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Health condition

Polycystic ovary syndrome, diagnosis, treatment and long-term health.

PCOS is far more than irregular periods. This is the full guide - how it is diagnosed, what treatment options exist for your priorities, and how to look after your health for the long term, whatever your weight.

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Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against the 2023 International Evidence-based Guideline, NICE CKS and RCOG, all listed at the end.

  • 03

    Current for 2026

    Reflects letrozole as first-line ovulation induction, weight-inclusive care and long-term cardiometabolic follow-up.

Key facts

PCOS at a glance.

The essentials, in plain English - what PCOS is, how it is confirmed and what it can mean for your health.

  • What it is

    A common hormonal and metabolic condition of the reproductive years, involving ovulation, androgen hormones and often insulin resistance.

  • How common

    Roughly 1 in 10 women and people with ovaries of reproductive age - and many go undiagnosed for years.

  • How it is diagnosed

    Rotterdam criteria - any 2 of 3: irregular or absent ovulation, high androgens (signs or blood tests), polycystic ovarian morphology - once look-alike conditions are excluded.

  • Weight

    Many people with PCOS carry extra weight, but lean PCOS is well recognised. Weight does not cause PCOS and does not define it.

  • Beyond periods

    Higher rates of insulin resistance, type 2 diabetes, sleep apnoea, low mood and anxiety, and - with infrequent periods - endometrial hyperplasia.

  • Fertility

    Ovulation is often irregular, but most people with PCOS can conceive - naturally or with treatment such as letrozole.

Why this guide matters

A whole-person condition, not just a period problem.

PCOS touches hormones, metabolism, fertility, skin, mood and sleep. The three points below shape everything else on this page.

  • A diagnosis unlocks better care

    Delays are common, and symptoms are often treated one at a time. A clear diagnosis lets cycle, skin, fertility and metabolic health be planned together.

  • The long-term picture matters

    Insulin resistance, type 2 diabetes, sleep apnoea and endometrial protection all need thought, even when periods and skin are the main worry today.

  • Care should be weight-inclusive

    PCOS occurs at every body size. Good care offers weight support sensitively and never makes treatment for other symptoms depend on it.

Names and related guides

Same condition, several names.

This is our comprehensive guide. For a shorter overview, see our quick PCOS guide. If you searched for the scan finding, read polycystic ovaries and PCOS. An international consensus process in 2025 also proposed a new name, and we explain it on our page about polyendocrine metabolic ovarian syndrome. UK guidance still uses PCOS, so this guide does too.

How the diagnosis is made

From a pattern of symptoms to a clear diagnosis.

The steps a UK GP, gynaecologist or endocrinologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Your story

    Cycle length, hair and skin changes, weight history, mood, sleep, family history of diabetes, and whether you hope to conceive.

  2. 02

    Assessing

    Examination

    Blood pressure, BMI and waist (with your consent), and a look for hirsutism, acne, scalp thinning and dark velvety skin patches.

  3. 03

    Assessing

    Ruling out look-alikes

    Pregnancy test, thyroid function, prolactin and 17-hydroxyprogesterone for non-classic congenital adrenal hyperplasia. FSH and LH if periods are absent.

  4. 04

    Confirming

    Androgen blood tests

    Total testosterone and SHBG, with a calculated free androgen index. Hormonal contraception alters these, so timing matters.

  5. 05

    Confirming

    Ultrasound or AMH

    In adults, a pelvic ultrasound or an AMH blood test can show polycystic morphology. Not needed if the other two criteria are already met.

  6. 06

    Planning

    Criteria applied, baseline set

    Two of three Rotterdam criteria confirms PCOS. HbA1c or a glucose tolerance test and a lipid profile set the metabolic baseline.

  7. 07

    Planning

    Mood, sleep and a plan

    Screening for anxiety, depression, disordered eating and sleep apnoea, then a plan built around your priorities.

Typical timeline: one to three visits, depending on how quickly blood tests and any scan can be arranged.

Symptoms

What PCOS can look and feel like.

