Polycystic Ovary Syndrome

What is polycystic ovary syndrome?

Polycystic ovary syndrome is a common hormonal condition involving irregular or absent ovulation, raised androgen levels and often polycystic appearing ovaries on ultrasound. Insulin resistance underlies much of it, which is why metabolic health matters as much as fertility. The name is misleading, since the follicles seen on scan are not true cysts.

Causes

• Insulin resistance driving increased ovarian androgen production
• Disordered gonadotrophin secretion
• Genetic predisposition
• Excess adipose tissue amplifying hormonal disturbance

Symptoms

• Irregular or absent periods
• Excess hair growth on face, chest or back
• Acne and oily skin
• Difficulty conceiving
• Weight gain and difficulty losing weight
• Thinning hair on the scalp
• Darkened skin patches in body folds

Risk factors

• Family history of polycystic ovary syndrome or type 2 diabetes
• Obesity, though it occurs in lean women too
• South Asian ancestry with earlier and more severe presentation
• Physical inactivity

Diagnosis

• Rotterdam criteria requiring two of three features
• Irregular ovulation, clinical or biochemical androgen excess, polycystic ovaries on scan
• Testosterone and sex hormone binding globulin measurement
• Exclusion of thyroid disease, prolactin excess and congenital adrenal hyperplasia
• Screening for impaired glucose tolerance and lipids

Treatment

• Weight management and regular exercise, which improve ovulation
• Combined hormonal contraception to regulate cycles and reduce androgens
• Metformin for metabolic features
• Letrozole as first line for ovulation induction
• Antiandrogens or cosmetic measures for hirsutism
• Endometrial protection when periods are very infrequent
• Screening for diabetes, sleep apnoea and mood disorders

Self care

• Focus on sustainable weight management, since modest loss restores ovulation for many
• Exercise regularly, including resistance training
• Reduce refined carbohydrates and sugary drinks
• Track periods to monitor cycle frequency
• Manage hair growth with your preferred method without shame
• Prioritise sleep and screen for sleep apnoea symptoms
• Seek mental health support if mood is affected

When to see a doctor

Book an appointment if:

• Fewer than four periods a year, which needs endometrial protection
• Difficulty conceiving after 12 months, or 6 months over 35
• Rapidly worsening hair growth or voice deepening
• Symptoms of diabetes
• Low mood or disordered eating
• To discuss contraception and cycle regulation

Some symptoms need emergency care rather than an appointment. See the warning signs listed above.

Prevention

• PCOS cannot be prevented, but metabolic complications can be
• Maintain a healthy weight and stay active
• Screen for diabetes regularly
• Ensure regular withdrawal bleeds to protect the womb lining
• Address sleep apnoea and cardiovascular risk

Outlook

PCOS is lifelong but its features change over time, with cycles often becoming more regular in the late thirties and forties. Most people who want children conceive, naturally or with ovulation induction. The main long term considerations are type 2 diabetes, cardiovascular risk and endometrial protection, all of which are manageable with monitoring.

Related conditions

Common questions