PCOS Symptoms and Treatment: UK Guide

PCOS symptoms and treatment are topics that affect roughly 1 in 10 people with ovaries in the UK, making polycystic ovary syndrome one of the most common hormonal conditions seen in primary care. Symptoms range from irregular periods and excess hair growth to acne, fertility difficulties and mood changes, and they vary considerably between individuals. Although there is no single cure, a combination of NHS-supported medical treatments and lifestyle changes can effectively manage symptoms and reduce the risk of longer-term complications such as type 2 diabetes. This article explains what PCOS is, how it is diagnosed, and what options are available.

What is PCOS and how does it affect your body?

PCOS is a hormonal condition affecting roughly 1 in 10 people with ovaries, characterised by elevated androgens, disrupted ovulation and, frequently, insulin resistance, which raises the risk of type 2 diabetes.

Polycystic ovary syndrome (PCOS) is a common hormonal condition affecting people with ovaries, typically becoming apparent during the reproductive years. It is one of the most frequently diagnosed endocrine disorders in the UK. NHS guidance estimates that PCOS affects roughly 1 in 10 people with ovaries, though the condition is thought to be underdiagnosed because its symptoms overlap with other conditions.^[1] Despite its name, not everyone with PCOS has cysts on their ovaries; the term refers to a cluster of symptoms linked to hormonal imbalance rather than a single structural problem.

Diagnosis is usually based on the Rotterdam criteria, which require at least two of the following three features: irregular or absent ovulation; clinical or biochemical signs of elevated androgens; and polycystic ovarian morphology on ultrasound. A diagnosis can therefore be made without an ultrasound if the other two criteria are met. In adolescents, diagnosis requires particular care because irregular cycles and acne are common in the years following the first period, and the Rotterdam criteria may not apply in the same way.

The underlying mechanism involves a disruption in the balance of reproductive hormones, particularly elevated levels of androgens (often called "male hormones") such as testosterone. The ovaries may produce higher than normal amounts of androgens, which can interfere with the development and release of eggs during the menstrual cycle. This disruption often leads to irregular or absent ovulation, which in turn affects menstrual regularity and fertility.

Insulin resistance is also closely associated with PCOS. When the body's cells do not respond efficiently to insulin, the pancreas produces more of it to compensate. Higher insulin levels can further stimulate androgen production in the ovaries, creating a cycle that worsens hormonal imbalance.^[2][10] This link between PCOS and insulin resistance means that people with the condition have a higher risk of developing type 2 diabetes and are more likely to have cardiometabolic risk factors such as raised blood pressure and unfavourable lipid profiles.^[9][10] Whether this translates into a higher rate of cardiovascular events over a lifetime is less certain, and the evidence continues to evolve.

When PCOS is suspected, a GP will typically arrange blood tests to assess androgen levels and to exclude other conditions that can cause similar symptoms, including thyroid disorders, raised prolactin, and non-classical congenital adrenal hyperplasia. A pregnancy test is usually performed first where relevant. Long-term monitoring for people with PCOS generally includes periodic checks of blood pressure, fasting glucose or HbA1c, and lipids, in line with NICE CKS guidance on PCOS.^[2]

PCOS is a long-term condition with no single cure, but its symptoms can be effectively managed with the right combination of medical treatment and lifestyle adjustment. Early diagnosis is important, as it allows for timely intervention to reduce the risk of longer-term complications.

What are the most common symptoms of PCOS in the UK?

The most common PCOS symptoms are irregular or absent periods, hirsutism, acne, scalp hair thinning and fertility difficulties, though presentation varies widely between individuals.

The most common symptoms of PCOS include irregular or absent periods, excess hair growth, acne, and difficulty conceiving, though the condition presents differently in each individual. Because symptoms vary so widely, PCOS is often not recognised for some time, and some people live with it for years before receiving a formal diagnosis. It is also important to note that PCOS can occur at any body weight; it is not confined to people who are overweight.

Menstrual irregularity is one of the hallmark features. Periods may be infrequent (fewer than eight cycles per year), unpredictable, or absent altogether (a condition known as amenorrhoea).^[2][6] This occurs because disrupted ovulation means the uterine lining does not shed on a regular cycle. When periods do occur, they may be heavier or more prolonged than usual. Pelvic pain is not a characteristic feature of PCOS; if prominent pelvic pain is present, other causes such as endometriosis should be considered and discussed with a GP.

