some languages, PCOS has been described with terms that imply the ovaries are “lazy”. Clinically, PCOS is the recognised medical condition; the key issue is irregular ovulation and hormone imbalance.

5) What tests should I ask my GP for?

Ask about hormone blood tests (including androgens), and checks to rule out other causes of irregular periods (such as thyroid and prolactin tests). Depending on your situation, an ultrasound and metabolic checks may be discussed.

6) Will the pill make PCOS worse?

For many people, combined hormonal contraception improves bleeding patterns and androgen-related symptoms. Symptoms can return after stopping, which can feel like it “worsened”, but it’s usually the underlying PCOS reappearing.

7) What’s the best diet for PCOS?

There isn’t one perfect diet. A pattern that’s higher in fibre and protein, with fewer ultra-processed foods and sugary drinks, is a sensible starting point.

8) Is metformin safe?

It’s widely used for insulin resistance and diabetes. For PCOS, your clinician weighs benefits and side effects (often stomach upset at the start) and monitors you as needed.