No two people have exactly the same mix. You may have several of these features or only one or two.

  • Irregular or absent periods

    Cycles longer than 35 days, fewer than 8 periods a year, or long gaps - the most common sign of infrequent ovulation.

  • Excess hair (hirsutism)

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

  • Acne and skin changes

    Persistent acne, oily skin, and dark velvety patches (acanthosis nigricans) in skin folds, which can point to insulin resistance.

  • Scalp hair thinning

    Androgenic alopecia - thinning at the crown or widening parting rather than a receding hairline.

  • Insulin resistance and weight

    Weight gain, or difficulty losing it, is common but not universal. Insulin resistance can occur at any weight.

  • Low mood and anxiety

    More common in PCOS and deserving proper screening and support - not simply a reaction to symptoms.

  • Poor sleep and fatigue

    Obstructive sleep apnoea is more common in PCOS, so loud snoring and unrefreshing sleep are worth raising.

  • Difficulty conceiving

    Infrequent ovulation is the usual reason. It is often very treatable, and early advice helps.

Treatment

How PCOS is treated in the UK.

There is no single cure. Treatment follows your priorities - cycle, skin and hair, fertility or metabolic health - and is reviewed over time.

  • Lifestyle and weight-neutral support

    Balanced eating, regular movement and good sleep help everyone with PCOS. Weight-management medicines, including GLP-1 receptor agonists, follow general UK criteria and are stopped before conception.

  • Combined oral contraceptive

    First-line for irregular cycles, hirsutism and acne when pregnancy is not wanted. It also protects the womb lining, and is checked against your personal risks such as migraine with aura, clot risk and blood pressure.

  • Metformin

    An off-label option that improves insulin resistance and can help cycle regularity, particularly with a BMI of 25 or above. Nausea and loose stools are common; modified-release tablets are usually gentler.

  • Endometrial protection

    If periods come less often than every three months and you are not taking the pill, a cyclical progestogen or a levonorgestrel intrauterine system protects against endometrial hyperplasia.

  • Hirsutism and acne treatments

    The pill first, then spironolactone (off-label, needs reliable contraception) if there is little change after around six months. Eflornithine cream, laser or IPL, and topical acne treatments can be added.

  • Letrozole for ovulation induction

    The first-line drug for inducing ovulation when trying to conceive, with better live-birth rates than clomifene in trials. Used off-label in the UK, with ultrasound monitoring in many clinics.

  • Clomifene, gonadotrophins and IVF

    Clomifene (or metformin) is an alternative first step. Injectable gonadotrophins, laparoscopic ovarian drilling and IVF are next steps, with protocols chosen to limit multiple pregnancy and ovarian hyperstimulation.

  • Psychological support

    Screening for anxiety, depression and body-image distress is part of routine care. Talking therapy such as CBT, peer support and, where needed, medication all have a place.

What this guide is based on

The sources behind every claim on this page.

International and UK national guidance, 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, gynaecologist or endocrinologist knows your history and can tell you which parts apply to you. Many drugs mentioned here are used off-label in PCOS, so always take prescribing advice from a clinician.

  • International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023 (Monash University with partner societies).

  • NICE. Clinical Knowledge Summary: Polycystic ovary syndrome.

  • RCOG. Long-term consequences of polycystic ovary syndrome (Green-top Guideline No. 33, 2014).

  • NICE. Fertility problems: assessment and treatment (CG156).

  • Verity - the UK charity for people with PCOS.

Red flags

When to seek advice sooner.

Most PCOS care is planned and routine. These are the situations that need prompt attention - or that suggest something other than PCOS.

  • Long gaps between periods

    Fewer than four periods a year, or none for three months or more, thickens the womb lining over time. Ask about protection rather than waiting.

  • Heavy, prolonged or unexpected bleeding

    Especially after a long gap, or between periods. Needs assessment for endometrial hyperplasia, sometimes with ultrasound or biopsy.

  • Rapid virilisation

    Hair growth that appears within months, a deepening voice, or clitoral enlargement is not typical PCOS. Urgent review for an androgen-secreting tumour.