Excess androgen activity produces a range of physical signs:

• Hirsutism: Unwanted hair growth on the face, chest, back or abdomen

• Acne: Persistent or severe spots, particularly along the jawline and chin

• Alopecia: Thinning hair or hair loss from the scalp, following a pattern similar to male-pattern baldness

• Oily skin: Increased sebum production linked to elevated androgens

Weight gain or difficulty losing weight is frequently reported, particularly around the abdomen, and is closely tied to insulin resistance. Mood changes, including low mood and anxiety, are increasingly recognised as part of the PCOS experience, though the precise relationship is still being studied.

Fertility difficulties arise because irregular ovulation reduces the chances of conception. However, many people with PCOS do conceive, either naturally or with medical support.

Some symptoms warrant prompt medical review rather than routine investigation. You should contact your GP promptly if you notice rapid or severe hair growth, deepening of the voice, or other signs of virilisation, as these may indicate a different or additional diagnosis requiring urgent assessment. Prolonged or very heavy bleeding that is causing significant symptoms also warrants prompt review. If you are experiencing several of the more typical symptoms together, speaking to your GP is the recommended first step towards investigation and diagnosis.

What treatments are available for PCOS on the NHS?

NHS PCOS treatment is symptom-led: the combined pill for menstrual regulation and androgen excess, letrozole for ovulation induction, and metformin off-label for insulin resistance and cycle irregularity.

NHS treatment for PCOS is tailored to the individual's most troublesome symptoms and whether they are trying to conceive, as there is no single treatment that addresses all aspects of the condition. NICE CKS guidance on PCOS and NICE CG156 (Fertility problems: assessment and treatment) outline a range of pharmacological and non-pharmacological options depending on the presenting concerns.

For menstrual regulation and contraception, the combined oral contraceptive pill is commonly recommended. It helps regulate periods, reduce androgen levels, and improve acne and hirsutism. Where the combined pill is not suitable, endometrial protection in anovulatory PCOS is typically provided by cyclical oral progestogen taken every three to four months, or by a levonorgestrel intrauterine system (LNG-IUS). A progestogen-only pill alone may not reliably protect the endometrium in anovulatory PCOS, and the most appropriate approach should be discussed with a clinician.

For people with PCOS who are trying to conceive, ovulation induction may be offered, and this is usually managed by a specialist. Letrozole (an aromatase inhibitor) is recommended by NICE CG156 as a first-line option for ovulation induction in anovulatory PCOS.^[12][13] Clomifene citrate has historically been used but is now less favoured in some settings. In cases where these are unsuccessful, gonadotrophin injections or surgical options such as laparoscopic ovarian drilling may be considered. Referral to a fertility service is appropriate after a period of trying to conceive without success, or earlier depending on age, the degree of menstrual irregularity, or other clinical factors.

Metformin, a medicine more commonly associated with type 2 diabetes, is sometimes prescribed off-label for PCOS, particularly in people with a BMI of 25 or above where insulin resistance or menstrual irregularity is a concern.^[2][15] Its primary roles in PCOS are improving cycle regularity and supporting ovulation induction in selected patients; it is not a weight-loss medicine in this context. Patients should be aware that its use in PCOS is not always within its licensed indication, and prescribing decisions should be made on an individual basis.

For hirsutism and acne, topical treatments or eflornithine cream (licensed for facial hirsutism) may be considered.^[2] Co-cyprindiol is sometimes used for severe acne or hirsutism but carries a higher risk of venous thromboembolism (VTE) than standard combined pills and is generally reserved for cases where other treatments have not worked.^[3][4] Spironolactone is used off-label for hirsutism and acne in PCOS. Because it has anti-androgenic effects that could harm a developing baby, effective contraception is essential during treatment and it must not be used during pregnancy. Clinician-led monitoring, including potassium levels where clinically indicated, is appropriate during spironolactone use. Prescribing decisions for all anti-androgen medicines should be made by a clinician familiar with the individual's full medical history.

Bolt Pharmacy is a GPhC-registered UK online pharmacy offering online consultations, with prescriber review and pharmacist support, and is one option for people seeking guidance on managing certain PCOS-related concerns alongside their NHS care. Referral to a specialist endocrinologist or gynaecologist is appropriate where symptoms are complex or initial treatments have not been effective.

