PCOS: Symptoms, Diagnosis and Treatment Options

Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions I see, and one of the most misunderstood. It is manageable, but it needs to be recognised properly and treated as the whole-body condition it is, not just a menstrual problem.

What is PCOS?

PCOS is a condition of reproductive-age women driven by an imbalance in reproductive hormones. The name refers to the small fluid-filled sacs that can appear on the ovaries, although not everyone with PCOS has these. In PCOS the ovaries can produce higher than usual levels of androgens (often called male hormones), which can interfere with the regular development and release of eggs.

How PCOS affects your periods

Because ovulation becomes irregular, periods can be infrequent, prolonged or absent altogether. Many women first notice something is wrong because their cycle is unpredictable, or because they are having difficulty conceiving. PCOS can also raise the risk of recurrent miscarriage, which is worth knowing if you are planning a pregnancy.

When does it start, and how common is it?

Symptoms can begin after puberty, though many women are diagnosed in their twenties or thirties, often when trying to conceive. PCOS is common: the World Health Organization estimates it affects around 8 to 13 per cent of women of reproductive age, and the NHS notes it affects about 1 in 10 women in the UK.

Common symptoms

• Irregular, infrequent or absent periods
• Excess hair growth on the face, chest or back
• Acne and oily skin
• Weight gain, particularly around the abdomen
• Thinning hair on the scalp
• Difficulty getting pregnant due to irregular ovulation
• Darkening of skin in body creases such as the neck
• Fatigue and disturbed sleep

What causes PCOS?

• Genetics: PCOS often runs in families
• Insulin resistance, which raises insulin levels and can increase androgen production
• Hormonal imbalance, with raised androgens affecting egg development and release

Ethnic variations and disparities in PCOS

PCOS does not present the same way in every population, and understanding ethnic differences matters for accurate diagnosis and equitable care. Research consistently shows that PCOS is more prevalent in certain ethnic groups and that the way it presents can vary significantly.

South Asian women are disproportionately affected, with studies reporting a higher prevalence of PCOS compared with White European populations. They are also more likely to develop insulin resistance and metabolic complications at a lower BMI, which means standard weight-based screening thresholds can miss them. The International Evidence-based Guideline for the Assessment and Management of PCOS (2023) highlights that ethnic-specific BMI cut-offs should be considered, particularly for women of South Asian, South-East Asian and East Asian heritage.

Black women with PCOS tend to show higher rates of cardiovascular and metabolic risk factors, including insulin resistance, elevated blood pressure and unfavourable lipid profiles. However, they may present with less clinical hyperandrogenism (for example, less hirsutism) compared with White or South Asian women, which can lead to under-recognition and delayed diagnosis if clinicians rely heavily on visible androgen signs.

Hispanic and Latin American women also show an elevated prevalence and are more likely to present with central adiposity and metabolic features. Meanwhile, East Asian women may have a milder hormonal profile but still carry significant metabolic risk.

These variations matter in practice. A diagnosis that depends on visible signs such as excess hair growth, or that uses universal BMI thresholds, will systematically miss women from populations where PCOS looks different. Addressing these disparities requires clinicians to take a comprehensive approach: considering metabolic markers, insulin resistance and reproductive history alongside any visible symptoms, and adjusting clinical thresholds for ethnicity where evidence supports it.

Access to diagnosis and specialist care is also unequal. Women from minority ethnic backgrounds in the UK are less likely to be referred for PCOS evaluation and more likely to experience diagnostic delay. This is compounded by cultural stigma around weight and fertility in some communities, which can prevent women from seeking help. Culturally sensitive, evidence-based care is essential to close these gaps.

How is PCOS diagnosed?

Diagnosis involves your medical history, an examination, blood tests and sometimes an ultrasound scan. The commonly used Rotterdam criteria require at least two of the following three features: irregular or absent ovulation, clinical or biochemical signs of raised androgens, and polycystic ovaries seen on ultrasound. Because other conditions can mimic PCOS, a proper assessment matters.

Why PCOS is a whole-body condition

PCOS is linked to longer-term health risks beyond fertility, including type 2 diabetes, high blood pressure, unfavourable cholesterol levels, sleep apnoea, and a higher risk of womb cancer if periods are very infrequent over long periods. There is also a higher likelihood of anxiety, depression and disordered eating. This is why I treat PCOS as a metabolic and emotional condition, not simply a gynaecological one.

Managing PCOS: lifestyle first

• A balanced diet rich in whole foods, with fewer processed foods and added sugars
• Lower glycaemic-index choices to help steady blood sugar and improve insulin sensitivity
• Regular activity: aim for at least 150 minutes of moderate exercise a week, plus strength training
• Even modest weight loss, where relevant, can meaningfully improve symptoms

Medical treatment options

• Combined hormonal contraception to regulate cycles and reduce androgen-related symptoms
• Metformin to improve insulin resistance
• Anti-androgen medicines such as spironolactone for excess hair and acne
• Fertility treatments such as letrozole, clomiphene or IVF where conception is the goal
• Incretin-based medicines, such as semaglutide or tirzepatide, may be considered for weight management in some people where clinically appropriate. Eligibility is assessed individually in line with current guidance, taking account of factors such as BMI, associated health conditions and clinical context.

Supplements that may help

Some supplements have supportive evidence in PCOS, including vitamin D where levels are low, and inositol (myo-inositol and D-chiro-inositol), which may improve insulin sensitivity and help restore ovulation. Always discuss supplements with your doctor, as quality and dosing vary and they are not a substitute for the core management above.

Protecting the womb lining

If natural periods occur less often than roughly every three months, the womb lining needs protection to reduce cancer risk. This can be achieved with cyclical progesterone to induce a bleed, combined hormonal contraception, or a Mirena intrauterine system. Weight is central to PCOS for many women, and my weight and metabolic health service can support this alongside your gynaecological care.

“PCOS is complex, but it responds well to a clear plan. Understand your own picture, treat the metabolic side as seriously as the periods, and you can live very well with it.”

Dr Itunu Johnson

If you think you may have PCOS, or you have a diagnosis and want a plan that fits your goals, you can book a consultation or read more about my women’s health care. And because hormonal health continues to evolve over a lifetime, you may also find my guide to hormone replacement therapy myths and facts helpful as you look ahead.