PCOS: symptoms, causes and what you can actually do about it

PCOS (polycystic ovary syndrome) is one of the most common hormonal conditions in women, affecting roughly 1 in 10 of reproductive age, and it usually shows up as irregular or missed periods, acne, and extra hair growth. It’s driven by a mix of factors, insulin resistance often chief among them, and while there’s no cure, the symptoms can be genuinely improved, first through lifestyle and, where needed, medication. This piece walks through what PCOS is, why it happens, and your realistic options. It’s here to inform you, not to diagnose you, so if this sounds like you, take it to your GP.

What PCOS actually is

PCOS stands for polycystic ovary syndrome. It’s a hormonal condition that affects the ovaries, which is why it shows up in women. The word “syndrome” is doing a lot of work here: it means a cluster of symptoms whose exact cause still isn’t fully pinned down. That’s not us being vague, it’s the honest state of the science. The precise mechanism behind how PCOS develops hasn’t been completely worked out yet.

PCOS is recognised by a set of features that tend to appear together, but not everyone has all of them, and that variation is part of what makes it tricky. One woman mainly struggles with her cycle, another with acne or unwanted hair, and someone else barely notices it at all.

The symptoms and signs

PCOS revolves around three main features, with a fourth that often tags along:

• Cycle problems. Often there’s no ovulation, so periods become irregular or stop altogether. A telltale sign is fewer than 10 periods a year, and sometimes none.
• Too much male hormone (testosterone/androgens). This can show up as acne and as hair growth in places where women normally only have fine hairs, such as the arms, legs, stomach and sometimes the face.
• Follicles on the ovaries. On an ultrasound you’ll see small follicles, sometimes described as a “string of pearls”. These are egg cells that started to mature but never actually released.
• Insulin resistance. This isn’t an official diagnostic criterion, but it often plays a big part. It’s linked to storing fat more easily, weight gain, and over time a higher risk of type 2 diabetes and heart disease.

On top of that, low mood, mood swings and anxiety are more common. Weight gain and visible hair growth can also weigh heavily on how you feel in your own body and on your day-to-day quality of life. None of that is something to just “push through” quietly.

What causes PCOS

There’s no single known cause. PCOS is multifactorial, meaning a lot of things play a part at once. That said, the picture has become clearer in recent years about where it probably goes wrong.

The core seems to sit at brain level, in the signals that control your ovaries, with insulin resistance playing a central role. When you’re insulin resistant, your body needs a lot of insulin to process the carbohydrates in your food. That upsets the balance between two key hormones (LH and FSH), which pushes the ovaries to make more testosterone and leaves egg cells maturing but not releasing.

Genetics matter too, PCOS clearly runs in families. And there’s a frustrating loop: insulin resistance encourages weight gain, and weight gain feeds the insulin resistance straight back. That’s why PCOS can flare up more when weight goes up.

How PCOS is diagnosed

Diagnosis is made using the Rotterdam criteria, and the rule is simple: you need to meet two of the following three.

• An irregular cycle (fewer than 10 periods a year, or none).
• Signs of too much male hormone, seen as acne or excess hair, or measurable in a blood test.
• The typical follicles on the ovaries, visible on an ultrasound. A high level of the hormone AMH now counts as an alternative here too.

Often the diagnosis can be made from a blood test and your cycle alone, without necessarily needing a scan. What matters is that the doctor first rules out other possible causes, such as thyroid problems or other hormonal conditions that can mimic PCOS. The picture shouldn’t secretly be something else.

Lifestyle: the first and most important step

With PCOS you almost always start with lifestyle. Because insulin resistance is likely a driving force behind the syndrome, the aim is to improve how well your body responds to insulin. You do that with the ordinary building blocks of a healthy life, which matter that bit more for women with PCOS:

• Diet, and where it’s needed, some weight loss.
• Moving and exercising more.
• Sleeping well.
• Cutting down stress and making room to switch off.

The evidence for this is solid, and these changes can genuinely ease PCOS symptoms. Plenty of women deliberately choose to get their lifestyle in order for a while before they even think about medication, and that’s a perfectly reasonable route. And if medication does come into the picture later, a healthy lifestyle still stays important underneath it.

Medical treatments

There’s no treatment that removes the cause, simply because that cause isn’t precisely known yet. So treatment targets the symptoms that bother you most, which makes it very personal. A few of the commonly used options:

• The pill. Often the standard first choice. It puts your own ovaries on a low setting, lowers free testosterone and protects the womb lining, which frequently improves the cycle, the acne and the excess hair at the same time. Worth noting: the pill obviously isn’t for you if you’re actively trying to conceive.
• Metformin. This lowers insulin resistance, which brings it closest to tackling a root driver. It’s especially useful when weight gain or insulin resistance are clearly present.
• Targeted testosterone blockers (such as spironolactone or finasteride) for acne and excess hair. These can’t be used if you’re trying to get pregnant.
• GLP-1 medication (the well-known weight-loss drugs). Early results in PCOS look promising, but it doesn’t yet have a fixed place in treatment.

Which route fits depends on your situation, your symptoms and your stage of life. That’s exactly why individual guidance matters so much here: there are lots of treatment options, but no treatment obligations.

PCOS and wanting to get pregnant

A common and completely understandable worry: can you still get pregnant with PCOS? The short answer is yes, though you’ll often need some medical help to get there.

The lack of ovulation is actually the best-understood part of PCOS. With medication that triggers ovulation (such as letrozole or clomifene), ovulation returns in more than 70 to 80 per cent of women, after which pregnancy often follows. If that doesn’t do it, there are further steps available, up to and including IVF.

One thing to plan for: because some PCOS medications don’t mix with pregnancy, it’s worth raising your plans with your doctor in good time. Often you work on conceiving first and only tackle something like the testosterone afterwards, or the other way round, but not both jumbled together.

Recognise these signs? Get it checked

If your cycle is unpredictable, you regularly skip a period, or you’ve had acne for years despite being well past your teens, it can be worth having it looked into. In the UK that starts with a chat with your GP, who can arrange blood tests and refer you on if needed.

A lot of PCOS is relatively straightforward to investigate. Insulin resistance, testosterone and your metabolic profile can be measured in the blood, and you already know how your cycle behaves. A check can make it clear whether lifestyle changes are especially worthwhile for you, or whether it’s worth sorting something now with a future pregnancy in mind.

The thread running through all of this: every case of PCOS is different, and the right approach is always personal. So take your symptoms to your GP or a gynaecologist, and get properly informed about what suits you.