Polycystic ovary syndrome

Also called PCOS

A common hormonal condition affecting periods, fertility, skin and metabolism. Around 1 in 10, and many are undiagnosed.

What it is

Polycystic ovary syndrome affects around one in ten women of reproductive age in the UK, and a substantial proportion are undiagnosed.

The name is misleading. The cysts are not cysts, they are follicles, and you do not need them to have the condition. Diagnosis needs two of three: irregular or absent ovulation, signs of excess androgens, and polycystic ovaries on ultrasound.

Insulin resistance underlies much of it, which is why PCOS carries a substantially raised long-term risk of type 2 diabetes and cardiovascular disease. That metabolic side is frequently not discussed at all, because appointments focus on periods and fertility.

Signs you might notice

Irregular, infrequent or absent periods.

Excess hair growth on the face, chest or back, and sometimes hair thinning on the head.

Acne that persists into adulthood.

Difficulty getting pregnant.

Weight gain, particularly around the middle, and difficulty losing it.

Skin tags and darkened patches of skin in folds, which indicate insulin resistance.

How it can affect day-to-day life

The psychological impact is heavily under-recognised. Excess facial hair and acne affect how women feel about themselves profoundly, and both are treated as cosmetic by services that will not fund treatment.

Depression and anxiety rates are significantly higher in PCOS, and eating disorders more common.

Fertility is treatable in most people with PCOS, and the anxiety about it often exceeds the actual difficulty.

The long-term metabolic risk is the part that should be managed lifelong and usually is not.

Supporting someone well

Ask for the metabolic side to be monitored: glucose or HbA1c, blood pressure, cholesterol, at diagnosis and periodically. This is the most commonly skipped part of PCOS care.

Ask about periods, because fewer than four a year raises the risk of endometrial problems and usually needs treatment even if pregnancy is not wanted.

Exercise and, where relevant, modest weight loss improve insulin resistance, periods and fertility measurably.

Take the hair and skin symptoms seriously, and ask what treatment is available rather than accepting cosmetic as a dismissal.

Screen for depression and disordered eating.

For fertility, ask for referral early rather than after years of trying.

Where to get help

A GP can diagnose and start management, and refer to endocrinology or gynaecology.

Verity, the UK PCOS charity, provide support and information.

Ask specifically about long-term metabolic monitoring if nobody has raised it.