Do I Have PCOS? Signs, Diagnosis and Treatment

Do I have PCOS? It is a question many people ask when they notice irregular periods, excess hair growth, persistent acne or unexplained weight gain. Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions affecting people with ovaries in the UK, yet it frequently goes undiagnosed for years. This article explains the key signs and symptoms to look out for, how PCOS is diagnosed on the NHS, which other conditions can mimic it, the long-term health risks involved, and the treatments and lifestyle changes that can help you manage it effectively.

What are the most common signs and symptoms of PCOS?

The most common PCOS symptoms are irregular or absent periods, excess facial or body hair, persistent acne and weight gain around the abdomen, caused by elevated androgen levels disrupting the menstrual cycle.

The most common signs of polycystic ovary syndrome (PCOS) are irregular or absent periods, excess hair growth (hirsutism), acne, and difficulty losing weight. PCOS is a hormonal condition affecting people with ovaries, typically becoming apparent during the reproductive years. It is one of the most common endocrine disorders in the UK, though estimates of prevalence vary because many cases go undiagnosed.

Symptoms arise largely because the ovaries produce higher than usual levels of androgens (often called male hormones, though they are present in everyone). This hormonal imbalance can disrupt the normal menstrual cycle, prevent regular ovulation, and cause physical changes such as:

• Irregular, infrequent or prolonged periods (NICE CKS defines oligomenorrhoea as cycles longer than 35 days or fewer than eight cycles per year)^[1]

• Excess facial or body hair, particularly on the chin, upper lip, chest or abdomen

• Oily skin and persistent acne, often on the face, chest or back

• Thinning hair or hair loss from the scalp (androgenic alopecia)

• Weight gain, particularly around the abdomen

• Difficulty conceiving due to irregular ovulation

• Signs of insulin resistance, such as darkened, velvety patches of skin (acanthosis nigricans) or skin tags, which can be a prompt to seek GP review

Not everyone with PCOS will have all of these features. Some people have very mild symptoms and are only diagnosed incidentally, for example during an ultrasound for another reason. Others experience significant disruption to daily life. Because symptoms overlap with many other conditions, it is important not to self-diagnose: a GP assessment is the appropriate starting point if you recognise several of these features in yourself.

How is PCOS diagnosed on the NHS?

PCOS is diagnosed using the Rotterdam criteria, requiring at least two of three features, confirmed through clinical history, blood tests including testosterone and SHBG, and often a pelvic ultrasound.

PCOS is diagnosed using the Rotterdam criteria, which require at least two of three features: irregular or absent ovulation, clinical or biochemical signs of excess androgens, and polycystic-appearing ovaries on ultrasound.^[1] No single test confirms PCOS on its own, so diagnosis involves a combination of clinical history, blood tests and, in many cases, a pelvic ultrasound.

Your GP will typically begin by asking about your menstrual cycle, symptoms such as acne or excess hair, and any difficulties conceiving. A pregnancy test is recommended as an early step when periods are absent or significantly delayed, before other investigations are pursued.

Blood tests will usually include:

• FSH and LH to help exclude other causes of menstrual irregularity (such as premature ovarian insufficiency); the LH:FSH ratio is not used to diagnose PCOS and is not recommended for this purpose in UK guidance^[1][2]

• Total testosterone and sex hormone-binding globulin (SHBG), to calculate the free androgen index and identify biochemical hyperandrogenism; DHEAS may also be measured if an adrenal source of androgens is suspected

• Thyroid function tests and prolactin, to rule out thyroid disease and hyperprolactinaemia

• Glucose assessment: a 75 g oral glucose tolerance test (OGTT) is the preferred method for detecting impaired glucose tolerance and type 2 diabetes in people with PCOS, as fasting glucose and HbA1c can miss impaired glucose tolerance; where OGTT is not feasible, fasting glucose or HbA1c may be used^[1]

A pelvic ultrasound may show multiple small follicles arranged around the edge of the ovary. The technical criteria for a polycystic-appearing ovary are assessed by the clinician performing the scan; this finding alone is not sufficient for diagnosis and is not always present. Ultrasound is not required if a person already meets the other two Rotterdam criteria. Importantly, ultrasound is not recommended for diagnosing PCOS in adolescents within approximately eight years of their first period, as a polycystic-appearing ovary can be a normal finding in this group.^[1][3]

Diagnosis can sometimes take time, and it is not uncommon for people to see their GP more than once before a clear picture emerges. If your GP suspects PCOS but is uncertain, they may refer you to a gynaecologist or endocrinologist for further assessment. Keeping a record of your menstrual cycle and symptoms before your appointment can be very helpful.

