What Is PCOS? Symptoms, Diagnosis and Treatment Options

PCOS, or polycystic ovary syndrome, can affect periods, ovulation, androgen-related symptoms, metabolic health, emotional wellbeing and fertility. It does not look the same in each person. Some have irregular cycles, acne, excess hair growth or scalp hair thinning; others first seek assessment when planning pregnancy.

PCOS is a long-term condition that can be managed according to symptoms, metabolic health and reproductive goals. It is not diagnosed from one symptom, one ultrasound appearance, one hormone result or an insulin assay.

After other relevant causes have been excluded, adult diagnosis generally requires at least two of three features: ovulatory dysfunction or irregular or absent cycles; clinical or biochemical hyperandrogenism; and polycystic ovarian morphology on ultrasound. The clinician interprets the whole pattern and the person’s life stage.

In adults, anti-Müllerian hormone may be used as an alternative marker of polycystic ovarian morphology within the current diagnostic algorithm. It is not a stand-alone PCOS test and should not be added to ultrasound simply to increase the chance of meeting a criterion.

Cycle irregularity is common soon after menarche, so adult thresholds should not be applied immediately. Adolescent diagnosis requires both persistent ovulatory dysfunction defined in relation to years after menarche and clinical or biochemical hyperandrogenism after relevant alternative causes are considered.

Ultrasound and AMH should not be used to diagnose PCOS in adolescents. Someone with suggestive features who does not yet meet criteria can receive symptom support and planned reassessment without being given a premature lifelong label.

The assessment considers pregnancy where relevant, thyroid dysfunction, hyperprolactinaemia and non-classic congenital adrenal hyperplasia. Other testing is directed by history, examination, rapid symptom change or marked virilisation. There is no rigid universal laboratory panel that each person needs.

Insulin resistance is relevant to PCOS, but routine insulin assays have limited clinical value and are not recommended as a diagnostic test. Glycaemic assessment is different: it evaluates blood-glucose risk using an appropriate clinical test.

PCOS care includes blood pressure and glycaemic assessment, lipid and cardiovascular-risk review where appropriate, and questions about sleep-apnoea symptoms. Timing and test choice depend on age, pregnancy plans, previous results and other risk factors rather than body size alone.

Anxiety, depression, eating concerns, body-image distress and reduced quality of life can accompany PCOS. These concerns deserve direct, non-stigmatising assessment and support; they should not be reduced to motivation or weight.

Long untreated amenorrhoea may increase the risk of endometrial hyperplasia. Routine endometrial-cancer screening is not recommended solely because PCOS is present, but cycle regulation or progestogen protection may be discussed according to the clinical situation.

Treatment is matched to current goals: cycle control, androgen-related symptoms, metabolic health, contraception or pregnancy. Fertility care may include supervised ovulation induction and later options when indicated, but IVF is not required for every person with PCOS. The plan should be reviewed as goals and health needs change.