8 Dec 2022

What is polycystic ovary syndrome (PCOS)?

PCOS is a common condition that affects the ovaries. Symptoms include irregular periods, fertility problems, acne, unwanted hair growth and scalp hair loss. Treatments can help manage symptoms.

Ovaries are called “polycystic” when they have more egg-containing sacs called follicles.

These can be seen on ultrasound scan. In PCOS, these follicles release an egg (ovulate) less frequently, and produce more testosterone. These are the two main features of PCOS that cause the symptoms.

PCOS affects about 1 in 10 people in the UK.

What are the symptoms of PCOS?

Irregular or absent ovulation leads to:

irregular or absent periods, since periods occur 14 days after ovulation (unless pregnant). Without ovulation, the lining of the womb sometimes breaks down causing unpredictable vaginal bleeding. This may be light or heavy, lasting hours to weeks
problems getting pregnant as there are fewer chances to conceive

Increased testosterone production leads to:

unwanted facial/body hair (hirsutism). Hairs are thicker, darker and longer than normal, commonly on the upper lip, chin, jaw-line, neck, midline below the belly-button (and sometimes above), chest, around the nipples, back, buttocks, arms and/or legs
spots (acne) on the face, chest and/or back. Skin and/or hair may be greasy
thinning scalp hair, typically over the crown (alopecia). It usually occurs with other symptoms when due to PCOS

Easy weight gain

PCOS makes weight gain easier, in part due to increased insulin secretion. Being overweight also increases insulin. High insulin makes the body store more dietary calories as fat, contributing to weight gain.

Insulin makes ovaries:

increase testosterone production
less likely to ovulate

Can PCOS affect my mental health?

Anxiety and depressive symptoms are common, although doctors do not know if this is caused by hormonal imbalances, distressing symptoms, or something else.

When do PCOS symptoms start?

These usually develop in the teens or early twenties. Sometimes you might notice symptoms after stopping combined hormonal contraception (“the pill”, patch or ring), as this is good at controlling PCOS. Weight gain makes symptoms more obvious.

What causes PCOS?

It is probably genetic and often runs in families, although symptoms may vary.

When should I consult a GP?

Talk to your GP if you have symptoms. Read our information on how to prepare for your doctor's appointment.

Discuss your symptoms, fertility plans/contraception, weight changes or difficulties maintaining a healthy weight, and any mental health concerns.

Your doctor may:

measure your blood pressure, height and weight
arrange tests looking for other causes of your symptoms and to confirm the diagnosis:
- hormone blood tests
- ultrasound scan: transvaginal is best for examining ovaries. A tummy scan through a full bladder is an alternative
prescribe treatment and/or refer you to a gynaecologist or endocrinologist (hormone specialist), depending on local expertise. If you are trying to have a baby, you will be referred to a fertility clinic

What treatments are available for PCOS?

There are a variety of treatments for symptoms, although there is no “cure”.

Weight loss

If over-weight, losing some will improve all your PCOS symptoms and make treatments more effective. Even a small reduction in weight (5-10%) make noticeable improvements, especially to period irregularities.

Lifestyle changes:

set realistic, short-term goals, eg 1-2 kg/month
gain support from those around you
reduce calorie intake by 500-750 kcal/day: this usually means eating 1,200-1,500 kcal/day
monitor your progress: weigh yourself or measure your waist circumference regularly.

Meals

3 balanced meals daily: avoid skipping any
smaller portions
stop snacks
avoid high calorie drinks
plan ahead.

Activity

make exercise routine - 150 minutes vigorous activity (250 minutes moderate) every week in total
all activity helps: walking/cycling/housework/gardening/games/sports.

If you are very over-weight, ask your GP about specialist help.

For symptoms of raised testosterone

Hormonal

Combined oral contraceptive pills are effective. These reduce testosterone production and activity. Alternatively, there are tablets to block the action of testosterone. Some contraceptive pills contain a testosterone-blocker.

Hormone treatment does not replace hair removal, but reduces the time spent it. It usually takes 6-9 months to make a noticeable difference to unwanted hair growth or to reduce scalp hair loss. Acne can improve quicker.

If you are trying to have a baby, you cannot take these treatments.

Non-hormonal

Unwanted hair:

waxing, plucking, threading
laser or electrolysis: effective but expensive
Vaniqa cream (prescription only, may require specialist referral): slows growth of hairs and makes them less thick
bleaching (for fair skins).

Avoid shaving the face/neck, as it it can make the skin rough.

Acne:

lotions/gels/creams
antibiotic creams/tablets
Roaccutane tablets: not suitable for everyone (only prescribed by dermatologists).

Scalp hair loss:

minoxidil scalp lotion

For irregular/absent periods

Combined oral contraceptive pills are good for controlling abnormal bleeding patterns. Or your doctor may recommend progestogen treatment (tablets, injections, implant or hormone-releasing coil). This does not treat testosterone-driven symptoms.

These treatments are not suitable if you are trying to have a baby.

Metformin

Together with lifestyle changes to lose weight, Metformin may improve symptoms plus reduce diabetes risk. Metformin, although not licenced for treating PCOS, can be prescribed if your doctor thinks it may help.

You can take Metformin if you are trying to have a baby.

Will I be able to have a baby?

If you have regular periods, you are likely to have the same chance as anyone else.

If you have infrequent or no periods, you may be offered a course of fertility treatment called ovulation induction (tablets or injections). It does not work very well if you are overweight.

Laparoscopic ovarian drilling, an operation under general anaesthetic, may increase frequency of ovulation (for selected cases only).

Your specialist may recommend IVF, especially if you are not pregnant after ovulation induction. NHS funding for IVF varies by area: your GP will advise whether you are eligible. Funding is not available if your weight is too high.

What are the long-term consequences of PCOS?

You may have increased risks of:

high cholesterol
raised blood pressure
type 2 diabetes
diabetes in pregnancy (gestational diabetes).

When periods occur less than four time/year, there is an increased chance of a rare cancer affecting the womb lining (endometrial cancer): hormone treatments reduce this risk.