Polycystic ovary syndrome, or PCOS, is one of the most common hormonal conditions in women of reproductive age. It can affect periods, fertility, skin, hair, weight and long-term metabolic health. Despite how common it is, many women wait years for a diagnosis. This guide explains the signs, how PCOS is diagnosed and the treatments that help.
What is PCOS?
PCOS is a condition in which the ovaries and hormone system do not work in the usual way. Women with PCOS often have:
- Irregular or absent ovulation, which leads to irregular periods
- Higher levels of androgens, sometimes called “male” hormones, which all women have in small amounts
- Insulin resistance, where the body needs extra insulin to keep blood sugar normal
The name is a little misleading. The “cysts” are actually many small, immature follicles that have not released an egg. Not everyone with PCOS has them, and having them does not by itself mean you have PCOS.
The World Health Organization estimates that PCOS affects 10% to 13% of women of reproductive age, and that up to 70% of those affected are undiagnosed.
Common symptoms
Symptoms vary widely from person to person and can change over time.
- Irregular periods: cycles longer than 35 days, fewer than eight periods a year, or no periods at all
- Excess hair growth (hirsutism): on the face, chin, chest, abdomen or back
- Acne that persists past the teenage years or is hard to treat
- Thinning hair on the scalp
- Weight gain or difficulty losing weight, especially around the waist
- Darkened, velvety skin in body folds such as the neck or underarms
- Difficulty getting pregnant because of irregular ovulation
Not every woman with PCOS is overweight, and PCOS can occur at any body size.
What causes PCOS?
The exact cause is not fully understood. Contributing factors include:
- Genetics: PCOS often runs in families.
- Insulin resistance: high insulin levels can prompt the ovaries to make more androgens.
- Hormone signaling: changes in signals between the brain and ovaries affect ovulation.
- Low-grade inflammation, which is often seen in PCOS.
How PCOS is diagnosed
There is no single test for PCOS. Most clinicians use the Rotterdam criteria, which require at least two of these three features, once other causes have been ruled out:
- Irregular or absent ovulation, usually shown by irregular periods
- Signs of high androgens, either on a blood test or as symptoms like excess hair growth or acne
- Polycystic-appearing ovaries on ultrasound, or a high anti-Müllerian hormone (AMH) level in adults
Your clinician may order:
Keep reading
The rest of this guide is free. Watch a short ad to unlock it and support independent health writing.
Preparing your ad…
- Blood tests for androgens (such as testosterone), thyroid function, prolactin and other hormones to exclude conditions that mimic PCOS
- Blood sugar tests (A1C or a glucose tolerance test) and a cholesterol panel
- A pelvic ultrasound in some cases
In teenagers, diagnosis is more cautious because irregular periods and acne can be normal in the first years after periods start.
Long-term health risks
PCOS is more than a reproductive condition. It is linked with a higher risk of:
- Prediabetes and type 2 diabetes
- Gestational diabetes during pregnancy
- High blood pressure and unhealthy cholesterol levels
- Obstructive sleep apnea
- Thickening of the uterine lining (endometrial hyperplasia) and endometrial cancer when periods are very infrequent
- Depression and anxiety
Regular check-ups help catch these problems early.
Treatment options
There is no cure for PCOS, but symptoms can be managed well. Treatment depends on your symptoms and whether you are trying to get pregnant.
Lifestyle changes
Healthy eating, regular physical activity and good sleep improve insulin sensitivity and can make periods more regular. For women with overweight, losing even 5% to 10% of body weight can improve symptoms and ovulation.
Medicines to regulate periods and reduce androgen symptoms
- Combined hormonal birth control (pill, patch or ring) can regulate periods, protect the uterine lining and reduce acne and unwanted hair.
- Progestin therapy taken for part of each cycle, or a hormonal IUD, can protect the uterine lining.
- Anti-androgen medicines such as spironolactone may be added for hair growth or acne. They must not be used during pregnancy, so effective contraception is needed.
- Metformin may improve insulin resistance and cycle regularity for some women.
Treatments for excess hair
Besides medicine, options include shaving, waxing, prescription creams, laser hair removal and electrolysis.
Help with fertility
Many women with PCOS can get pregnant. Options include:
- Letrozole, which is often the first-choice medicine to trigger ovulation
- Clomiphene citrate
- Gonadotropin injections
- In vitro fertilization (IVF) if other treatments are not successful
A fertility specialist can guide you through these choices.
Living well with PCOS
- Keep track of your periods with a calendar or app.
- Get screened regularly for diabetes, blood pressure and cholesterol.
- Seek support for mood changes; they are common and treatable.
- Ask your clinician about a personalized plan rather than a one-size-fits-all approach.
Frequently asked questions
Can you have PCOS with regular periods?
Yes. Some women have high androgens and polycystic ovaries on ultrasound but still have regular cycles. They may meet the criteria for PCOS.
Does PCOS go away after menopause?
Periods stop at menopause, but metabolic risks such as diabetes and heart disease can continue, so ongoing health checks remain important.
Can PCOS be prevented?
There is no known way to prevent PCOS, but healthy habits can reduce symptoms and lower the risk of complications.
The bottom line
PCOS is common, varied and very manageable. If you have irregular periods, unwanted hair growth, persistent acne or trouble getting pregnant, talk to a healthcare professional. Early diagnosis helps protect both your fertility and your long-term health.
This article is for general information and is not a substitute for advice from a qualified healthcare professional.