PCOS: a common condition that deserves better understanding

Polycystic Ovary Syndrome (PCOS) is one of the most common conditions affecting women of reproductive age. Despite its prevalence, it is frequently under-recognised, and many women live with symptoms for years before a formal diagnosis is made. For some, features emerge during adolescence, while for others PCOS only becomes apparent when menstrual irregularity or difficulty conceiving prompts investigations.

If you have recently been told you may have PCOS, or you suspect you might, it is important to know that you are not alone and that help is available.

This article explains what PCOS is, how common it is, how it is diagnosed, and what it means for fertility and long term health. You may also find it helpful to explore our guide on fertility evaluation and what to expect if you are considering an assessment.

What Is PCOS (Polycystic Ovary Syndrome)?

PCOS is a complex endocrine and metabolic condition characterised by a combination of reproductive, hormonal, and metabolic features. Although the ovaries may be involved, PCOS is not just about ovaries.

Women with PCOS may have higher levels of androgens, sometimes referred to as male type hormones. This hormonal imbalance can interfere with ovulation, which is why periods may be irregular or absent. Some women experience symptoms of high androgens such as acne, greasy skin, excessive hair on face and/or body and hair loss from the scalp/male type baldness.

It is also important to understand the difference between Polycystic ovaries (Polycystic ovary Morphology is the appropriate term) and PCOS. Polycystic ovary morphology (PCOM) describe the appearance of the ovaries on an ultrasound scan, where many (>20 in each ovary) small follicles (egg containing sacs) are seen or the ovaries are enlarged (> 10 ml in volume). Not everyone with PCOM has symptoms of PCOS. The ‘cysts’ in polycystic is a misnomer - these are not cysts, but immature follicles (egg containing sacs)

How Common Is PCOS?

It is estimated that PCOS affects approximately 1 in 10 women of reproductive age*.

For many women, the condition remains undiagnosed, especially if they are not trying to conceive or if symptoms are mild. This means the true number of women affected by PCOS may be higher than current estimates.

Common Symptoms of PCOS

PCOS symptoms can be different from one person to another. Some women experience mild symptoms whereas some may experience many or severe symptoms.

Menstrual/Ovulation Symptoms

• Irregular or infrequent or absent menstrual periods suggesting infrequent ovulation or not ovulating at all
• Difficulty conceiving due to ovulation dysfunction

Hormonal and Physical Symptoms

• Acne or oily skin that persists beyond adolescence
• Excess facial or body hair growth
• Thinning hair or hair loss from the scalp or male type baldness
• Weight gain or difficulty losing weight

If you are searching online for phrases such as “how do I know if I have PCOS” or “what are the first signs of PCOS”, these symptoms are often what prompt women to seek medical advice.

How Is PCOS Diagnosed?

If symptoms suggest PCOS, a structured fertility evaluation can help assess hormone levels, ovulation, and overall reproductive health in a clear and supportive way.

PCOS is diagnosed based on an internationally accepted criteria. A diagnosis is usually considered when two out of three of the following features are present, after excluding other conditions*:

• High androgen levels, either through symptoms as described above or on blood tests
• Infrequent or absent menstrual periods or ovulation
• Polycystic ovary morphology seen on ultrasound scan

A structured fertility evaluation can help assess hormone levels, ovulation, and overall reproductive health in a clear and supportive way.

Tests Commonly Used

Your GP or specialist may recommend:

• Blood tests to assess hormone levels in early phase of menstrual cycle if you get menstrual periods or randomly if no periods.
• A pelvic ultrasound scan (internal scan) to assess ovaries for polycystic ovary morphology
• Tests to rule out other hormonal conditions such as thyroid dysfunction or high prolactin levels.

A diagnosis of PCOS does not always require an ultrasound scan, particularly in younger women.

PCOS and Fertility

Having PCOS does not always mean you cannot get pregnant. Many women with PCOS conceive naturally.

For some women, infrequent or absent ovulation can make it harder to conceive naturally and fertility treatments such as ovulation induction may be required. PCOS is one of the most common causes of ovulation related fertility difficulties*.

If you are concerned about fertility or symptoms of PCOS, an early assessment can help clarify your ovulation pattern and identify appropriate next steps.

Long Term Health Considerations With PCOS

PCOS is not only a gynaecological condition. It is actually an endocrine and metabolic condition with several long term health considerations.

Women with PCOS are more likely to experience:

• Insulin resistance
• Increased risk of type 2 diabetes
• Higher risk of cardiovascular health issues later in life

This does not mean these outcomes are inevitable. Regular monitoring, lifestyle support, and appropriate medical care can significantly reduce long term risks.

You may also wish to read our related article on body weight and fertility, which explores how metabolic health can influence reproductive outcomes.

Managing PCOS Symptoms

Management of PCOS is individualised and goal-oriented, taking into account symptoms, metabolic health, reproductive plans, and personal priorities.

Lifestyle interventions (lifestyle modifications) are recommended as first-line management for most women, particularly where metabolic health or excessive weight is a concern. JIVA Fertility’s Dietitian-Nutritionist, Maria Kolotorou has expertise in supporting patients with PCOS.

Medical treatments may be offered to:

• Regulate menstrual cycles
• Manage symptoms of excess androgens
• Support ovulation and fertility

Care is most effective when delivered within a supportive, informed, and multidisciplinary framework.

When Should You Seek Medical Advice?

You should consider speaking to a GP or fertility specialist if you experience:

• Irregular/infrequent or absent periods
• Difficulty getting pregnant
• Symptoms of high androgen levels that affect your confidence or quality of life
• Concerns about long term health risks

Early assessment can provide reassurance and help you understand your options.

Frequently Asked Questions

Q: Is PCOS common?

A: Yes. PCOS affects around 1 in 10 women and is considered the most common hormonal disorder in women of reproductive age*.

Q: Can you have PCOS without cysts?

A: Yes. PCOS can be diagnosed even if no cysts are seen on ultrasound. Hormonal symptoms and ovulation patterns are equally important. The ‘cysts’ in polycystic is a misnomer - these are not ovarian cysts, but immature follicles (egg containing sacs).

Q: Can you get pregnant if you have PCOS?

A: Many women with PCOS conceive naturally or with fertility support. Treatment is tailored to the individual.

Q: How is PCOS treated?

A: Treatment focuses on managing your symptoms, supporting ovulation if fertility is a concern, and measures to reduce long term health risks, in line with NHS and NICE guidance.

Final Thoughts

PCOS is common, heterogeneous, and frequently misunderstood. With accurate diagnosis and evidence-based management, most women with PCOS achieve good fertility and long-term health outcomes.

If you have concerns about your symptoms or difficulty conceiving, please book an appointment with our consultants at JIVA Fertility for personalised assessment and advice.

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References*

• NHS. Polycystic ovary syndrome (PCOS).
• NICE Clinical Knowledge Summaries. Polycystic ovary syndrome.
• Royal College of Obstetricians and Gynaecologists. Long term consequences of PCOS.
• Human Fertilisation and Embryology Authority. Causes of infertility.

Disclaimer: This article is intended for educational purposes and does not replace individual medical advice. Please consult a qualified healthcare professional for personalised assessment and treatment.

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