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Polycystic ovary syndrome


Expert reviewer, Dr Madhavi Vellayan, Consultant Gynaecologist
Next review due February 2024

Polycystic ovary syndrome (PCOS) is a condition that affects the way your ovaries work. PCOS can cause irregular periods, unwanted hair on your body and face, and acne. It is also associated with type 2 diabetes, and can make it more difficult to get pregnant.

There’s no cure for PCOS but there are treatments that can help to ease your symptoms, prevent complications and improve your chances of having a baby. It’s important to get medical advice as soon as you notice a problem as it can help to prevent long-term health problems.

An image showing an ovary affected by polycystic ovary syndrome

More about polycystic ovary syndrome

You have two ovaries and they’re part of your reproductive system. They store and release eggs, and produce sex hormones. About once a month, one ovary should release an egg ready to be fertilised.

Before an egg is released, it develops in a small fluid-filled swelling called a follicle. More than one follicle starts to develop, but usually only one becomes a fully mature egg. If you have polycystic ovaries, 12 or more follicles start to grow, but none develop into an egg that can be fertilised. These follicles range in size from 2mm to 9mm, and stay on your ovaries containing undeveloped eggs. Despite the name, it’s actually follicles that are on your ovaries, not cysts.

You can have lots of follicles on your ovary without having polycystic ovary syndrome (PCOS). You can also have PCOS without having any follicles on your ovaries.

Causes of polycystic ovary syndrome

Doctors don’t know exactly what causes polycystic ovary syndrome (PCOS), but how you get PCOS is likely to be a mix of things.

  • PCOS may run in families, so your genetics may be part of the reason why you develop it. You may have more risk of developing PCOS if a close family member such as your mother or sister has the condition.
  • Some of the hormones in your body may be out of balance. Your body may produce too much oestrogen, luteinising hormone and testosterone.
  • Your cells may be resistant to insulin – a hormone that helps your body to control the level of sugar in your blood. If your cells are resistant to insulin, your body makes more insulin than it should. The extra insulin may cause your ovaries to make too much testosterone, which can stop them from releasing an egg each month.
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Symptoms of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) symptoms usually start around the time of puberty through to your early 20s. You may also develop symptoms if you put on weight. Sometimes, symptoms only become noticeable if you stop taking the oral contraceptive pill. Or you might find out that you have PCOS if you see your doctor because you’re having trouble getting pregnant.

The main polycystic ovary syndrome symptoms include:

  • irregular periods – eight or fewer in a year and sometimes none at all; when they do come, you may have heavy periods that last longer
  • problems getting pregnant (infertility)
  • being overweight or finding it hard to lose weight
  • having more hair than usual, often on your top lip, chin, around your nipples and in a line down from your tummy button
  • thinning hair and losing hair on your head
  • acne
  • patches of dark thick skin in your armpit or around your groin or neck

PCOS is also linked with anxiety, depression, mood swings and low self-esteem.

If you have any of these symptoms, see your GP.

Diagnosis of polycystic ovary syndrome

Your GP will ask about your symptoms, your periods and your medical history. They will look for signs of polycystic ovary syndrome (PCOS) and try to rule out other conditions that can cause similar symptoms (for example, diabetes). You may need to have some of the following tests.

  • Blood tests to measure your hormone levels and to check for other conditions.
  • An ultrasound scan to see if your ovaries look like you have PCOS. The scan can look at your womb and ovaries from the outside (through your tummy) and from the inside (using a slim device that goes into your vagina).

If your GP thinks you may have severe PCOS or problems with infertility, they’ll refer you to see a specialist doctor.

Self-help for polycystic ovary syndrome

Making changes to your lifestyle can help to control polycystic ovary syndrome (PCOS) symptoms, improve your fertility and reduce the chance of long-term health problems. Your doctor may suggest that you do the following.


For tips and advice on how to eat healthily and be more active, see our section on related information below.

If you have more hair than usual, you can try different hair removal techniques, such as hair-removing creams, waxing, shaving, electrolysis or laser hair removal. Or you could give bleaching products a go.

Treatment of polycystic ovary syndrome

There’s no cure for polycystic ovary syndrome (PCOS) but there are treatments that can help to ease your symptoms, prevent complications and improve your chances of getting pregnant.

The aim of PCOS treatment will depend on your situation, and the symptoms you have. If you want to get pregnant, your treatment will focus on your fertility and giving you the best chance of having a baby. If you don’t wish to become pregnant, your treatment will focus on managing your symptoms.

