Polycystic ovary syndrome (PCOS) – how to manage it

Polycystic ovary syndrome (PCOS) is caused by a hormonal imbalance. This means if you have it you might not have the right balance of hormones for ovulation (when your ovary releases an egg), which may stop you from ovulating, and mean you have irregular periods, or no periods at all.

This can trigger a whole host of symptoms, such as weight gain, excess body hair, infertility, and acne.

PCOS is a common hormonal disorder – up to 1 in 8 women in the UK are thought to have it, alongside up to 15% of women of childbearing age in the US.

While there’s no cure for PCOS, certain medicines and lifestyle tips can help you manage things.

What are the symptoms?

PCOS usually starts around the late teens or early 20s, but can begin with the first period. It can cause a range of symptoms, which may show up in different ways, and range from mild to severe.

You might not have all of them, but some of the most common signs include:

• irregular periods – missed periods, light periods, or no periods at all
• problems getting pregnant (infertility) – because of irregular ovulation or no ovulation
• extra body hair (hirsutism) – usually on your face, chest, back or bottom
• putting on weight – especially around your tummy
• hair thinning and hair loss
• oily skin or acne – especially on your back, chest and face
• darker skin patches – especially around your armpits, groin, neck and under your breasts (acanthosis nigricans)
• follicles on your ovaries – when the ovaries have lots of fluid-filled follicles on them (also known as ovarian cysts)
• skin tags – small pieces of extra skin on your neck or armpits.

It’s possible to have PCOS without any symptoms. In fact, some people don’t realize they have the condition until they have trouble getting pregnant, or start gaining weight for no reason.

What causes PCOS and who is affected?

The exact cause is unknown, but PCOS is thought to be connected with abnormal hormone levels, including:

• insulin resistance – insulin is a hormone that regulates the amount of sugar in the blood. When your body becomes resistant to it, the response is to make extra insulin to make up for it. These higher levels of insulin trigger the ovaries to produce more ‘male hormones’ (known as androgens), which can affect normal ovulation and trigger PCOS symptoms
• increased levels of luteinizing hormone (LH) – that stimulates ovulation, but can affect the ovaries if levels are too high
• low sex hormone-binding globulin (SHBG) – a protein in the blood that binds to testosterone and reduces its effect
• high prolactin (only in some women with PCOS) – it stimulates breast glands to produce milk during pregnancy.

It’s not certain if the cause of PCOS begins in the ovaries, the glands that produce the hormones, or the brain area that controls hormone production. Having a resistance to insulin could also be an issue.

Some factors may make developing PCOS more likely, including if:

• it runs in your family – certain genes may be linked to PCOS
• you’re overweight or obese – this can increase insulin levels and make PCOS symptoms worse
• you have insulin resistance – it increases the level of androgens (‘male’ hormones) in your body.

When to see a doctor and getting diagnosed

See a doctor if you think you might have symptoms of PCOS, including:

• a menstrual cycle that’s not regular or longer than 40 days between periods
• excess hair growth or hair loss
• trouble getting pregnant.

Your doctor will ask you about your symptoms and check your blood pressure.

You may have blood tests to check your hormone levels and help your doctor work out if PCOS is the issue, or if your symptoms are down to another condition, like diabetes or high cholesterol.

You may also need an ultrasound scan or a pelvic exam – it can show whether you have polycystic ovaries.

You’ll usually be diagnosed with PCOS if other causes have been ruled out and you have 2 of the following:

• your periods are not regular or they are infrequent (missed periods) – meaning you aren’t ovulating (your ovaries are not releasing eggs)
• you have high levels of androgens (male hormones) – such as high testosterone. Or signs of high testosterone like acne and hair loss, even if blood tests come back as normal
• polycystic ovaries – which can be detected on an ultrasound or pelvic scan.

You may then be referred to a gynecologist or an endocrinologist for further advice and treatment.

Self-care tips

While there’s no cure for PCOS, it can be managed with self-care, especially if you have mild symptoms.

Losing excess weight (if you’re overweight or obese) can help reduce your symptoms, enable your body to use insulin better, and may help you ovulate. Losing as little as 5% of your bodyweight has been shown to lead to improvements in symptoms. Seek advice from your healthcare provider about the best ways to get active and follow a healthy and balanced diet.

More research is needed, but some studies show certain treatments may be helpful for PCOS symptoms, such as minoxidil cream, available from a pharmacy for use on the scalp if you have hair loss, but it’s not suitable if you’re pregnant.

Alongside other frustrating symptoms, excessive hair growth caused by PCOS can make you feel really self-conscious. Semi-permanent hair removal methods may be helpful here, such as laser removal.

Medical treatments for PCOS

Which treatments you’re offered will depend on your symptoms, how severe they are, and other factors, for example, if you’re trying to get pregnant.

Your doctor will help you work out the best treatment plan for you, which may include:

• the contraceptive pill – used to help with irregular or absent menstrual cycles, and to keep your womb lining thin, to help prevent endometrial cancer. The pill can also help with excessive hair growth, hair loss and acne
• eflornithine – a cream often used to slow down the growth of facial hair, to be used alongside other hair removal methods
• acne treatments – topical retinoids and/or antibiotics, azelaic acid, or antibiotic tablets
• clomifene/letrozole – suggested if you’re having trouble getting pregnant. Both work by helping the body to ovulate
• metformin – used if clomifene or letrozole hasn’t helped. Metformin works by lowering insulin and blood sugar levels to encourage ovulation
• anti-androgens – such as cyproterone acetate and spironolactone, may be offered if you have excessive hair growth and/or acne, but they’re not safe if you’re trying to get pregnant
• in vitro fertilisation (IVF) – suggested if you want to get pregnant but can’t, and if other treatments haven’t helped
• laparoscopic ovarian drilling (LOD) – a minor surgery to rebalance your hormones. It may be offered if nothing else has worked and you’re trying to get pregnant.

With treatment, most people who are trying to get pregnant with PCOS are usually able to.