What Does PCOS Stand For? Symptoms and Treatment

Polycystic ovary syndrome, commonly known by the question 'what does PCOS stand for', is one of the most frequently diagnosed hormonal conditions in the UK, affecting roughly 1 in 10 people with ovaries. PCOS involves an imbalance of reproductive hormones, particularly elevated androgens, which can disrupt ovulation, menstrual cycles, fertility, skin health and metabolism. Symptoms vary widely between individuals, and the condition can present at different life stages. This article explains what PCOS is, its most common symptoms, what causes it, and the treatments and lifestyle changes available to help manage it effectively.

What does PCOS stand for and what is it?

PCOS stands for polycystic ovary syndrome, a hormonal condition affecting roughly 1 in 10 people with ovaries in the UK, diagnosed using the Rotterdam criteria when at least two of three defining features are present.

PCOS stands for polycystic ovary syndrome, a common hormonal condition that affects people with ovaries, typically during their reproductive years. The name refers to the appearance of the ovaries on ultrasound, where multiple small follicles (sometimes described as cysts) can be seen, although not everyone with PCOS has this finding and it is not required for diagnosis. PCOS is one of the most frequently diagnosed hormonal disorders in the UK, estimated to affect roughly 1 in 10 people with ovaries, according to the NHS.^[1]

The condition is characterised by an imbalance in reproductive hormones, often involving elevated levels of androgens (sometimes called male hormones), which can disrupt the normal development and release of eggs from the ovaries. This disruption can affect menstrual regularity, fertility, metabolism and skin health, among other areas. Because PCOS presents differently from person to person, it can take time to diagnose and may be identified at different life stages, sometimes only when someone is trying to conceive.

Diagnosis in the UK is typically made using the Rotterdam criteria, which require at least two of the following three features: irregular or absent periods, evidence of elevated androgens (either through blood tests or physical signs), and polycystic ovaries on ultrasound. Where two of these features are clearly present and other causes have been excluded, ultrasound may not be necessary in adults. NICE guidance supports this approach and recommends that other conditions with similar presentations are excluded before a diagnosis of PCOS is confirmed; these include thyroid disorders, hyperprolactinaemia, non-classic congenital adrenal hyperplasia, Cushing's syndrome, and androgen-secreting tumours.

In adolescents, diagnosis requires particular care. Within approximately two years of the first menstrual period, irregular cycles are common and may not indicate PCOS. Ultrasound criteria also differ in this age group, and imaging is generally not recommended for diagnostic purposes in early post-menarchal adolescents. A specialist opinion is advisable if PCOS is suspected in a young person shortly after periods begin.

What are the most common symptoms of PCOS?

The most common symptoms are irregular or absent periods, hirsutism, acne, oily skin and difficulty conceiving, all driven primarily by elevated androgen levels and disrupted ovulation.

The most common symptoms of PCOS include irregular or absent menstrual periods, excess hair growth (hirsutism), acne, oily skin, and difficulty conceiving. These symptoms arise primarily from elevated androgen levels and disrupted ovulation, though their severity varies considerably between individuals. Some people experience only mild symptoms, while others find that PCOS significantly affects their daily life and wellbeing.

Irregular periods are among the most frequently reported features. Cycles may be longer than 35 days, unpredictable, or absent altogether (a condition known as amenorrhoea). Because ovulation is often irregular or absent, fertility can be affected, and PCOS is one of the leading causes of ovulatory infertility in the UK.^[14][15] Hirsutism, which refers to coarse or dark hair appearing on the face, chest, back or abdomen, affects a significant proportion of those with PCOS and can have a considerable psychological impact.

Weight gain or difficulty managing weight is also commonly reported, and many people with PCOS have insulin resistance, meaning the body does not respond efficiently to insulin. This can contribute to weight gain around the abdomen and increases the longer-term risk of developing type 2 diabetes. Physical signs of insulin resistance, such as acanthosis nigricans (darkened, velvety patches of skin, typically at the neck or armpits), may also be present. Hair thinning or loss from the scalp (alopecia) and mood changes, including low mood and anxiety, are also recognised features. If you are experiencing low mood or anxiety related to PCOS, speaking to your GP about mental health support is worthwhile; organisations such as the PCOS charity Verity also offer peer support.

If you experience very heavy or prolonged bleeding, severe acute pelvic pain, or pain alongside bleeding in early pregnancy, seek urgent medical attention. Persistent amenorrhoea or cycles longer than 90 days should prompt a GP review, as prolonged infrequent periods can affect the lining of the womb (endometrium) and may require treatment to protect it.

