Health condition · Clinically reviewed
PCOS, the guide that answers what to do next.
A hormonal and metabolic condition that goes far beyond periods and hair. Here is how it is diagnosed, treated, and how modern care — including GLP-1s — is changing outcomes.
Why trust this guide
- 01
Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
- 02
Sourced from guidance
Checked against NICE, RCOG and the 2023 International Evidence-Based Guideline for PCOS.
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Current for 2026
Reflects modern criteria and the role of GLP-1s alongside metformin and lifestyle.
Key facts
PCOS at a glance.
The essentials, in plain English — what PCOS is, how it is diagnosed, and how it is treated in the UK today.
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What it is
A hormonal condition of the reproductive years — insulin resistance drives high androgens, irregular ovulation and metabolic risk.
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How common
Around 1 in 10 women of reproductive age — often under-diagnosed.
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Diagnostic criteria
Rotterdam — any 2 of 3: irregular ovulation, clinical/biochemical hyperandrogenism, or polycystic ovarian morphology on ultrasound.
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Main features
Irregular periods, acne, hirsutism, insulin resistance, fertility challenges, weight difficulty.
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Long-term risks
Type 2 diabetes, gestational diabetes, cardiovascular disease, endometrial cancer if periods stop long-term.
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Treatment
Individualised — combined pill for cycle and skin; metformin/GLP-1s for metabolic; letrozole for fertility.
Why this guide matters
More than periods and hair.
PCOS is a hormonal, metabolic and reproductive condition all at once. The three points below shape everything else on this page.
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The right criteria matter
Rotterdam — any two of three — is decisive. Diagnosis should not rely on ultrasound alone.
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Metabolic health is central
PCOS is a cardiovascular and diabetes risk — not just a fertility issue.
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Fertility is usually treatable
Most women with PCOS conceive — often with letrozole, sometimes IVF.
How the diagnosis is made
From first suspicion to a clear plan.
The steps a UK GP will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Spotting the pattern and excluding other causes
Phase 2 · Confirming
Ultrasound if needed and Rotterdam criteria
Phase 3 · Managing
Individualised plan and long-term monitoring
- 01
Recognising
A recognisable pattern
Long or missing periods, acne, unwanted hair, weight difficulty — especially since teenage years.
- 02
Recognising
Rule out other causes
Pregnancy, thyroid disease, hyperprolactinaemia and rare adrenal causes need excluding first.
- 03
Recognising
Baseline blood tests
Total testosterone (with SHBG), TSH, prolactin, and if amenorrhoeic FSH and LH. HbA1c and lipids for metabolic screening.
- 04
Confirming
Ultrasound (if needed)
Transvaginal or pelvic ultrasound looks for polycystic ovarian morphology. Not required if the other two Rotterdam criteria are already met.
- 05
Confirming
Rotterdam criteria applied
Two of three (oligo/anovulation; hyperandrogenism; polycystic ovaries) confirms PCOS.
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Managing
Individualised plan
Cycle control, skin, fertility and metabolic priorities set what treatment starts.
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Managing
Long-term monitoring
Annual weight, BP, glucose (or HbA1c) and lipids — as cardiovascular risk is higher.
Typical timeline: 4-8 weeks from first appointment to a settled plan.
Symptoms
What PCOS actually looks like.
PCOS varies from person to person — but a few features recur. Here is what to look for, and when to seek urgent care.
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Irregular or missed periods
Fewer than 8 periods a year, or long gaps — a hallmark feature.
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Persistent acne
Adult acne, especially along the jawline — often androgen-driven.
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Excess hair (hirsutism)
Coarse hair on face, chest, back or abdomen — graded with the Ferriman-Gallwey score.
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Weight difficulty
Weight gain or difficulty losing — driven by insulin resistance, not willpower.
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Low mood & anxiety
More common in PCOS, deserves screening and treatment.
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Signs of insulin resistance
Skin tags, dark velvety skin patches (acanthosis nigricans) — especially in axillae or neck.
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Difficulty conceiving
Anovulation is common but treatable — most women with PCOS can conceive with support.
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Red-flag features
Very rapid hair growth, virilisation, or a period that has been missing for 6+ months — see the red-flag section.
Treatment
How PCOS is treated in the UK.
Individualised — priorities differ. What each option does, and where it fits into modern care including GLP-1s.
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Lifestyle first
Even a 5% weight loss can restore ovulation, improve symptoms and reduce diabetes risk.
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Combined hormonal pill
Regulates cycle, reduces androgens, improves acne and hirsutism — first-line for many.
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Metformin
Improves insulin resistance and menstrual regularity — first-line metabolic treatment.
