PCOS: Symptoms, Diagnosis,
and Treatment Options
PCOS can affect periods, skin, fertility and metabolic health. Diagnosis depends on the whole clinical picture and on excluding other possible causes; no single blood test or ultrasound result confirms it alone.
Evidence-only patient information
In brief: PCOS is a common hormonal condition with a range of possible symptoms. Diagnosis uses recognised criteria after other causes have been considered; ultrasound and blood tests may be helpful, but are not automatic or diagnostic in isolation. The clinic confirms the appropriate assessment pathway, reporting and follow-up arrangements at booking.
Symptoms of PCOS
PCOS is a heterogeneous condition — no two women present identically. The core features relate to androgen excess and ovulatory dysfunction, but metabolic and psychological manifestations are also common and significantly affect quality of life. A 2023 review in Diagnostics highlighted that PCOS remains substantially underdiagnosed, with many women experiencing delays of several years before receiving a formal diagnosis.[2]
| Symptom | Detail |
|---|---|
| Irregular or absent periods | Oligomenorrhoea (cycles >35 days) or amenorrhoea — due to anovulation |
| Hyperandrogenism | Excess male hormones causing acne, hirsutism (excess hair growth), and male-pattern hair thinning |
| Polycystic ovarian morphology | An ultrasound appearance that can be one feature considered as part of assessment |
| Weight change | Weight may change for many reasons and is not used alone to diagnose PCOS |
| Fertility difficulties | Anovulation is the most common cause of infertility in women with PCOS |
| Mood changes | Depression and anxiety are significantly more prevalent in women with PCOS |
| Metabolic features | Insulin resistance, impaired glucose tolerance, and dyslipidaemia |
How PCOS Is Diagnosed
PCOS is commonly diagnosed using Rotterdam criteria: two of three features — ovulatory dysfunction, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology — after other causes have been excluded. The choice of blood tests, metabolic assessment and ultrasound depends on age, symptoms, medicines, pregnancy possibility and the clinical question.[4]
| Investigation | Purpose |
|---|---|
| LH and FSH | Elevated LH:FSH ratio (>2:1) is common in PCOS but not diagnostic |
| Total and free testosterone | May help assess biochemical hyperandrogenism where clinically appropriate |
| SHBG | Often low in PCOS due to insulin resistance — used to calculate free androgen index |
| Fasting glucose and insulin | Assess insulin resistance — HbA1c for diabetes screening |
| Thyroid function (TSH) | Exclude thyroid disease as a cause of irregular periods |
| Prolactin | Exclude hyperprolactinaemia as a cause of anovulation |
| Pelvic ultrasound | Assess ovarian morphology — polycystic appearance on ultrasound is one of three Rotterdam criteria |
Evidence-only information
PCOS assessment considers symptoms, menstrual pattern, relevant history and exclusion of other causes. Tests are selected to answer a clinical question, not simply to complete a standard panel.
Frequently Asked Questions
How is PCOS diagnosed?
In adults, PCOS may be considered after other possible causes have been investigated when two of three features are present: ovulatory dysfunction, clinical or biochemical hyperandrogenism, or polycystic ovarian morphology. An ultrasound result alone does not establish the diagnosis, and ultrasound is not used to diagnose PCOS in adolescents.
Can PCOS be cured?
PCOS is a long-term condition. Support and treatment decisions depend on the symptoms, health priorities and whether pregnancy is planned, and should be discussed with an appropriate clinician.
Does PCOS affect fertility?
PCOS can affect ovulation and may contribute to difficulty conceiving. Fertility assessment and treatment options are individual; a result cannot predict whether someone will conceive.
How do I arrange an assessment for possible PCOS?
The clinic confirms the appropriate appointment route, any referral requirements, and whether gynaecology, blood tests or imaging may be appropriate after discussing your symptoms and history. It also confirms reporting and follow-up arrangements at booking.
What is the link between PCOS and diabetes?
Women with PCOS have a significantly increased risk of type 2 diabetes due to insulin resistance. The 2018 international PCOS guideline recommends screening for impaired glucose tolerance and type 2 diabetes in all women with PCOS, particularly those with additional risk factors such as obesity or family history.
References
- [1]Neven A, Laven J, Teede HJ, Boyle JA. A Summary on Polycystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management. Semin Reprod Med. 2018;36(1):5–12. https://doi.org/10.1055/s-0038-1667351
- [2]Fahs D, Abou-Abbas L, Hamdan Z, Salameh P. Polycystic Ovary Syndrome: Pathophysiology and Controversies in Diagnosis. Diagnostics. 2023;13(7):1252. https://doi.org/10.3390/diagnostics13071252
- [3]Lazareva L. Prevalence of polycystic ovary syndrome using Rotterdam 2003 criteria (literature review). Acta Biomed Sci. 2023;8(3):27–35. https://doi.org/10.29413/ABS.2023-8.3.4
- [4]Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602–1618. https://doi.org/10.1093/humrep/dey256
- [5]Lim SS, Hutchison SK, Van Ryswyk E, et al. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2019;3:CD007506. https://doi.org/10.1002/14651858.CD007506.pub4
- [6]NICE. Polycystic ovary syndrome. NICE Clinical Knowledge Summary. 2023. https://cks.nice.org.uk/topics/polycystic-ovary-syndrome/
When to seek urgent help
Seek urgent NHS care for severe sudden pelvic pain, very heavy bleeding with faintness, or pain or bleeding in pregnancy. For non-urgent concerns, the clinic can explain suitable assessment routes at booking.
Book a PCOS Assessment
The clinic can discuss whether a PCOS assessment route is appropriate and confirm appointment, reporting and follow-up arrangements at booking.
020 3146 9508