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

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 a single presentation – it exists on a spectrum, which is why PCOS symptoms, severity and long-term impact can vary significantly between individuals.

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.

 

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.

 

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.

 

What Causes PCOS?

The exact cause of PCOS is not fully understood, but it is widely recognised as a multifactorial condition – meaning several biological mechanisms contribute simultaneously rather than a single trigger being responsible.

Genetics

PCOS tends to run in families. If a close female relative has PCOS, your risk of developing it is higher. Researchers have identified multiple genes associated with insulin signalling, androgen production, and ovarian function that may contribute to its development.

Insulin resistance

Insulin resistance is present in a significant proportion of people with PCOS – even those who are not overweight. When cells become resistant to insulin, the pancreas produces more of it. Elevated insulin then stimulates the ovaries to produce excess androgens, disrupting ovulation and driving many classic PCOS symptoms.

Androgen excess

Elevated androgens (male hormones such as testosterone and DHEA-S) are a hallmark feature of many PCOS presentations. These can interfere with normal follicle development in the ovaries and contribute to symptoms such as acne, hirsutism (excess hair growth), and scalp hair thinning.

Low-grade inflammation

Chronic low-grade inflammation is increasingly recognised as both a driver and a consequence of PCOS. Inflammatory signals can stimulate androgen production and impair insulin sensitivity, creating a self-reinforcing cycle that sustains symptoms over time.

Hypothalamic-pituitary signalling

In PCOS, the signalling between the brain (hypothalamus and pituitary gland) and the ovaries is often disrupted. An elevated ratio of LH (luteinising hormone) to FSH (follicle-stimulating hormone) is a common finding, and this imbalance can impair ovulation and further drive androgen production.

 

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 fasting blood 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.

 

Why PCOS Is Often Missed

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.

 

Long-Term Health Risks Associated with PCOS

PCOS is more than a reproductive condition. Without appropriate support, the underlying hormonal and metabolic imbalances can contribute to a range of longer-term health risks.

Understanding these is important – not to cause alarm, but to inform a proactive approach to monitoring and management.

Type 2 diabetes and insulin resistance

People with PCOS have a significantly elevated risk of developing type 2 diabetes and impaired glucose tolerance, largely due to the insulin resistance that underlies many presentations. Regular monitoring of fasting insulin and glucose – not just HbA1c – is important, as conventional tests can miss early dysregulation.

 

Cardiovascular health

PCOS is associated with an increased risk of high blood pressure, elevated triglycerides, low HDL cholesterol, and other markers of cardiovascular risk. These risks are partly linked to insulin resistance and chronic inflammation and reinforce the importance of a whole-systems approach to PCOS care.

 

Endometrial health

Irregular or absent ovulation means the endometrium (uterine lining) may not shed regularly. Over time, this can lead to endometrial hyperplasia and, in some cases, increase the risk of endometrial cancer. Maintaining regular cycles – naturally or with support – is an important protective factor.

 

Mental health

Anxiety, depression, and disordered eating are significantly more prevalent in people with PCOS compared to the general population. This may be driven by the hormonal environment, the burden of managing a chronic condition, and in some cases the impact of symptoms such as acne, hair growth, or weight changes on body image and self-esteem.

 

Sleep and energy

Sleep apnoea is more common in people with PCOS, particularly where insulin resistance and weight are contributing factors. Chronic fatigue and poor sleep quality are also frequently reported and can compound the metabolic and mood-related aspects of the condition.

 

Managing PCOS: A Personalised Approach

There is no single cure for PCOS, but it is highly manageable. The most effective approaches are tailored to the individual – based on their specific symptom picture, bloodwork, lifestyle, and goals – rather than applied as a blanket protocol.

 

Nutrition and lifestyle

Dietary and lifestyle changes are often the most powerful lever available. For those with insulin-driven PCOS, reducing refined carbohydrates and improving insulin sensitivity through whole foods, regular movement, and stress management can meaningfully improve symptoms – including cycle regularity, androgen levels, and energy.

This is not about weight loss for its own sake; the metabolic improvements are largely independent of body weight.

 

Medical management

A range of medications may be used depending on the presentation and goals of the individual:

•       The combined oral contraceptive pill: commonly used to regulate cycles, reduce androgen levels, and manage acne and hirsutism

•       Metformin: an insulin-sensitising medication that can improve cycle regularity and metabolic markers, particularly where insulin resistance is a key driver

•       Anti-androgens (such as spironolactone): used for managing symptoms like hirsutism and hair loss where androgen excess is significant

•       Ovulation induction agents (such as letrozole or clomifene): used when fertility support is required

 

These decisions are best made in collaboration with a knowledgeable clinician and informed by comprehensive testing rather than symptom management alone.