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GLP-1 receptor agonists
Semaglutide or tirzepatide — strong evidence for weight loss and metabolic improvement in PCOS.
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Topical & cosmetic
Eflornithine cream, laser hair removal, and topical acne treatments alongside hormonal therapy.
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Letrozole for ovulation
First-line for ovulation induction (better than clomifene) if trying to conceive.
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Endometrial protection
If periods are >3 months apart, cyclical progestogen protects the endometrium.
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Mental-health support
Screening for anxiety and depression is standard; treatment includes CBT and, where needed, medication.
What this guide is based on
The sources behind every statement on this page.
International and UK guidance and patient-charity resources, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or specialist knows your history and can tell you which parts apply to you. If in doubt, ask.
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International Evidence-Based Guideline for the Assessment and Management of PCOS (2023).
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NICE. Polycystic ovary syndrome (Clinical Knowledge Summary).
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RCOG. Long-term consequences of PCOS (Green-top guideline 33).
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Verity — the UK charity for women with PCOS.
Red flags
When PCOS deserves prompt review.
PCOS is a long-term condition, but a few features should never be waited out. Act on these.
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No periods for 6+ months
Prolonged amenorrhoea raises endometrial risk — discuss cyclical progestogen or an IUS.
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Rapid hair growth or virilisation
Voice deepening or clitoral change — urgent review to exclude androgen-secreting tumour.
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Very heavy or prolonged bleeding
Especially after long gaps — assess for endometrial hyperplasia.
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Difficulty conceiving after 12 months
Fertility referral — PCOS is very treatable but early advice helps.
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HbA1c 42-47 (prediabetes)
Lifestyle intervention and consider medication — PCOS raises T2D risk significantly.
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Symptoms of pregnancy
Test early — PCOS pregnancies need earlier care and gestational-diabetes screening.
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Persistent low mood or anxiety
Both are more common in PCOS — effective treatment exists.
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Blood pressure raised
Cardiovascular risk is higher — treat vigorously and screen annually.
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Sudden onset of adult acne, hair growth
Rapid onset (as opposed to years) — deserves prompt investigation.
Living with it
A lifelong condition, but a very manageable one.
Four things that make the biggest difference day to day — long-term risk, fertility, weight and mental health.
A quiet reminder
Consistency beats intensity, every time.
Small, steady changes — kept up for months — do more than a heroic week that does not last.
- 01 Long-term
It is metabolic as well as reproductive
Cardiovascular and diabetes risk raise the stakes on lifestyle — and lower them with treatment.
- 02 Fertility
Plan early where possible
Most women with PCOS can conceive, often with support. Early advice avoids years of frustration.
- 03 Weight
Modest change moves the needle
A 5% loss restores ovulation in around half — and reduces long-term risks.
- 04 Mental health
Ask for support
Anxiety and depression are more common — screening and treatment are part of proper care.
Frequently asked
Everything we get asked about PCOS.
Quick answers on diagnosis, ultrasound, fertility, medication and when to see your GP.
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How is PCOS diagnosed?
By the Rotterdam criteria — any two of three: irregular ovulation, high androgens (clinical or blood), or polycystic ovarian morphology on ultrasound. Other causes of the same picture must be excluded first.
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Do I need an ultrasound?
Not if the other two Rotterdam criteria are already met. Ultrasound is used when the picture is unclear or when appearances would change management.
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What does “polycystic ovaries” mean on an ultrasound?
Multiple small follicles arranged around the ovary — it does not mean cysts in the everyday sense, and can be a normal finding in some women.
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Will I still be able to have children?
Most women with PCOS can conceive — naturally or with help. Letrozole is very effective at inducing ovulation; IVF is available when needed.
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What causes PCOS?
A combination of insulin resistance, hormonal imbalance and genetics — not one single cause. Lifestyle worsens or improves it, but does not create it.
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Is PCOS the same as endometriosis?
No — they are different conditions and can coexist. Endometriosis is womb-like tissue outside the uterus; PCOS is a hormonal/metabolic condition. Different tests, different treatments.
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Do I have to take the pill?
No — but the combined pill is often first-line for cycle regulation, acne and hirsutism. Alternatives exist depending on your priorities.
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Does metformin help?
Yes for many — it improves insulin resistance, menstrual regularity and modestly aids weight change. Not first-line for hair or acne alone.
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Are GLP-1s (semaglutide, tirzepatide) safe in PCOS?
Yes — and increasingly used. They improve weight, insulin resistance and menstrual regularity. Stop before conception; discuss with a specialist.
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When should I see my GP?
Fewer than 8 periods a year, six months without a period, adult acne or hirsutism, difficulty conceiving after 12 months, or a raised blood pressure or HbA1c.