Polycystic ovary syndrome

The name is unhelpful. PCOS is not really a problem of cysts — it is a hormonal and metabolic imbalance that happens to produce a particular appearance on an ultrasound. Underneath most cases sit two things: raised androgens, and very often insulin resistance.

How it shows up

• Irregular, infrequent or absent periods — usually the first clue
• Weight that is difficult to shift, particularly around the abdomen
• Excess hair growth on the face, chest or back
• Acne or oily skin persisting well beyond the teenage years
• Thinning hair on the scalp
• Difficulty conceiving

You do not need all of these. Many women have two or three.

How it is diagnosed

There is no single test. Under the Rotterdam criteria, a diagnosis needs at least two of three features: irregular ovulation, signs of excess androgens, and polycystic ovaries on a scan — with other conditions excluded first. Because two of the three come from history and blood tests, a scan supports the diagnosis but is not always essential.

What actually helps

Treatment follows what matters to you now — regular cycles, skin and hair, or fertility. A modest reduction in weight can restore ovulation on its own. Beyond that there are effective options for cycle regulation, for androgen-driven skin and hair changes, and for supporting ovulation if you are trying to conceive.