It is important to note that not everyone with PCOS will experience all of these symptoms, and some people are diagnosed incidentally during investigations for an unrelated concern. If you are experiencing several of these symptoms, speaking to your GP is the appropriate first step. They can arrange relevant investigations, which may include blood tests for testosterone, sex hormone-binding globulin (SHBG) or free androgen index, prolactin, thyroid-stimulating hormone (TSH), HbA1c or fasting glucose, and fasting lipids, as well as measurement of blood pressure, BMI and waist circumference, and an ultrasound referral where appropriate.

What causes PCOS and who is most at risk?

PCOS results from a combination of genetic, hormonal and environmental factors; insulin resistance is central to many cases, and risk is higher in those with a family history of PCOS or type 2 diabetes.

The exact cause of PCOS is not fully understood, but the condition is thought to result from a combination of genetic, hormonal and environmental factors rather than a single identifiable cause. Research consistently shows that PCOS runs in families, suggesting a significant genetic component. If a close female relative has PCOS, the likelihood of developing it is higher, though having a family history does not make it inevitable.

Insulin resistance plays a central role in many cases. When cells do not respond effectively to insulin, the pancreas produces more of it to compensate. Higher insulin levels can stimulate the ovaries to produce excess androgens, which in turn disrupt ovulation and contribute to many of the symptoms associated with PCOS. This link between insulin resistance and androgen excess is one reason why lifestyle factors, particularly diet and physical activity, can influence symptom severity.

Low-grade chronic inflammation has also been identified as a contributing factor in some research, and there is evidence that inflammatory markers are elevated in people with PCOS. This remains an active area of research and it is not yet clear whether inflammation is a cause or a consequence of the condition.

PCOS can affect people with ovaries of any body weight, ethnicity or background, though certain groups may face a higher risk. People with a family history of PCOS or type 2 diabetes, those with obesity, and those from South Asian backgrounds appear to have a higher prevalence, according to NHS and NICE sources.^[4] Importantly, PCOS is not caused by anything a person has done, and it is not a reflection of lifestyle choices.

PCOS is also associated with a number of longer-term health risks that are worth being aware of. These include an increased risk of type 2 diabetes, gestational diabetes, hypertensive disorders in pregnancy, dyslipidaemia, non-alcoholic fatty liver disease (NAFLD), obstructive sleep apnoea (OSA), and endometrial hyperplasia or endometrial cancer (particularly where periods are very infrequent and the womb lining is not shed regularly).^[16][17] Periodic metabolic screening, including blood glucose, blood pressure and lipid checks, is recommended by UK guidance for people with PCOS.^[6][20] Your GP can advise on how often these should be carried out based on your individual risk factors.

What treatments and lifestyle changes can help manage PCOS?

PCOS symptoms are managed through lifestyle modification, combined oral contraceptives, metformin and, for fertility, letrozole under specialist care, with treatment tailored to each person's priorities.

PCOS cannot be cured, but its symptoms can be effectively managed through a combination of lifestyle changes and medical treatments tailored to each person's priorities, whether that is regulating periods, improving fertility, managing skin symptoms or reducing longer-term health risks. NICE guidance recommends that treatment decisions are made collaboratively, taking into account which symptoms are most affecting quality of life.

Lifestyle modification is considered a first-line approach for many people, particularly those with insulin resistance or excess weight. Regular physical activity and a balanced diet that supports stable blood glucose levels can improve insulin sensitivity, help regulate menstrual cycles and reduce androgen levels. Even modest weight loss, where relevant, has been shown to have a meaningful effect on hormonal balance and ovulation in some individuals.

Medical treatments include:

• Combined oral contraceptive pills, which can regulate periods, reduce androgen levels and improve acne and hirsutism. They also provide endometrial protection where periods are infrequent. Where a combined pill is not suitable, cyclical progestogen may be used to protect the womb lining.

• Metformin, an insulin-sensitising medicine sometimes used off-label in PCOS to improve metabolic features and support cycle regularity, particularly in those with insulin resistance.^[3][23]

• Treatments for acne and hirsutism: co-cyprindiol (a combined preparation with anti-androgenic properties) may be prescribed for moderate to severe acne or hirsutism where other treatments have not worked. It carries a higher risk of venous thromboembolism (VTE) compared with many standard combined pills and is not recommended as a first-line contraceptive; it is generally used for a limited period.^[7][8] Topical eflornithine cream can help slow facial hair growth. Anti-androgens such as spironolactone may be considered off-label for hirsutism; reliable contraception is required alongside these medicines.^[24] Non-pharmacological hair-removal methods (such as laser or electrolysis) are also recognised options.