Could something else be causing my symptoms instead of PCOS?

Thyroid disorders, hyperprolactinaemia, non-classic congenital adrenal hyperplasia and androgen-secreting tumours can all mimic PCOS, so blood tests to exclude these are a standard part of the NHS workup.

Several other conditions can cause symptoms that closely resemble PCOS, which is why a thorough clinical assessment is essential before a diagnosis is made. Thyroid disorders, hyperprolactinaemia, congenital adrenal hyperplasia (CAH), and androgen-secreting tumours can all produce irregular periods, excess hair growth or hormonal imbalance, and each requires a different approach to management.

A pregnancy test should be the first step if your periods are absent or significantly delayed, as pregnancy is the most common cause of secondary amenorrhoea.

Thyroid dysfunction (both underactive and overactive thyroid) commonly disrupts the menstrual cycle and can cause weight changes and fatigue. A simple blood test measuring thyroid-stimulating hormone (TSH) can identify this. Hyperprolactinaemia, where the pituitary gland produces too much prolactin, can suppress ovulation and cause irregular periods; it is usually identified by measuring serum prolactin. It is worth noting that certain medicines, particularly antipsychotics, are a common cause of raised prolactin and should be considered as part of the assessment.

Non-classic congenital adrenal hyperplasia is a genetic condition affecting cortisol production that can cause elevated androgens and mimic PCOS closely. It is distinguished by measuring 17-hydroxyprogesterone, ideally in the early morning. Cushing's syndrome, caused by prolonged excess cortisol, can produce weight gain, acne and menstrual irregularity, though it is relatively rare.

Androgen-secreting tumours are uncommon but important to consider. Features that should prompt urgent specialist referral include rapidly progressive hirsutism developing over weeks to months, signs of virilisation (such as deepening of the voice or clitoromegaly), or a serum testosterone level markedly above the female reference range. These features require prompt assessment and should not be attributed to PCOS without specialist evaluation.

In younger adolescents, it is worth noting that irregular periods are common in the first two years after menstruation begins, and this does not necessarily indicate PCOS. Similarly, some people experience temporary hormonal disruption after stopping hormonal contraception, which can cause a period of irregular cycles.

Because the symptom overlap between these conditions is significant, blood tests to exclude thyroid disease, hyperprolactinaemia and CAH are a standard part of the NHS diagnostic workup for suspected PCOS, as outlined in NICE CKS guidance on PCOS.

What health risks are linked to PCOS in the long term?

PCOS is associated with higher risks of type 2 diabetes, cardiovascular risk factors, endometrial cancer and mental health difficulties, making ongoing monitoring and lifestyle management important.

People with PCOS have a higher risk of developing type 2 diabetes, cardiovascular risk factors, endometrial cancer and mental health difficulties compared with the general population. Understanding these risks is important not to cause alarm, but to support informed decisions about monitoring and lifestyle.

Insulin resistance is present in a significant proportion of people with PCOS, even those who are not overweight. Over time, this can progress to impaired glucose tolerance and type 2 diabetes. A 75 g oral glucose tolerance test (OGTT) is the preferred screening method at the time of diagnosis, as it detects impaired glucose tolerance that fasting glucose or HbA1c may miss. Repeat testing is typically recommended every one to three years, depending on individual risk factors such as obesity, a family history of diabetes, or a history of gestational diabetes, in line with NICE CKS guidance.^[1]

Cardiovascular risk factors are more prevalent in people with PCOS, including insulin resistance, dyslipidaemia (abnormal blood lipid levels), hypertension and obesity. The evidence for increased cardiovascular events is less clear-cut, so the focus of long-term care is on identifying and managing these risk factors: monitoring blood pressure, lipid profiles, smoking status and weight is a reasonable part of ongoing care.

Endometrial cancer risk is increased in people who have infrequent periods, because the endometrium (womb lining) is not shed regularly and can become thickened over time. Ensuring regular withdrawal bleeds, typically at least every three to four months, helps protect the endometrium. This can be achieved with a combined oral contraceptive pill or with a course of cyclic oral progestogen to induce a bleed. Your GP or specialist can advise on the most suitable approach for you.

