Your Expert Guide To Polycystic Ovarian Syndrome (PCOS)
- Alex Morris
- Jun 9
- 6 min read
Polycystic ovary syndrome (PCOS) is a common condition caused by a hormonal
imbalance, and it affects far more than just your ovaries. It can lead to irregular
periods, unwanted hair growth, weight gain, acne, fertility struggles, and even
long term health risks like type 2 diabetes and heart disease.
It’s thought that somewhere between 2 and 26 in every 100 women have PCOS, according to
the Royal College of Obstetricians & Gynaecologists. But despite how common it is, many
women face long delays in getting diagnosed, and some are told their symptoms are just
“part of being a woman.”
It’s frustrating, and it shouldn’t be that way. If you’re trying to understand what’s going on with your body, you deserve clear, supportive answers.
This guide walks you through the key signs of PCOS, how it’s diagnosed, and what you
can do to take control of your health.
What is Polycystic Ovarian Syndrome?
The condition has three defining features:
1. Irregular periods occur as your ovaries aren’t releasing eggs regularly.
2. High androgen levels (male hormones, think testosterone) cause physical signs like
excess facial or body hair.
3. Polycystic ovaries simply mean your ovaries have many (poly-) fluid-filled sacs (cysts)
that surround your eggs. However, you don’t have to have ovarian cysts to have PCOS.
These changes occur due to metabolic processes, mainly how your body handles hormones
like insulin known as insulin resistance. Women with PCOS don’t respond correctly to insulin,
triggering a spike in insulin levels. High insulin levels, in turn, trigger the ovaries to produce
more androgens (e.g., testosterone).
One of the hormonal imbalances in PCOS involves luteinising hormone (LH) and follicle stimulating hormone (FSH). Usually, LH and FSH rise early in your menstrual cycle, triggering
ovulation each month.
However, in PCOS, LH levels are much higher while FSH remains low. This prevents normal
ovulation, causing irregular or absent periods.
PCOS Symptoms
These present differently from woman to woman. Look for:
Irregular periods – cycles that are too long, too short, or skipped altogether.
Excess facial or body hair – especially on the face, chest, or back.
Acne or oily skin – often stubborn and adult onset.
Thinning hair – particularly around the scalp or temples.
Weight gain – or struggling to lose weight despite efforts.
Difficulty getting pregnant – due to irregular ovulation.
Dark patches of skin – especially on the neck, groin, or underarms.
Low mood or mood swings – feeling down or emotionally up and down.
Fatigue – low energy levels or feeling unusually tired.
Polycystic Ovaries
Your ovaries contain follicles, undeveloped sacs that produce an egg during ovulation. In
PCOS, cysts form that contain a large number of harmless follicles (up to 8 mm in size). Unlike normal follicles, these sacs cannot release an egg.
What Causes Polycystic Ovarian Syndrome?
The exact cause of PCOS is unknown. The condition often runs in families, implying that it’s in your genes. However, there isn’t a clear pattern of inheritance. Here are the potential culprits:
Genetics
People with a close relative who has PCOS are more likely to develop it themselves. But it’s not that simple. Unlike other conditions, where the responsible genes are clear, in PCOS there are likely many different genes involved. That means inheritance isn’t as simple as getting it from your mother or father.
Insulin Resistance
Insulin resistance is one of the most common features of PCOS, affecting up to 70% of
women with the condition.
Insulin is usually produced by the pancreas. This hormone is responsible for lowering blood
sugars, especially after a meal. In some people, the body’s cells don’t respond to insulin
adequately, causing the pancreas to pump out higher levels. Extra insulin then causes male
hormone release.
Precisely why insulin resistance occurs is a mystery. However, insulin resistance is present in
people with obesity or type 2 diabetes.
Inflammation
Inflammation is both good and bad.
In the short term, it’s a critical response to injuries and infection, helping your body fight off nasty invaders. But if inflammation persists for long periods, it can begin to harm and degrade the body.
Women with PCOS often have higher levels of inflammation in their bodies. This might be
connected to being overweight or obese, this has yet to be confirmed.
How Is PCOS Diagnosed?
