Have you ever had the feeling that your body was against you because of the irregular periods, sudden weight gain, or stubborn acne that won’t go away? You’re not alone, and you’re not imagining it. These symptoms might be your body’s way of telling you something deeper is going on: a hormonal disorder known as Polycystic Ovary Syndrome (PCOS).

Although the name may sound complex, the condition is more common than you think. Understanding how it functions can significantly impact how you feel and manage your health.

What is Polycystic Ovary Syndrome?

PCOS is a complicated hormonal condition that impacts ovarian function. It is thought to affect roughly 13% of women of reproductive age worldwide and is one of the most prevalent causes of infertility in women. Despite the widespread nature, about 70% of cases go undiagnosed.¹

At its core, PCOS is caused by a hormonal imbalance that interferes with ovulation (the regular monthly release of eggs from the ovaries). This disruption usually involves:²

• Irregular or absent menstrual periods
• Excess levels of androgens (male hormones) result in acne, oily skin, and excess facial/body hair
• Polycystic ovaries, which appear enlarged with many small, fluid-filled follicles visible on an ultrasound scan

It is called “polycystic” because many women with PCOS develop these small, fluid-filled sacs or “cysts” on their ovaries, although not everyone presents this feature, and not all ovarian cysts mean PCOS.³

PCOS doesn’t just affect the menstrual cycle or fertility; it can impact your entire body, increasing the risk of type 2 diabetes, hypertension, cardiovascular diseases, and mental health conditions.⁴ 

Causes of PCOS

The exact cause of PCOS remains unclear, but several contributing factors have been identified:

• Genetics: PCOS shows a strong familial tendency, with a higher likelihood among women whose mothers, aunts, or sisters are also affected⁵
• Insulin Resistance (IR): Common in PCOS. Many individuals have some degree of IR, which is a condition in which their cells don’t respond well to insulin. This causes the body to produce more insulin, stimulating the ovarian cells to produce more androgen⁶
• Lifestyle: Poor diet, lack of physical activity, and obesity can worsen symptoms
• Hormonal Imbalance: The primary cause is the disruption of several hormones

Understanding the hormonal imbalance in PCOS

To understand PCOS, it is helpful to know how hormones typically interact. During the normal menstrual cycle:

• Luteinising hormone (LH) and Follicle-Stimulating Hormone (FSH) coordinate the development and release of an egg
• Oestrogen and progesterone maintain the uterine lining and menstruation
• Small amounts of androgens are also produced to promote ovarian function and fertility

In PCOS, this balance is disrupted:^7,8

• Androgens: Overproduced, resulting in physical manifestations such as acne and excessive hair growth
• LH: Raised, further increasing androgen production
• FSH: Insufficient to initiate egg development, resulting in anovulation (the lack of ovulation)
• Progesterone: Low due to infrequent ovulation, contributing to irregular/absent periods and potential fertility issues
• Sex Hormone-Binding Globulin (SHBG): Decreased, allowing more free testosterone to circulate in the bloodstream

Insulin resistance often makes this imbalance worse, which increases androgen production and decreases SHBG, creating a vicious cycle that perpetuates PCOS symptoms.

Signs and symptoms

PCOS looks different for everyone and can present with a wide range, which may vary in severity but typically includes:^9,10,11

Reproductive

• Irregular periods or amenorrhoea (the absence of periods)
• Anovulation (the lack of ovulation)
• Infertility or difficulty conceiving

Physical

• Hirsutism (excess facial and body hair)
• Oily skin and acne
• Excessive hair growth is present in areas where males tend to have facial hair, such as the chin, jawline, and upper neck
• Hair thinning or female-pattern baldness
• Weight gain or difficulty losing weight
• Acanthosis nigricans: dark, velvety skin patches, usually around the neck, armpits, groin, knuckles, or elbows

Psychological

• Mood swings
• Anxiety
• Depression

These symptoms can appear later in life, but they usually develop in adolescence. Since not everyone experiences every symptom, PCOS can be challenging to diagnose without medical evaluation.

How is PCOS diagnosed?

There is no single definitive test for PCOS. Clinicians use a standard called the Rotterdam criteria, which requires an individual to meet two out of the following three features to be diagnosed with PCOS:¹²

• O: Irregular or absent periods
• A: High androgen levels (detected through symptoms or blood tests)
• P: Polycystic ovaries are visible on ultrasound

Is PCOS the same for everyone?

