Polycystic Ovary Syndrome (PCOS)

What PCOS is

Polycystic ovary syndrome (PCOS) is a hormone condition that can affect periods, hair growth, fertility, skin and mood. The NHS now calls it polyendocrine metabolic ovarian syndrome (PMOS), noting it used to be called PCOS. This guide uses PCOS, the long-used name. [1] It can affect anyone who has ovaries, usually starting around puberty. [1] Symptoms can be mild, severe, or absent. [1] There is no cure, but treatment and lifestyle changes help. [1]

Common features

The NHS lists irregular periods or long gaps, excess hair growth or hair loss, weight gain or difficulty losing weight, difficulty getting pregnant, depression or anxiety, oily skin and acne, tiredness, and dark patches of skin on the neck or armpits. [1] Many of these also have other causes, so having them does not mean you have PCOS. [1] See also acne, hair shedding and thinning and heavy and irregular periods.

How it is evaluated

A clinician may arrange blood tests for hormones and insulin resistance, and an ultrasound of the ovaries in adults. [1] The 2023 international guideline simplified the diagnostic approach and allows anti-Mullerian hormone (AMH) testing as an alternative to ultrasound in adults only. [2] It also stresses that PCOS involves broader features: metabolic risk, cardiovascular disease, sleep apnea and a very high prevalence of psychological features. [2]

Established care

• Lifestyle: a balanced diet and regular exercise are advised by the NHS, along with talking therapy when mood is affected. [1] The guideline maintains emphasis on healthy lifestyle and emotional wellbeing, with attention to weight stigma. [2]
• Medicines: hormonal contraception or an intrauterine system for irregular periods, metformin, medicines to reduce hair growth, acne treatments, and fertility medicines where needed. [1]
• Longer-term health: PCOS can increase the risk of type 2 diabetes, high blood pressure, cardiovascular disease, fatty liver disease and uterine cancer, so regular check-ups matter. [1] MedlinePlus lists PCOS among factors that raise heart disease risk. [3]

The guideline reports that evidence in PCOS has improved but is still of low to moderate quality. [2]

Supplements: what the research shows

Evidence labels: promising but limited, mixed, insufficient evidence.

Do not stop prescribed medicines for supplements. Check medication interactions and product quality. Pregnancy planning: see preconception and pregnancy. In the sources we read, no supplement was shown to guarantee fertility. PCOS can make pregnancy harder, usually because the ovaries do not release an egg each month, and clinician-guided treatments exist. [1]

When to get help

See a clinician if you think you may have PCOS or symptoms affect daily life. [1] Seek mental health support if mood is low; call or text 988 in the US in a crisis. See when to get help.