Lifestyle changes that can help manage PCOS symptoms

A sustainable energy deficit, low-GI diet and at least 150 minutes of moderate aerobic activity per week can improve hormonal balance, menstrual regularity and insulin sensitivity in PCOS.

Lifestyle modification is a cornerstone of PCOS management and is recommended by NICE CKS as a first-line intervention, particularly for people who are living with overweight or obesity. Even modest weight loss can meaningfully improve hormonal balance, menstrual regularity and fertility in those for whom it is appropriate. Clinical studies have reported improvements in ovulation and androgen levels with a reduction of around 5 to 10 per cent of body weight, though individual responses vary.^[6][8] For people with PCOS who are not overweight, lifestyle goals should focus on diet quality, physical fitness, sleep and metabolic health rather than weight loss.

Diet plays a significant role. The 2023 international evidence-based guideline for PCOS, alongside NICE CKS, emphasises that there is no single diet that is superior for PCOS.^[6][7] The most important principle for those aiming to lose weight is achieving a sustainable energy deficit through a healthy eating pattern. Practical dietary principles that support stable blood glucose levels include:

• Choosing lower glycaemic index (GI) carbohydrates such as wholegrains, legumes and vegetables over refined or sugary foods

• Including adequate protein and healthy fats to support satiety and blood sugar control

• Reducing ultra-processed foods and sugary drinks

• Eating regular meals to avoid large fluctuations in blood glucose

A referral to a registered dietitian can be helpful for personalised guidance, and GPs can arrange this where appropriate.

Physical activity improves insulin sensitivity, supports weight management and has a positive effect on mood. The UK Chief Medical Officers' Physical Activity Guidelines recommend at least 150 minutes of moderate-intensity aerobic activity per week, alongside strength or resistance training on two or more days.^[16][17] Both aerobic exercise and resistance training have shown benefit in PCOS, and the best approach is one that is sustainable and enjoyable for the individual.

Stress management and sleep are often overlooked but are clinically relevant. Chronic stress can elevate cortisol, which may worsen insulin resistance and hormonal disruption. Techniques such as mindfulness, cognitive behavioural therapy (CBT) and adequate sleep hygiene can support overall wellbeing alongside medical treatment. If you feel your symptoms are not well controlled, returning to your GP for a review is always appropriate.

Scientific References

1. Polycystic ovary syndrome (PCOS) – NHS.
2. Polycystic ovary syndrome | Treatment summaries – BNF – NICE.
3. Co-cyprindiol | Drugs – BNF – NICE.
4. Combined hormonal contraceptives and venous thromboembolism: review confirms risk is small.
5. Adolescents diagnosed with polycystic ovary syndrome under the Rotterdam criteria but not meeting the diagnosis under the updated guideline.
6. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome (Teede HJ et al.).
7. International evidence-based guideline on assessment and management of PCOS – A Nordic perspective. Acta Obstet Gynecol Scand 2023.
8. Lifestyle management in polycystic ovary syndrome – beyond diet and physical activity. BMC Endocrine Disorders 2023.
9. Lifestyle interventions for cardiometabolic health in women with polycystic ovary syndrome: a systematic review and network meta-analysis. Human Reproduction Update.
10. Recent advances in polyendocrine metabolic ovarian syndrome, formerly polycystic ovary syndrome, with emphasis on endocrine and metabolic dysfunction and cardiovascular risk. Journal of Internal Medicine.
11. Association of polycystic ovary syndrome with metabolic syndrome and its components in adolescents: a systematic review and meta-analysis. Frontiers in Medicine.
12. Phenotype-specific efficacy of letrozole versus clomiphene citrate in polycystic ovary syndrome: a prospective cohort study. BMC Women's Health.
13. Efficacy of sequential letrozole and gonadotropin therapy for ovulation induction in women with polycystic ovary syndrome: a systematic review and meta-analysis. Annals of Medicine and Surgery.
14. Prepregnancy insulin resistance and fertility and pregnancy outcomes in women with polycystic ovarian syndrome. Obstetrics and Gynecology.
15. Metformin treatment of PCOS during adolescence and the reproductive period. European Journal of Obstetrics, Gynecology, and Reproductive Biology.
16. UK Chief Medical Officers' Physical Activity Guidelines.
17. Physical activity guidelines for adults aged 19 to 64 – NHS.

Frequently Asked Questions