No, PCOS is considered a spectrum disorder, meaning it can manifest in different ways. To reflect this, clinicians use the Rotterdam criteria to group PCOS into four subtypes/phenotypes (A-D):¹³

Other factors like body weight, ethnicity,¹⁴ and lifestyle also strongly influence how PCOS symptoms present and progress.

Long-term health risks

PCOS is more than a reproductive disorder; if left untreated, it can pose serious long-term health issues, including:

• Diabetes: Overweight or obese women with PCOS are eight times more likely to develop type 2 diabetes (T2D).¹⁵ Even non-obese women with PCOS have a higher risk due to IR.¹⁶ During pregnancy, there’s an increased risk of gestational diabetes¹⁷
• Cardiovascular Diseases (CVD) & Hypertension: Hormonal imbalances and metabolic disturbances increase the risk of high blood pressure, unhealthy cholesterol levels, and obesity¹⁸
• Cancer:
  • Endometrial (Uterine): Chronic anovulation leads to prolonged oestrogen exposure without the counteracting effect of progesterone, which increases the risk of abnormal uterine lining growth, subsequently the risk of endometrial hyperplasia and, eventually, cancer¹⁹
• Ovarian: Association with PCOS is less clear, but some studies suggest a slightly increased risk in women with long-standing PCOS and infertility. Contributing factors may include chronic inflammation and hormonal imbalance, which could influence ovarian tissue changes, as well as infertility medications used to induce ovulation, although the evidence remains inconclusive
• Breast: Current evidence does not show a significant increase in breast cancer risk, but it is speculated that prolonged exposure to oestrogen and obesity may play a role in this
• Sleep apnoea: Obstructive Sleep Apnoea (OSA) is more prevalent in women with PCOS, especially those who are overweight or obese²⁰
  Psychological disorders

Management and treatment

Although there is currently no cure for PCOS, it can be effectively managed with personalised approaches that combine lifestyle changes, medications, and occasionally surgery.^21,22

Lifestyle

Often, the first line of treatment, small changes, can significantly improve symptoms.

• Diet: A diet low in refined carbohydrates and sugar supports hormone balance and weight control
• Exercise: Regular physical activity improves insulin sensitivity and boosts mental health
• Weight management: For overweight or obese individuals in particular, even a 5-10% drop in body weight can improve menstrual regularity, lower androgen levels, and improve fertility outcomes

Medication

Used to target specific symptoms such as irregular periods, acne, excessive hair growth, or infertility.

• Contraceptives: Contain oestrogen and progesterone, which help regulate periods, reduce androgen levels, and treat acne and hirsutism (the growth of excessive male-pattern hair in women)
• Metformin: Commonly used for T2D, it improves insulin sensitivity, assists with weight loss, and regulates periods
• Anti-androgens, such as spironolactone, may be prescribed to block the effects of excess androgen, improve acne, and reduce hair growth
• Fertility treatments: Drugs like clomiphene citrate or letrozole can induce ovulation. In Vitro Fertilisation (IVF) may be considered when other treatments are unsuccessful

Surgical

• Laparoscopic Ovarian Drilling (LOD): A minimally invasive procedure typically considered when first-line fertility treatments are unsuccessful. During LOD, tiny holes are made in the ovary using a laser or fine needle, which reduces androgen production and triggers ovulation. While generally safe and effective, LOD carries potential risks such as scar tissue formation and a reduction in ovarian reserve, so it is usually used as a last resort

FAQs

Can I get pregnant if I have PCOS?

Although it may be more difficult, it is possible to conceive naturally with PCOS. Many women with PCOS can conceive with the help of medical assistance and lifestyle modifications.²²

Can I still have or get PCOS after menopause?

PCOS typically begins during the reproductive years, but its effects can persist after menopause. Hormonal and metabolic issues may continue even after menstruation ends. While PCOS does not newly develop after menopause, undiagnosed cases may still be identified due to lasting symptoms. Research suggests menopause may occur slightly later in those with PCOS.²³

Does PCOS cause pain?

PCOS usually doesn’t hurt much, although some women report pelvic discomfort due to enlarged ovaries or follicular development.

Summary

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that affects millions of women worldwide. It involves elevated androgens and insulin resistance, leading to reproductive, metabolic, and psychological challenges.

Though there is no cure, early diagnosis using the Rotterdam criteria and consistent management through lifestyle changes, medications, and support can greatly improve quality of life. Understanding PCOS helps individuals to take proactive control over their health, fertility, and overall well-being.