About polycystic ovary syndrome (pcos)
PCOS is diagnosed when two of three features are present: irregular or absent ovulation, signs or blood test evidence of excess androgens, and polycystic ovaries on ultrasound. Ultrasound alone is not enough, and many women with "cysts" on a scan do not have the syndrome.
Because PCOS affects periods, fertility, skin, weight and long-term health at once, it benefits from a single specialist plan rather than piecemeal treatment of each symptom.
Symptoms we assess
Reasons for referral include:
- Irregular, infrequent or absent periods
- Difficulty conceiving
- Excess hair on the face, chest or abdomen (hirsutism)
- Persistent acne or thinning scalp hair
- Weight gain that is hard to shift, particularly around the middle
- Darkened skin in the folds of the neck or armpits, a sign of insulin resistance
- Abnormal glucose or cholesterol results
How we diagnose it
The consultant takes a careful history of periods, weight, skin and hair changes, and family history of diabetes. Blood tests measure androgens, LH and FSH, prolactin and thyroid function, both to support the diagnosis and to exclude other causes such as thyroid disease, high prolactin or, rarely, an adrenal condition. Metabolic tests (glucose, HbA1c, cholesterol) assess long-term risk.
A pelvic ultrasound is arranged where it changes the diagnosis. In adolescents the diagnosis is made cautiously, because irregular periods and acne are common in the first years after periods start.
Treatment and follow-up
There is no single cure for PCOS, but every feature of it can be treated. The plan depends on what matters most to you now. For irregular periods and skin symptoms, the combined pill or other hormonal options regulate cycles and lower androgens. For hirsutism, hormonal treatment is combined with hair removal advice. For insulin resistance and weight, a structured approach to food, activity and, where appropriate, medication such as metformin or newer weight-management drugs improves both symptoms and long-term risk.
If conception is the goal, the consultant addresses weight and metabolic health first, which improves ovulation on its own, and coordinates with fertility services for ovulation induction where needed. Because the risk of type 2 diabetes is raised, glucose is checked regularly for life.
The plan is reviewed at follow-up and shared with your GP. Many women need only periodic review once a plan is in place.
When to see a GP, and when to see a consultant
A GP can diagnose PCOS and start hormonal treatment. Consultant review is useful when the diagnosis is uncertain, symptoms are severe or not responding, androgen levels are unusually high, there is abnormal glucose or cholesterol, or fertility is the priority and a metabolic plan is needed alongside fertility care.