 

Targeted supplementation

Certain nutrients and supplements have an evidence base in PCOS, including inositol (particularly myo-inositol), magnesium, vitamin D, and omega-3 fatty acids.

Supplementation is most effective when guided by bloodwork that identifies actual deficiencies or suboptimal levels rather than taken as a general routine.

 

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.

Frequently Asked Questions

 

Can you have PCOS without cysts on your ovaries?

• Yes. Despite the name, you do not need to have cysts on your ovaries to be diagnosed with PCOS. Diagnosis is based on the Rotterdam criteria, which requires meeting two out of three criteria – only one of which is polycystic ovarian morphology on ultrasound.
• Many people are diagnosed on the basis of irregular periods and elevated androgens alone.

 

Is PCOS curable?

• PCOS is not currently considered curable, but it is highly manageable. Many of the underlying drivers – insulin resistance, inflammation, androgen excess – are modifiable through nutrition, lifestyle, and targeted clinical support.
• Many people with PCOS see significant improvements in symptoms and metabolic markers with the right approach.

 

Does PCOS affect fertility?

• PCOS is one of the most common causes of irregular ovulation, which can make conception more challenging. However, PCOS does not mean infertility. Many people with PCOS conceive naturally.
• Where ovulation is irregular, ovulation induction and other fertility supports are often effective, particularly when underlying hormonal and metabolic imbalances are addressed first.

 

Can PCOS go away on its own?

• Symptoms of PCOS can change across life stages – for example, some women notice changes in their PCOS presentation after pregnancy or as they approach perimenopause.
• However, the underlying hormonal and metabolic tendencies generally persist. Addressing root causes rather than waiting for symptoms to resolve on their own leads to better long-term outcomes.

 

What blood tests are used to diagnose or investigate PCOS?

• A comprehensive PCOS panel typically includes sex hormones (testosterone, SHBG, oestrogen, progesterone), gonadotropins (LH and FSH), adrenal hormones (DHEA-S), thyroid function, fasting insulin and glucose, lipids, inflammatory markers, and nutrient levels.
• Standard GP testing often covers only a fraction of this – which is why many people remain undiagnosed or without a clear picture of their presentation.

 

How is PCOS different from endometriosis?

• PCOS and endometriosis are two distinct conditions, though they can co-exist. PCOS is primarily a hormonal and metabolic condition characterised by androgen excess and disrupted ovulation.
• Endometriosis is an inflammatory condition in which tissue similar to the uterine lining grows outside the uterus, typically causing pelvic pain – especially around periods.
• Both conditions are frequently under-diagnosed and can share some symptoms, such as painful periods and fertility challenges.

 

References

This article was written by Holly Devine and reviewed for clinical accuracy. It is intended for informational purposes only and does not constitute medical advice. If you have concerns about your health, please consult a qualified healthcare professional.

Diagnosis & prevalence

•       World Health Organisation. Polycystic ovary syndrome. who.int (2023). Available at: https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome

•       Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Human Reproduction. 2004;19(1):41–47.

•       National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. NICE Guideline NG156. nice.org.uk (2023). Available at: https://www.nice.org.uk/guidance/ng156

 

Insulin resistance & metabolic risk

•       Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocrine Reviews. 1997;18(6):774–800.

•       Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction. 2016;31(12):2841–2855.

 

Long-term health risks

•       Wild RA, Carmina E, Diamanti-Kandarakis E, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome. Journal of Clinical Endocrinology & Metabolism. 2010;95(5):2038–2049.

•       Fearnley EJ, Marquart L, Spurdle AB, Weinstein P, Webb PM. Polycystic ovary syndrome increases the risk of endometrial cancer in women aged less than 50 years: an Australian case-control study. Cancer Causes & Control. 2010;21(12):2303–2308.

•       Cooney LG, Dokras A. Depression and anxiety in polycystic ovary syndrome: etiology and treatment. Current Psychiatry Reports. 2017;19(11):83.

 

Management

•       Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction. 2018;33(9):1602–1618. Available at: https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline

•       Unfer V, Carlomagno G, Dante G, Facchinetti F. Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials. Gynecological Endocrinology. 2012;28(7):509–515.