Polycystic ovary syndrome (PCOS) is a common hormonal condition. The World Health Organization estimates it affects 10 to 13% of women of reproductive age, and many do not know they have it. PCOS can make ovulation irregular, but many people with PCOS do become pregnant, sometimes with help.
What is PCOS?
PCOS is a hormonal condition linked to higher levels of androgens (hormones such as testosterone) and to insulin not working as well as it should. The exact cause is not known, but it often runs in families.
The name can be confusing. The small 'cysts' seen on scans are follicles, tiny fluid sacs that hold eggs which have not been released. Some people with PCOS do not have polycystic-looking ovaries at all.
Common signs and symptoms
Symptoms vary a lot from person to person. You may notice:
- Irregular periods, long gaps between periods, or no periods
- Difficulty getting pregnant because eggs are not released regularly
- Extra hair on the face or body, or thinning hair on the head
- Acne or oily skin
- Weight gain, tiredness or darker patches of skin
- Low mood or anxiety, which are common and worth mentioning to your doctor
PCOS is also linked to a higher risk of type 2 diabetes, high blood pressure and heart disease, so long-term check-ups matter even when you are not trying to conceive.
How PCOS is diagnosed
There is no single test for PCOS. Doctors commonly use the Rotterdam criteria: PCOS is diagnosed when at least two of these three are present, after other causes are ruled out.
| Criterion | How it is checked |
|---|---|
| Irregular or absent periods | Your menstrual history |
| Signs or blood levels of excess androgens | Examination and blood tests |
| Polycystic-appearing ovaries | Pelvic ultrasound |
Your doctor may also check blood sugar and other hormones. The NHS notes that ovary scans are generally used for adults over 18.
How PCOS affects fertility
To conceive, an egg must be released (ovulation). With PCOS, ovulation may happen rarely or not at all, so there are fewer chances each year to get pregnant. WHO describes PCOS as the most common cause of anovulation.
Having PCOS does not mean you cannot get pregnant. Many people conceive once ovulation is supported. Pregnancy may need closer monitoring.
Living with PCOS day to day
If you are not trying to conceive right now, treatment focuses on your symptoms. The NHS lists hormonal contraceptives to make periods more regular, and medicines such as spironolactone or eflornithine cream to reduce unwanted hair.
WHO notes that PCOS can affect emotional wellbeing, with higher rates of anxiety and depression, partly because of stigma about weight, skin and fertility. Talking to someone you trust, or to a counsellor, is a healthy step.
Because PCOS is linked to diabetes, heart disease and endometrial cancer, regular check-ups of weight, blood pressure and blood sugar are worthwhile at every stage of life.
Treatment options when trying to conceive
There is no cure for PCOS, but symptoms and fertility can be helped. Your doctor will tailor a plan; a typical path looks like this:
- Lifestyle firstBalanced eating, regular exercise and a weight that is healthy for you can improve insulin levels and, for some, periods.
- Ovulation tabletsLetrozole or clomiphene help the ovaries release an egg. Your doctor monitors response, often with ultrasound.
- Metformin in some casesThis diabetes medicine helps the body use insulin; once insulin control improves, some people see more regular cycles.
- Injections or surgeryInjectable hormones (gonadotropins) or laparoscopic ovarian drilling may be considered if tablets do not work.
- IVFIn vitro fertilisation is an option when other treatments have not worked or other fertility factors are present.
- Track your periods and share the record with your doctor
- Choose movement you enjoy and can keep up
- Ask for blood sugar and blood pressure checks
- Take fertility medicines without medical monitoring
- Blame yourself; PCOS is a medical condition
- Try extreme diets that are hard to sustain
An ultrasound and hormone tests help your doctor see how your ovaries are working before choosing a treatment.
Pregnancy and long-term health
PCOS is very common. Cleveland Clinic says up to 15% of women of reproductive age have it, and that 40–80% of people with PCOS live with obesity, which can make symptoms harder to manage.
| Stage | Risks to discuss with your doctor |
|---|---|
| During pregnancy | Gestational diabetes, pre-eclampsia, high blood pressure, preterm birth, caesarean birth |
| Long term | Type 2 diabetes, high blood pressure, heart disease, fatty liver, womb cancer, sleep apnoea, depression |
- Ask for regular checks of blood sugar and blood pressure, even before pregnancy.
- Mention PCOS at your first antenatal visit so extra monitoring can be planned.
- Look after your mood too; anxiety and low mood are part of PCOS for many people.
Questions to ask at your visit:
- Do my blood tests show signs of insulin resistance or high androgens?
- Is tablet treatment such as letrozole or clomifene right for me, and how will ovulation be checked?
- When would injections, ovarian drilling or IVF be considered?
- How often should my blood sugar and blood pressure be checked?
Some UK sources now use a new name, polyendocrine metabolic ovarian syndrome (PMOS). It is the same condition you may know as PCOS.
When to see a doctor
- Your periods are irregular, very far apart or have stopped
- You have tried for 12 months if under 35, for 6 months if 35–39, or for less than 6 months if 40 or older
- You have been trying to conceive for some time without success
- You notice increasing facial or body hair, acne or hair thinning
- You already know you have PCOS and plan to get pregnant
Questions & answers
Can I get pregnant naturally with PCOS?
Yes, many people do, especially if they still ovulate sometimes. If ovulation is rare, treatment to support it can help.
Do I have PCOS if a scan shows many follicles?
Not necessarily. A scan is only one of three criteria, and diagnosis needs at least two plus ruling out other causes.
Will PCOS go away?
There is no cure, but symptoms can be managed well with lifestyle measures and treatment.
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Sources
- Polycystic ovary syndrome fact sheet — World Health Organization
- Polycystic ovary syndrome (PCOS) — NHS
- Polycystic Ovary Syndrome (PCOS) — Cleveland Clinic
- Infertility: causes, diagnosis & treatment — Cleveland Clinic