PCOS can increase your risk of developing long-term health problems such as heart disease, womb cancer and type 2 diabetes. So, part of your PCOS treatment will be to reduce your overall risk of developing these conditions.

You’ll probably need to keep on taking some of these treatments to manage the symptoms of PCOS over the long term. But once you reach the menopause, your symptoms may improve enough for you to stop taking some of them. Ask your doctor for more information.

Medicines

Which medicines your doctor suggests will depend on whether or not you’re planning to get pregnant.

If you are trying to have a baby, the following medicines may help.

  • Metformin may help you to start ovulating again and make your periods more regular if losing weight hasn’t helped.
  • Fertility medicines such as clomifene citrate or injections of gonadotrophins can help your ovaries to release eggs. If these medicines don’t work, your doctor may suggest fertility treatment such as IVF (in vitro fertilisation).

If you’re not trying to get pregnant, the following medicines may help.

  • Oral contraceptives can stop your ovaries from producing too much testosterone. This can help to improve acne, make your periods more regular and reduce the amount of excessive hair growth you may have in unwanted places.
  • If you can’t take oral contraceptives or they don’t work for you, your doctor may prescribe a cream to reduce extra hair growth.
  • Medicines such as orlistat can sometimes help you lose weight if lifestyle changes aren’t working.
  • Co-cyprindiol is a treatment for acne and extra hair growth. It can also make your periods more regular.

Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or doctor for advice.

Surgery

If medicines don’t work, your doctor may suggest you have an operation to improve your fertility.

If you’re trying for a baby, one option is a keyhole procedure called laparoscopic ovarian drilling. This reduces the amount of tissue in your ovaries, which changes the balance of hormones and can cause your ovaries to release eggs again. Surgery is usually only considered if other treatments have failed.

Complications of polycystic ovary syndrome

One of the main complications of polycystic ovary syndrome (PCOS) is infertility, which means it’s more difficult to become pregnant. For more information, see our FAQ: Can you get pregnant with PCOS? below.

PCOS can cause long-term health conditions for some women because of the hormone imbalance and changes to the amount of insulin in your body. These health problems include type 2 diabetes and obesity, which means you’re also more likely to develop the following conditions:


A healthy diet and exercise can significantly reduce your chances of obesity and diabetes and, therefore, the chances of developing the other conditions. So, it’s important to be active and to eat well. If you’re worried about getting pregnant or developing complications, talk to your doctor.

Frequently asked questions

  • Ovarian hyperstimulation syndrome (OHSS) is when your ovaries produce too many egg sacs (follicles), sometimes as many as 20 or more. It’s caused by the medicines used during fertility treatment. If you develop OHSS, your ovaries will get bigger and that can lead to discomfort and swelling in your lower abdomen (tummy).

    You’re more likely to develop OHSS if you have polycystic ovary syndrome (PCOS) and are having fertility treatment. OHSS often gets better without any specific treatment, but sometimes it can cause more serious health problems.

  • If you have polycystic ovary syndrome (PCOS) you might find it difficult to get pregnant. Having irregular periods, fewer periods or even none at all will make conception a challenge. But if you get treatment for PCOS, you may still be able to have a baby. There are also things you can do yourself to improve your chances of getting pregnant. See our sections on self-help and treatment above for more information on these.

    If you do get pregnant, you may be more likely to develop complications, which can include diabetes, high blood pressure or pre-eclampsia. Your baby is also more likely to be born early. But your antenatal team will take extra care to avoid problems by giving you regular health checks.

  • If you have polycystic ovary syndrome (PCOS), you may be more likely to gain weight or find it difficult to lose weight. Some women with PCOS are resistant to insulin. Insulin is a hormone produced by your pancreas that helps to control the level of glucose (sugar) in your blood. If your cells are resistant to insulin, your body makes more insulin than it should to compensate. Insulin resistance can lead to weight gain, which can make the symptoms of PCOS worse.

  • The cause of polycystic ovary syndrome (PCOS) is likely to be a mix of things. But PCOS may run in families. You may have a higher risk of developing PCOS if a close family member such as your mother or sister has the condition. Although no specific gene causing PCOS has been found yet, research suggests there is a link between your genetics and PCOS.



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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, February 2021
    Expert reviewer, Dr Madhavi Vellayan, Consultant Gynaecologist
    Next review due February 2024

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