• Ovulation induction treatments for those trying to conceive, usually managed by a specialist. Letrozole is recommended as first-line treatment for anovulatory infertility due to PCOS under specialist monitoring, though it is used off-label for this indication in the UK.^[6][21] Clomifene is an alternative that may also be considered.

If you are taking any medicines for PCOS and experience suspected side effects, you can report these to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk.

For people seeking support with weight management alongside PCOS, an online consultation with a registered provider such as Bolt Pharmacy, a GPhC-registered UK online pharmacy offering prescriber-led weight-management consultations, may be one avenue to explore alongside GP care. Any prescription medicine would only be provided where clinically appropriate following a consultation.

Ongoing metabolic monitoring is an important part of long-term PCOS management. Your GP can arrange periodic checks for blood glucose or HbA1c, blood pressure, and lipids, and can assess for conditions such as NAFLD or OSA where these are clinically indicated. Mental health support is also an important part of PCOS management, as anxiety and low mood are common. If symptoms are not adequately controlled, your GP can refer you to an endocrinologist or gynaecologist with expertise in PCOS.

Scientific References

1. Polycystic ovary syndrome (PCOS).
2. Polycystic ovary syndrome: metformin in women not planning pregnancy (ESUOM6) – what is PCOS?.
3. Polycystic ovary syndrome: metformin in women not planning pregnancy – full resource (ESUOM6).
4. Equality and health inequalities assessment – Polycystic ovary syndrome (GID-NG10436).
5. Guideline scope – Polyendocrine metabolic ovarian syndrome / PCOS (GID-NG10436).
6. Polyendocrine metabolic ovarian syndrome – NICE guideline document (GID-NG10436).
7. Cyproterone acetate with ethinylestradiol (co-cyprindiol): balance of benefits and risks remains positive.
8. Co-cyprindiol – British National Formulary.
9. Co-cyprindiol patient information leaflet.
10. Differential diagnosis of hyperandrogenism in women with polycystic ovary syndrome. Rachoń D. Exp Clin Endocrinol Diabetes. 2012..
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12. Adolescents diagnosed with polycystic ovary syndrome under the Rotterdam criteria but not meeting the diagnosis under the updated guideline. Human Reproduction..
13. Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review. Diagnostics (Basel). 2022..
14. Causal adiposity and clinical validation of regional fat distribution in PMOS: a multi-modal analysis. International Journal of Obesity..
15. GATA1 silencing restrains granulosa cell ferroptosis through downregulation of TFRC in polycystic ovary syndrome. Scientific Reports..
16. Screening for endometrial hyperplasia and endometrial cancer in premenopausal women with PCOS. BMJ Open..
17. Polycystic ovary syndrome and risk of endometrial hyperplasia and endometrial cancer in women with abnormal uterine bleeding: A systematic review and meta-analysis. Biomolecules & Biomedicine..
18. Risk of cardiovascular and cerebrovascular events in polycystic ovarian syndrome women: An updated meta-analysis of cohort studies. Turkish Journal of Obstetrics and Gynecology..
19. The Role of Lifestyle Interventions in PCOS Management: A Systematic Review. Nutrients. 2025..
20. Polycystic ovary syndrome (PCOS): assessment and management – consultation comments and responses (GID-NG10436).
21. Efficacy of sequential letrozole and gonadotropin therapy for ovulation induction in women with PCOS: a systematic review and meta-analysis. Annals of Medicine and Surgery..
22. Extended Letrozole Treatment for Ovulation Induction and Clinical Pregnancy in Conventional Treatment-resistant PCOS Patients. Journal of Obstetrics and Gynaecology of India..
23. Metformin for treating polycystic ovary syndrome in women who are not trying to get pregnant (ESUOM6).
24. Short-Term, Low-Dose Spironolactone for Treatment of Hirsutism. Viveiros TM et al. Annals of Medicine and Surgery..
25. A three-component cognitive behavioural lifestyle program for preconceptional weight-loss in women with PCOS: a protocol for a randomised controlled trial. Reproductive Health. 2017..
26. AACE/ACE/AE-PCOS Society Disease State Clinical Review: Guide to Best Practices in Evaluation and Treatment of PCOS – Part 2. Endocrine Practice. 2016..

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