Polycystic ovarian syndrome (PCOS) is one of the most common hormonal conditions affecting women of reproductive age. It is also one of the most misunderstood — the name suggests the problem is "cysts" on the ovaries, when in fact PCOS is a hormonal and metabolic imbalance that happens to show a particular pattern on an ultrasound.
If you have been told you might have PCOS, or you are struggling with irregular periods, weight that is hard to shift, or unwanted hair growth, this guide explains what is actually going on and what can be done about it.
What is PCOS?
PCOS is a condition in which the ovaries produce higher-than-usual levels of androgens ("male" hormones that all women have in small amounts). This disrupts the normal monthly release of an egg. Instead of one follicle maturing and releasing an egg, several small follicles remain partly developed — the "polycystic" appearance seen on a scan.
Two things sit underneath most cases: a hormonal imbalance and, very often, insulin resistance, where the body has to produce extra insulin to keep blood sugar normal. The extra insulin in turn drives the ovaries to make more androgens, which is why weight and diet play such a central role.
Common symptoms
PCOS looks different from one woman to the next. The most frequent signs are:
- Irregular, infrequent or absent periods — often the first clue
- Difficulty losing weight, or weight gain around the abdomen
- Excess hair growth (hirsutism) on the face, chest or back
- Acne or oily skin that persists beyond the teenage years
- Thinning hair on the scalp
- Difficulty conceiving
You do not need every symptom to have PCOS. Many women have just two or three.
How PCOS is diagnosed
There is no single test for PCOS. Internationally, a diagnosis is made when at least two of the following three features are present, and other conditions have been excluded:
- Irregular or absent ovulation (reflected in the menstrual pattern)
- Signs of excess androgens — either on examination or on blood tests
- Polycystic ovaries on ultrasound
Because two of those three can be established from your history, an examination and blood tests, a scan supports the diagnosis but is not always essential. Your gynaecologist will usually also check thyroid function and other hormones to rule out conditions that can mimic PCOS.
Treatment: what actually helps
Treatment is tailored to what matters most to you right now — regular cycles, skin and hair, or fertility.
Lifestyle first. Even a modest reduction in weight (5–10%) can restore regular periods and improve insulin sensitivity. A diet lower in refined carbohydrates, combined with regular activity, is the single most effective long-term step for most women.
Regulating periods. Where cycles are very irregular, a gynaecologist may recommend hormonal treatment to protect the lining of the uterus and bring predictability back to your cycle.
Managing skin and hair. Specific medical treatments can reduce androgen-driven acne and unwanted hair growth over several months.
Supporting fertility. If you are trying to conceive, ovulation-support treatment is highly effective for many women with PCOS, and is planned and monitored by your gynaecologist.
When to see a gynaecologist
Book a consultation if your periods are consistently irregular, if you have troubling skin or hair changes, or if you have been trying to conceive for several months without success. PCOS is very manageable, but the earlier it is addressed, the easier it is to keep symptoms — and the long-term metabolic risks — under control.