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Hormones & cycles

PCOS (Polycystic Ovary Syndrome)

The most common hormonal condition in women of reproductive age — and the most misunderstood.

Typical ovaryone follicle maturesPolycystic ovarymany paused follicles

One ovary matures a single follicle each month. In PCOS many start and none takes the lead.

01

What it actually is

PCOS is a hormonal condition, not a disease of the ovaries alone. The ovaries produce a little more androgen (a hormone everyone has, in different amounts) than usual, and ovulation becomes irregular or stops altogether. That single change explains most of what you notice: unpredictable periods, acne, unwanted hair, and difficulty conceiving.

The name is misleading. The "cysts" seen on a scan are not cysts in the way most people imagine — they are small, immature follicles that started to develop and paused. They do not need to be drained or removed. You can also have PCOS with completely normal-looking ovaries on ultrasound.

Estimates vary widely depending on the criteria used, but PCOS is generally reported to affect somewhere between roughly 1 in 10 and 1 in 5 women of reproductive age. Many go years without a name for it.

Insulin runs highthe body stops listeningMore androgentestosterone risesFollicles pausenone takes the leadOvulation skippedso the period is lateThe loopit feeds itself
PCOS is a loop, not a lump. Treatment works by breaking it at whichever point is easiest for you — not by removing cysts.

For general understanding only. These are drawings, including the ultrasound view — they are built from typical measurements to explain the idea, and are not real scan images or a picture of your own baby.

02

What you might notice

  • Periods that are irregular, infrequent, or stop for months at a time
  • Acne that persists past the teenage years, often along the jaw and chin
  • Coarse hair growth on the face, chest, stomach or back
  • Thinning hair at the crown of the scalp
  • Weight gain, or difficulty losing weight despite real effort
  • Darkened, velvety patches of skin at the neck, underarms or groin
  • Difficulty conceiving, because ovulation is unpredictable
  • Mood changes, low energy, disturbed sleep

Don't wait for an appointment if…

  • No period for three months or more when you are not pregnant
  • Very heavy bleeding after a long gap between periods
  • Rapid hair growth or voice deepening over a short period
  • A new diagnosis of high blood sugar or blood pressure alongside these symptoms
03

The tests that are actually useful

Not everyone needs every test. This is what each one is for, so you know why it was ordered — or why it wasn't.

A blood testHormones, thyroid and iron — the numbers no scan can show.
An ultrasoundThe shape of the uterus, the thickness of the lining, and the follicles on each ovary.
A camera, sometimesA keyhole look inside, offered only when it would change the plan.

Not everyone needs all three. Each answers a different question — which is why a test you were not offered is often the right call.

A proper cycle historyThe single most useful diagnostic tool. How long, how often, how predictable — this frequently tells more than any blood test.
Androgen levelsTotal and free testosterone to see whether raised androgens are driving the acne and hair changes.
Thyroid function and prolactinBoth can produce PCOS-like irregular cycles and must be excluded before PCOS is diagnosed.
Blood sugar and insulinFasting glucose, HbA1c or an insulin-resistance assessment. Insulin resistance is common in PCOS and changes how it is treated.
Lipid profilePCOS is associated with longer-term metabolic risk, so a baseline matters.
Pelvic ultrasoundLooks at follicle count and ovarian volume. Helpful, but never sufficient on its own — a scan alone does not diagnose PCOS.
AMHSometimes used as an additional marker, and relevant if you are thinking about fertility.
04

Treatment, in the order it's usually tried

  1. Start simpleLifestyle, pain relief, or a tablet — whatever is least disruptive to your life.
  2. Add if neededA hormonal option or a longer course, if the first step has not settled things.
  3. A procedureDay-case surgery when medicine cannot fix the structure causing the problem.
  4. Specialist routeFertility treatment or a referral, planned with you rather than sprung on you.

You move up a rung only if the one below it has not done the job — and you can stop at any step you are happy with.

First — what moves the needle most

Targeted changes to diet, movement, sleep and insulin resistance.

Where there is excess weight, even a modest reduction can restore ovulation on its own. This is not a lecture about willpower; it is a plan built around insulin, not calories.

Cycle regulation

Combined hormonal contraception, or cyclical progesterone.

Regulates bleeding, protects the lining of the uterus over the long term, and improves acne and hair symptoms. Chosen only if you are not currently trying to conceive.

Insulin resistance

Metformin, alongside the lifestyle plan.

Used where insulin resistance is demonstrated, not reflexively for everyone.

Skin and hair

Anti-androgen medication, topical treatment, and dermatological options.

These take months, not weeks. Expectations are set honestly at the start.

When you are trying to conceive

Ovulation induction — commonly letrozole — with follicular monitoring.

Most women with PCOS ovulate and conceive with straightforward induction. IVF is not the starting point.

Selected surgical cases

Laparoscopic ovarian drilling.

Reserved for specific situations where medication has not produced ovulation, and discussed carefully before it is offered.

05

What you were probably told that isn't true

The cysts need to be surgically removed.
They are immature follicles, not surgical cysts. Removing them is not the treatment and can damage ovarian reserve.
PCOS means you cannot get pregnant.
PCOS makes ovulation unpredictable, not impossible. Many women conceive naturally, and many more with simple ovulation induction.
It only happens if you are overweight.
Lean PCOS is well recognised. Weight influences severity for some women; it is not the cause.
It goes away after you have a baby.
PCOS is a long-term condition. Symptoms shift over the years, and it stays worth managing well past the years you are planning a family.
Next step

Bring this to someone who has time.

A 25–40 minute consultation, on video, with a doctor who will explain what applies to you specifically — and what doesn't.

This page is general information, not medical advice. Nothing here can diagnose you or replace an assessment of your own history, examination and results. If something here matches what you are experiencing, the next step is a consultation — not a conclusion. If you are in severe pain, bleeding heavily, or feel unwell, seek urgent care rather than waiting for an appointment. Awaiting final clinical review before publication.