  • Signs of Cushing’s syndrome

    Easy bruising, purple stretch marks, muscle weakness and new high blood pressure can mimic PCOS and need specific testing.

  • Milky nipple discharge or headaches

    With visual disturbance, this can point to raised prolactin or a pituitary cause rather than PCOS.

  • Symptoms of diabetes

    Marked thirst, passing large volumes of urine, weight loss or blurred vision - same-day blood glucose testing.

  • Low mood or thoughts of self-harm

    Seek help promptly: your GP, NHS 111 (mental health option), or Samaritans on 116 123. Call 999 if you are in immediate danger.

  • Loud snoring with breathing pauses

    Or persistent daytime sleepiness - screen for obstructive sleep apnoea, which is more common in PCOS.

  • Trying to conceive without success

    Seek advice after 12 months, or sooner if you already know your periods are infrequent, since ovulation is often the reason.

Living with it

A lifelong condition, managed with steady support.

Four things that make the biggest difference over the years - regular check-ups, sustainable habits, emotional support and planning for pregnancy and later life.

A quiet reminder

You are not doing it wrong.

PCOS is driven by biology, not willpower. Good care meets you where you are and treats the symptoms that matter most to you.

  1. 01 Check-ups

    Keep a long-term rhythm

    Blood pressure, weight if you wish to track it, glucose or HbA1c (often every one to three years, depending on risk) and lipids. PCOS is not a diagnosis that ends after the first appointment.

  2. 02 Habits

    Movement, food and sleep

    Regular activity, balanced meals and good sleep improve insulin sensitivity and mood at any weight. Aim for habits you can sustain, not a punishing plan.

  3. 03 Wellbeing

    Look after your mind

    Hair, skin and weight changes are emotionally heavy. Ask for screening, try talking therapy, and consider a group such as Verity for people who understand.

  4. 04 Later life

    Pregnancy and beyond

    Tell your midwife you have PCOS so glucose and blood pressure can be watched closely. Cycles often settle with age, but metabolic health still deserves attention.

Frequently asked

Everything we get asked about PCOS.

Quick answers on diagnosis, weight, fertility and long-term health.

  • What is PCOS?

    Polycystic ovary syndrome is a common condition in which ovulation is irregular or absent, androgen hormones are higher than typical, and the ovaries may show many small follicles on scan. Insulin resistance is frequent. It is diagnosed by the Rotterdam criteria - any two of three - after other causes have been excluded.

  • Can I have PCOS if I am slim or have no cysts?

    Yes. Lean PCOS is well recognised, and the “cysts” are actually small, immature follicles that are not true cysts. You do not need to see them on a scan if you meet the other two criteria, which are irregular ovulation and high androgens.

  • Do I need an ultrasound to be diagnosed?

    Not always. In adults, an ultrasound or an AMH blood test can be used to show polycystic morphology, but neither is required if you already have both irregular ovulation and high androgens. In teenagers within about eight years of their first period, scans are not recommended for diagnosis.

  • Will I be able to have a baby?

    Most people with PCOS can conceive, and many do so naturally. If ovulation is the barrier, letrozole is the recommended first-line treatment, with clomifene, injectable gonadotrophins, laparoscopic ovarian drilling and IVF as further options. Earlier advice usually shortens the journey.

  • Does PCOS raise my long-term health risks?

    It raises the risk of type 2 diabetes, gestational diabetes, high blood pressure in pregnancy, sleep apnoea, low mood and - if periods are very infrequent and unprotected - endometrial hyperplasia and cancer. Most people do not develop these, and regular monitoring and treatment lower the risks.

  • Are “polycystic ovaries” and PCOS the same thing?

    No. Polycystic ovarian morphology is a scan appearance that can be seen in people who have regular cycles and no PCOS. PCOS is a syndrome that needs at least two of the three Rotterdam criteria. An international process in 2025 also proposed a new name for the condition; this guide keeps to PCOS, which UK guidance still uses.

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