Learn about PCOS symptoms, Rotterdam criteria, AMH and ultrasound, lifestyle and medicines, pregnancy planning and long-term health monitoring.
Polycystic ovary syndrome (PCOS) is a hormonal and metabolic condition that may involve irregular periods, signs of excess androgens (male hormones) and polycystic-looking ovaries. It is common during reproductive life; prevalence varies between countries and sources, and some people remain undiagnosed. Despite the name, ovarian cysts are not required for diagnosis. Diagnosis uses specific criteria, while treatment depends on symptoms and goals such as periods, hair growth, weight or pregnancy. This information is general, not individual diagnostic or treatment advice.
What is PCOS?
Ovulation may be irregular in PCOS, and androgen levels may be high. The polycystic appearance of the ovaries actually refers to many small follicles rather than large cysts, so the name is sometimes considered misleading. PCOS is one of the most common causes of difficulty conceiving due to ovulatory dysfunction. However, many people with PCOS can become pregnant.
What symptoms occur with PCOS?
Symptoms vary, and not all need to occur together:
- Infrequent, irregular or absent periods
- Increased unwanted hair on the face, chest or abdomen (hirsutism), acne and hair loss
- Weight gain and fat accumulation around the abdomen
- Difficulty conceiving
- Mood changes, anxiety or low mood
Other hormonal conditions may cause these symptoms, so other causes need to be excluded before diagnosis.
How is PCOS diagnosed?
Current medical guidance diagnoses PCOS when two of the three Rotterdam criteria are present:
- Androgen excess (signs such as excessive hair growth or acne on examination, or raised androgens on blood testing)
- Ovulatory dysfunction (irregular or absent periods)
- Polycystic ovarian appearance (by ultrasound or AMH)
A polycystic ultrasound appearance alone therefore does not mean PCOS. Two criteria are required, and other causes are expected to have been excluded.
What roles do ultrasound and AMH have in diagnosis?
In adults, polycystic ovarian appearance is assessed through follicle count or ovarian volume using appropriate transvaginal ultrasound. Criteria vary with equipment features. Blood AMH levels may be used as an indicator of polycystic ovarian appearance in adults. However, according to current guidance, AMH is not a diagnostic test on its own. A high AMH level alone does not establish PCOS; diagnosis still relies on the criteria above.
How is PCOS diagnosed in adolescents?
Irregular periods and acne may be physiological soon after puberty, so adolescent diagnosis requires more caution. Current guidance uses two criteria: irregular periods and androgen excess; ultrasound and AMH criteria are not defined for this age group. If both are not met, you are monitored as being at increased risk of PCOS and reassessed during maturation. Weight and body image are sensitive issues, so assessment uses non-blaming language.
How are other conditions excluded before diagnosing PCOS?
Thyroid conditions, high prolactin, congenital adrenal enzyme deficiency and androgen-secreting tumours may cause similar symptoms. These possibilities are investigated particularly when androgen levels are very high or symptoms progress rapidly.
How is PCOS treated?
Treatment depends on symptoms and goals. There is no definitive cure, so the aim is symptom control and reducing long-term health risks. Balanced nutrition and regular physical activity are recommended regardless of weight. If weight loss is needed, a reasonable reduction may improve periods and metabolic measures; the process should be supportive and free from blame.
Which medicines are used for periods and androgen symptoms?
Combined hormonal contraceptive pills may be recommended for irregular periods and excessive hair growth in adults of reproductive age. Progesterone-group medicines may also be considered to support menstrual regularity and protect the womb lining in people not planning pregnancy. These medicines control symptoms rather than eliminate PCOS. Side effects and restrictions on hormonal methods, such as blood-clot risk, should be discussed with the doctor.
Metformin may be considered for metabolic purposes with a high body mass index. Gastrointestinal side effects may occur. Benefits from supplements such as inositol are limited; if used, they should be discussed with the doctor according to individual preferences.
Why is metabolic monitoring needed in PCOS?
