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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.

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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.

  • 03

    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.

  • What it is

    A hormonal condition of the reproductive years - insulin resistance drives high androgens, irregular ovulation and metabolic risk.

  • How common

    Around 1 in 10 women of reproductive age - often under-diagnosed.

  • Diagnostic criteria

    Rotterdam - any 2 of 3: irregular ovulation, clinical/biochemical hyperandrogenism, or polycystic ovarian morphology on ultrasound.

  • Main features

    Irregular periods, acne, hirsutism, insulin resistance, fertility challenges, weight difficulty.

  • Long-term risks

    Type 2 diabetes, gestational diabetes, cardiovascular disease, endometrial cancer if periods stop long-term.

  • 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.

  • The right criteria matter

    Rotterdam - any two of three - is decisive. Diagnosis should not rely on ultrasound alone.

  • Metabolic health is central

    PCOS is a cardiovascular and diabetes risk - not just a fertility issue.

  • 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.

  1. 01

    Recognising

    A recognisable pattern

    Long or missing periods, acne, unwanted hair, weight difficulty - especially since teenage years.

  2. 02

    Recognising

    Rule out other causes

    Pregnancy, thyroid disease, hyperprolactinaemia and rare adrenal causes need excluding first.

  3. 03

    Recognising

    Baseline blood tests

    Total testosterone (with SHBG), TSH, prolactin, and if amenorrhoeic FSH and LH. HbA1c and lipids for metabolic screening.

  4. 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.

  5. 05

    Confirming

    Rotterdam criteria applied

    Two of three (oligo/anovulation; hyperandrogenism; polycystic ovaries) confirms PCOS.

  6. 06

    Managing

    Individualised plan

    Cycle control, skin, fertility and metabolic priorities set what treatment starts.

  7. 07

    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.

  • Irregular or missed periods

    Fewer than 8 periods a year, or long gaps - a hallmark feature.

  • Persistent acne

    Adult acne, especially along the jawline - often androgen-driven.

  • Excess hair (hirsutism)

    Coarse hair on face, chest, back or abdomen - graded with the Ferriman-Gallwey score.

  • Weight difficulty

    Weight gain or difficulty losing - driven by insulin resistance, not willpower.

  • Low mood & anxiety

    More common in PCOS, deserves screening and treatment.

  • Signs of insulin resistance

    Skin tags, dark velvety skin patches (acanthosis nigricans) - especially in axillae or neck.

  • Difficulty conceiving

    Anovulation is common but treatable - most women with PCOS can conceive with support.

  • 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.

  • Lifestyle first

    Even a 5% weight loss can restore ovulation, improve symptoms and reduce diabetes risk.

  • Combined hormonal pill

    Regulates cycle, reduces androgens, improves acne and hirsutism - first-line for many.

  • Metformin

    Improves insulin resistance and menstrual regularity - first-line metabolic treatment.

  • GLP-1 receptor agonists

    Semaglutide or tirzepatide - strong evidence for weight loss and metabolic improvement in PCOS.

  • Topical & cosmetic

    Eflornithine cream, laser hair removal, and topical acne treatments alongside hormonal therapy.

  • Letrozole for ovulation

    First-line for ovulation induction (better than clomifene) if trying to conceive.

  • Endometrial protection

    If periods are >3 months apart, cyclical progestogen protects the endometrium.

  • 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.

  • International Evidence-Based Guideline for the Assessment and Management of PCOS (2023).

  • NICE. Polycystic ovary syndrome (Clinical Knowledge Summary).

  • RCOG. Long-term consequences of PCOS (Green-top guideline 33).

  • 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.

  • No periods for 6+ months

    Prolonged amenorrhoea raises endometrial risk - discuss cyclical progestogen or an IUS.

  • Rapid hair growth or virilisation

    Voice deepening or clitoral change - urgent review to exclude androgen-secreting tumour.

  • Very heavy or prolonged bleeding

    Especially after long gaps - assess for endometrial hyperplasia.

  • Difficulty conceiving after 12 months

    Fertility referral - PCOS is very treatable but early advice helps.

  • HbA1c 42-47 (prediabetes)

    Lifestyle intervention and consider medication - PCOS raises T2D risk significantly.

  • Symptoms of pregnancy

    Test early - PCOS pregnancies need earlier care and gestational-diabetes screening.

  • Persistent low mood or anxiety

    Both are more common in PCOS - effective treatment exists.

  • Blood pressure raised

    Cardiovascular risk is higher - treat vigorously and screen annually.

  • 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.

  1. 01 Long-term

    It is metabolic as well as reproductive

    Cardiovascular and diabetes risk raise the stakes on lifestyle - and lower them with treatment.

  2. 02 Fertility

    Plan early where possible

    Most women with PCOS can conceive, often with support. Early advice avoids years of frustration.

  3. 03 Weight

    Modest change moves the needle

    A 5% loss restores ovulation in around half - and reduces long-term risks.

  4. 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

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