Polycystic Ovary Syndrome (PCOS): Symptoms, Causes and What It Means for Your Health

Quick Facts

• PCOS is one of the most common hormonal conditions affecting women of reproductive age.
• It is characterised by hormone imbalance, irregular ovulation and sometimes polycystic ovaries.
• Symptoms can include irregular periods, acne, excess hair growth and fatigue.
• Many individuals with PCOS remain undiagnosed.
• Up to 70% of women with PCOS are undiagnosed, highlighting how often it is missed.

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal conditions affecting women – yet it remains widely misunderstood.

Despite its name, PCOS is not simply an ovarian condition, nor is it defined solely by the presence of cysts on an ultrasound.

PCOS is not just a reproductive condition – it also involves metabolic and hormonal pathways, including insulin resistance and androgen excess

Understanding PCOS properly is the first step toward meaningful support and personalised care in the UK.

What Is Polycystic Ovary Syndrome (PCOS)?

PCOS is a hormonal condition characterised by disrupted communication between the brain, ovaries, and metabolic system.

Diagnosis is typically based on meeting two out of three criteria (known as the Rotterdam criteria):

• Irregular or absent ovulation (irregular or missing periods)
• Clinical or biochemical signs of raised androgens (such as testosterone)
• Polycystic ovarian morphology on ultrasound

Crucially, you do not need ovarian cysts to have PCOS. 

PCOS can present in different forms, often described as phenotypes.

Many individuals experience clear symptoms despite ‘normal’ scans – and conversely, some people have polycystic-appearing ovaries without having PCOS at all.

Common Symptoms of PCOS

PCOS can present very differently from person to person.

Common symptoms include:

• Irregular, infrequent, or painful periods
• Acne, oily skin, or hair thinning
• Excess facial or body hair (hirsutism)
• Difficulty with weight management
• Low energy and fatigue
• Reduced libido
• Fertility challenges
• Mood changes, anxiety, or low mood

Because symptoms vary so widely, PCOS is often missed, delayed, or dismissed, particularly when symptoms don’t fit a stereotypical picture.

How PCOS Affects Hormones and Metabolism

PCOS is not just about reproductive hormones – it often involves metabolic and inflammatory pathways too.

Androgens

Many people with PCOS have elevated androgens (such as Testosterone and DHT) which can disrupt ovulation and contribute to skin and excess hair symptoms.

Insulin Resistance

A significant proportion of people with PCOS experience insulin resistance – even if blood fasted glucose levels appear normal. Elevated insulin can stimulate the ovaries to produce more androgens, perpetuating symptoms.

Inflammation

Low-grade, chronic inflammation is increasingly recognised as a contributor to PCOS, influencing hormone signalling, ovarian function, and metabolic health.

How PCOS Affects Hormones and Metabolism

Ultrasound findings are often over-relied upon in PCOS diagnosis.

Ovarian appearance can change with:

• Age
• Hormonal contraception
• Stress and energy availability
• Cycle timing

This is why blood testing and symptom history are essential. 

A normal scan does not rule out PCOS – and a cystic-appearing ovary does not confirm it.

The role of blood testing in PCOS

Comprehensive blood testing allows for a deeper understanding of why PCOS symptoms are occurring and how best to support them.

Key areas often explored include:

• Sex hormones (androgens, oestrogen, progesterone, SHBG)
• Gonadotropins (LH to FSH ratio)
• Adrenal Hormones (DHEA-S, Cortisol)
• Ovulatory markers
• Thyroid function
• Insulin and glucose regulation
• Lipids and cardiometabolic markers
• Inflammatory markers
• Nutrient status

Rather than a one-size-fits-all approach, this data helps create individualised, evidence-based strategies.

PCOS is not a dead-end diagnosis

PCOS is a long-term condition, but it is highly manageable with the right insight and support.

Many symptoms are driven by modifiable pathways – meaning targeted nutrition, lifestyle, and clinical interventions can make a meaningful difference.

Importantly, PCOS does not automatically mean infertility.

Many people with PCOS conceive naturally or with appropriate support once underlying imbalances are addressed.

A Personalised, Proactive Approach

At My Atlas, we view PCOS through a whole-systems lens – not just reproductive health, but metabolic, inflammatory, and hormonal balance.

Understanding your unique biology allows for informed decisions, clearer direction, and better long-term outcomes.

Because PCOS is not one condition, there should never be just one solution.