Risks of insulin resistance, abnormal blood glucose, high cholesterol and high blood pressure are increased in PCOS. Blood glucose status, particularly with a glucose tolerance test, blood lipids and blood pressure are therefore assessed at diagnosis and at regular intervals afterwards. A glucose tolerance test is recommended when planning pregnancy.
Can PCOS affect mental health?
Yes. Depression and anxiety are more common with PCOS. Current guidance recommends screening at diagnosis and during follow-up. Symptoms are treatable; seeking help is part of treatment.
How can PCOS affect pregnancy plans?
Irregular ovulation can make conception more difficult. Before pregnancy, counselling covers stopping smoking and alcohol, managing blood pressure and glucose, the adverse effect of excess weight on pregnancy rates and preconception vitamin use. According to current guidance, letrozole is recommended as the first choice for medication-based ovulation induction in people with PCOS and ovulatory problems when no other infertility cause is present. Later steps may include gonadotropin injections, laparoscopic ovarian surgery and IVF. The doctor determines medicine choice, conditions of use and monitoring. As PCOS increases the risk of ovarian hyperstimulation syndrome (OHSS) during IVF, this risk is included in treatment planning.
People with PCOS may have increased risks of gestational diabetes, pre-eclampsia, miscarriage, preterm birth and caesarean birth, so pregnancy is monitored more closely.
Which long-term health risks are monitored with PCOS?
PCOS is not limited to reproductive years. Long-term follow-up is needed for type 2 diabetes, high blood pressure, abnormal blood lipids, sleep apnoea, fatty liver and mental health conditions. When ovulation does not occur for a long time, the womb lining remains without the protective effect of progesterone for a prolonged period, increasing the risk of excessive thickening and cancer. Establishing menstrual regularity therefore matters in people without periods for months. Unexpected bleeding after absent periods should not be assumed normal and needs assessment. A normal smear or HPV result does not remove the need to assess the womb lining.
Frequently Asked Questions
Do I need ovarian cysts for the diagnosis?
No. A polycystic appearance means many small follicles, not large cysts. Cysts are not required; diagnosis is made when two Rotterdam criteria are met together.
Does a polycystic appearance on ultrasound establish PCOS?
No. It is one of three criteria; at least two must be present and other causes excluded.
Does a high AMH level diagnose PCOS?
No. In adults, AMH can indicate polycystic ovarian appearance, but is not a diagnostic test alone. The criteria above are assessed together.
Does PCOS mean I can never become pregnant?
No. It is a common cause of difficulty conceiving due to ovulation problems, but many people with PCOS can become pregnant.
Which blood tests are requested for suspected PCOS?
Total and free testosterone levels are used if androgen excess is assessed through blood tests. Results are interpreted alongside the menstrual history and examination findings.
Can a slim woman have PCOS?
Yes. PCOS can occur regardless of weight. People of normal weight may also have insulin resistance and other metabolic problems, so metabolic follow-up depends on individual risk rather than weight.
Can PCOS be diagnosed while taking the contraceptive pill?
Hormonal contraceptives affect menstrual patterns and androgen symptoms, making assessment of the criteria harder during their use. The doctor therefore considers the medicine's effects during diagnosis and plans test timing accordingly if needed.
Is there a definitive cure for PCOS?
No. Treatment aims to control symptoms and reduce long-term health risks.
Are other investigations needed before starting ovulation medication?
They may be. Tubal patency is assessed individually before ovulation induction; the doctor decides which investigations to request.
What is the first medicine option for ovulation problems?
With no other infertility cause, current guidance recommends letrozole first for ovulation induction. If there is no response, later options may include gonadotropin injections, laparoscopic ovarian surgery and IVF.
Does PCOS add a risk during IVF?
Yes. The increased risk of ovarian hyperstimulation syndrome (OHSS) is included in treatment planning.
Is PCOS associated with eating disorders?
Yes. Eating disorders are reported more frequently in PCOS and are therefore among the conditions requiring follow-up alongside depression and anxiety. Telling your doctor about significant distress around weight, body image or eating patterns can help arrange mental health support.
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