There’s no single test for PCOS. Instead, doctors look at a combination of symptoms, hormone levels, and scan results.
As mentioned earlier, a diagnosis typically involves at least two out of the three main
features: irregular periods, high androgen levels, or polycystic ovaries on an ultrasound.
To build a full picture, your doctor may also:
Run blood tests. Either to check hormone levels (especially testosterone or other androgens) or to assess your insulin, cholesterol, and blood sugar, since PCOS can increase the risk of type 2 diabetes and heart disease.
Perform a pelvic exam. A physical check of your reproductive organs to feel for any abnormalities or signs of enlarged ovaries.
Recommend an ultrasound scan. To check your ovaries for multiple small follicles and assess the lining of your womb.
Ask about your symptoms. Including acne, excess hair growth, scalp hair thinning, changes in weight, and your menstrual history.
PCOS Treatment
Treatments for PCOS are split into two categories:
1. Diet and lifestyle
2. Medication and surgery
Diet and Lifestyle
Lifestyle plays a major role in PCOS. Women who are overweight or obese often experience
more severe symptoms.
Losing weight (even just 5% to 10% of your body weight) can significantly reduce symptoms.
Weight loss also lowers cholesterol and insulin levels and reduces the risk of diabetes and heart disease.
A low carbohydrate or low glycemic index (low GI) diet, one that gets most of its carbs from
fruits, vegetables, and whole grains, may be particularly helpful. Research suggests it
supports better menstrual regularity than a standard weight loss diet.
Exercise matters, too. Studies show that 30 minutes of moderate intensity exercise (like brisk
walking or cycling), at least three times a week, can support weight loss, improve insulin
sensitivity, and encourage regular ovulation.
Medication and Surgery
The primary medication for PCOS is the birth control pill. It suppresses natural hormone levels and provides synthetic replicas to control levels, regulate ovulation and protect against endometrial cancer (greater risk due to PCOS), and relieves PCOS symptoms.
It’s not the only medication. Others include:
Metformin is a diabetic medication that improves blood sugar levels. Alongside diet and exercise, it can restore a normal menstrual cycle.
Clomiphene is a fertility drug that helps women with PCOS get pregnant. It’s an important part of family planning.
If these treatments don’t work, surgery may be necessary. It involves making tiny holes in the
ovaries to improve fertility and restore normal ovulation. It’s a final option.
Ready to take control of your PCOS?
You don’t have to manage it alone.
Lunaire offers personalised health coaching to help you balance hormones, improve your cycle, and feel more in control, whether you’re trying to manage symptoms or prepare for pregnancy.
Book a free consultation now to talk through your personal journey.
References
1. NHS. Polycystic ovary syndrome (PCOS). Available at: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/ [Accessed May 2025].
2. NICE Clinical Knowledge Summaries. Polycystic ovary syndrome. Available at: https://cks.nice.org.uk/topics/polycystic-ovary-syndrome/ [Accessed May 2025].
3. Patient.info. Polycystic Ovary Syndrome Leaflet. Available at: https://patient.info/womens-health/polycystic-ovary-syndrome-leaflet [Accessed May 2025].
4. Hillman SC, Bryce C, Caleyachetty R, Dale J. Women’s experiences of diagnosis and management of polycystic ovary syndrome: a mixed-methods study in general practice. Br JGen Pract. 2020;70(694):e322–e329. doi:10.3399/bjgp20X708881
5. Marshall JC, Dunaif A. All women with PCOS should be treated for insulin resistance. FertilSteril. 2012;97(1):18–22. doi:10.1016/j.fertnstert.2011.11.036. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277302/
6. Melo AS, Ferriani RA, Navarro PA. Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics. 2015;70(11):765–769.doi:10.6061/clinics/2015(11)09. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642490/
7. Palomba S, de Wilde MA, Falbo A, Koster MPH, La Sala GB, Fauser BCJM. Pregnancy complications in women with polycystic ovary syndrome. Hum Reprod Update.2015;21(5):575–592. doi:10.1093/humupd/dmv029
8. Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8:41. doi:10.1186/1741-7015-8-41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909929/
9. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(12):4565–4592. doi:10.1210/jc.2013-2350. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399492/
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