Polycystic Ovary Syndrome (PCOS)
A common hormonal disorder with irregular periods, androgen excess and metabolic features.
Overview
PCOS is the most common endocrine disorder of reproductive-age women. Diagnosis (Rotterdam criteria) requires two of: oligo/anovulation, clinical or biochemical hyperandrogenism, polycystic ovaries on ultrasound. It carries long-term cardiometabolic and reproductive risks.
Symptoms
- • Irregular or absent periods
- • Hirsutism, acne, scalp hair thinning
- • Difficulty conceiving
- • Weight gain or difficulty losing weight
- • Insulin resistance — acanthosis nigricans
- • Mood symptoms
Risk factors
- • Family history of PCOS or type 2 diabetes
- • Obesity
- • South Asian ancestry (more metabolic features)
Causes
- • Insulin resistance driving ovarian androgen production
- • Strong genetic component
- • Excess weight amplifies the syndrome
🚨 Red flags — seek urgent care
- • Sudden severe pelvic pain — consider ovarian torsion (rare without enlarged ovaries)
- • Postmenopausal bleeding or prolonged amenorrhoea with new bleeding — assess endometrium
- • Rapid virilisation — consider androgen-secreting tumour
When to seek care
- • Irregular cycles or difficulty conceiving
- • Distressing acne or hirsutism
- • Symptoms suggesting diabetes
Diagnosis
- • Rotterdam criteria (≥2 of 3): irregular cycles, hyperandrogenism, polycystic ovaries
- • Bloods: testosterone, SHBG, LH/FSH, prolactin, TSH, 17-OHP to exclude mimics
- • HbA1c or oral glucose tolerance test
- • Lipids, BP, weight, mental-health screen
Treatment
- • Lifestyle: weight loss, balanced diet, regular exercise — improves all features
- • Combined oral contraceptive for cycle regulation, acne and hirsutism
- • Metformin for insulin resistance, especially with impaired glucose tolerance
- • Anti-androgens (spironolactone) for hirsutism
- • Letrozole or clomifene for ovulation induction; gonadotrophins or IVF if needed
- • Endometrial protection in prolonged amenorrhoea
Prevention
- • Healthy weight and regular activity from adolescence
- • Screen and treat metabolic complications early
Complications
- • Type 2 diabetes and metabolic syndrome
- • Cardiovascular disease
- • Subfertility
- • Endometrial hyperplasia and cancer
- • Sleep apnoea, NAFLD
- • Depression and anxiety
Prognosis
PCOS is a lifelong condition but symptoms can be controlled and fertility is usually preserved with treatment. Long-term cardiometabolic surveillance is essential.
Education & self-care
PCOS is common and treatable. Weight, lifestyle and targeted medication control symptoms; long-term cardiometabolic monitoring is essential.
Frequently asked questions
Can I still get pregnant?
Yes — most women with PCOS conceive, often with weight optimisation and ovulation induction.
Do I have to take the pill?
Hormonal contraception is one option but not the only one. Metformin, anti-androgens and lifestyle measures also help.
Can I get pregnant with PCOS?
Yes — most women with PCOS conceive, although it may take longer. Weight optimisation, ovulation induction (letrozole, clomiphene) and IVF are effective treatments for PCOS-related infertility.
Does PCOS increase diabetes risk?
Yes. Insulin resistance is central to PCOS, and lifetime risk of type 2 diabetes is roughly doubled. Annual HbA1c or oral glucose tolerance testing is recommended.
How is unwanted hair best treated?
Combined oral contraceptives, anti-androgens (spironolactone) and topical eflornithine reduce growth over months. Laser hair removal addresses the cosmetic impact while medical treatment works.