Mental health is an important but sometimes overlooked aspect of PCOS. Rates of anxiety, depression and poor body image are higher in people with PCOS, likely reflecting both the physical symptoms and the challenges of living with a chronic condition.^[14][15] Psychological support should be considered as part of holistic care, and people should feel encouraged to raise mental health concerns with their GP.

What treatments and lifestyle changes can help manage PCOS?

PCOS is managed with lifestyle changes, the combined oral contraceptive pill for hormonal symptoms, metformin for insulin resistance, and specialist-supervised letrozole for ovulation induction in those trying to conceive.

PCOS has no cure, but symptoms can be effectively managed through a combination of lifestyle changes, hormonal treatments and, where relevant, medications to address specific features such as insulin resistance or fertility difficulties. Treatment is tailored to the individual's priorities, whether that is regulating periods, managing excess hair or acne, supporting fertility, or reducing long-term health risks.

Lifestyle changes are recommended as a first-line approach by NICE, particularly for people with PCOS who are overweight. Evidence from the 2023 International Evidence-Based Guideline for PCOS supports that even a modest reduction in body weight (around 5 to 10 per cent) can improve menstrual regularity, reduce androgen levels and improve insulin sensitivity. A balanced diet and regular physical activity are beneficial regardless of weight.

Hormonal contraception, particularly the combined oral contraceptive (COC) pill, is the standard first-line treatment for regulating periods and managing androgen-related symptoms such as acne and hirsutism. If a COC containing an anti-androgenic progestogen such as drospirenone is being considered, this should be discussed with a clinician. Co-cyprindiol (which contains cyproterone acetate) is not a first-line option: the MHRA has issued a Drug Safety Update advising that cyproterone acetate-containing medicines carry a risk of meningioma (a type of brain tumour), and their use should be restricted to people for whom other treatments have failed or are not tolerated.^[7][8] If co-cyprindiol is used, it should be at the lowest effective dose for the shortest necessary duration, with appropriate counselling about the risk.

Metformin, an insulin-sensitising medicine, may be offered to people with PCOS who have impaired glucose tolerance or who have not responded adequately to lifestyle changes, in line with NICE guidance. It is not licensed specifically for PCOS but is used off-label in this context. Common side effects include gastrointestinal symptoms such as nausea and diarrhoea, which are often reduced by taking it with food and starting at a low dose. Long-term use is associated with a risk of vitamin B12 deficiency, so monitoring may be appropriate. Renal function should be checked before starting and periodically during treatment. If you experience any suspected side effects from a medicine, you can report these to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk.

For people seeking to conceive, letrozole is recommended as first-line treatment for ovulation induction by the 2023 International PCOS Guideline, though it is used off-label in the UK and should be prescribed and supervised by a specialist.^[10][11] Clomifene may also be considered. Referral to a specialist fertility service is appropriate if conception has not occurred after 12 months of trying (or sooner, for example after six months if the person is over 36, or if there are known fertility factors), in line with NICE fertility guidance.

For those exploring weight management as part of their PCOS care, Bolt Pharmacy is a GPhC-registered UK online pharmacy offering online weight-management consultations, with prescriber review and pharmacist support, where clinically appropriate options can be discussed. Accessing care through a registered GP or specialist remains the cornerstone of PCOS management, and people should not feel they need to manage this condition alone.

Scientific References

1. Polycystic ovary syndrome – NICE Clinical Knowledge Summary.
2. The LH/FSH ratio has little use in diagnosing polycystic ovary syndrome.
3. Adolescent polycystic ovary syndrome according to the international guidelines.
4. Metformin and reduced vitamin B12 levels: new advice for monitoring patients at risk.
5. Polycystic ovary syndrome: metformin in women not trying to get pregnant – key points from the evidence.
6. Metformin hydrochloride – BNF.
7. Cyproterone acetate: new advice to minimise risk of meningioma.
8. High-dose cyproterone acetate: potential risk of (multiple) meningiomas.
9. Restrictions in use of cyproterone due to meningioma risk.
10. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome.
11. Polycystic ovary syndrome: Adaptation report 5 (GID-NG10436).
12. Infertility – NHS.
13. Initial advice to people concerned about delays in conception – NICE NG257.
14. Yoga as a complementary intervention for polycystic ovary syndrome management: a systematic review.
15. Depression and anxiety among women with polycystic ovarian syndrome in low- and middle-income countries: a systematic review and meta-analysis.

Frequently Asked Questions