The prostate is a small gland that tends to enlarge with age. Most changes are benign, but awareness matters.
From around age 45–50, discuss PSA testing with your doctor. Family history may mean starting earlier.
A plant-rich diet, regular activity and a healthy weight all support prostate health over the long term.
Perhaps your periods have never been predictable. You’re treating acne that keeps returning, noticing more facial hair, or struggling to conceive. These concerns may seem unrelated, but sometimes they share an underlying explanation: polycystic ovary syndrome, or PCOS.
PCOS affects people differently. Some have obvious symptoms from adolescence; others are diagnosed only when investigating fertility problems. Effective care starts with identifying your particular symptoms and priorities.
You may also encounter the newer name polyendocrine metabolic ovarian syndrome, or PMOS, introduced internationally in 2026 to better reflect the condition’s wider effects. PCOS remains a familiar term during this transition.
PCOS is a long-term hormonal and metabolic condition that can affect ovulation, skin, hair growth and how the body regulates blood sugar.
Many people with PCOS have increased levels or activity of androgens, including testosterone. Everyone produces these hormones, but an excess can contribute to acne, unwanted hair growth and disrupted ovulation.
Insulin resistance is also common. This means the body responds less effectively to insulin, the hormone that helps regulate blood glucose. Higher insulin levels can encourage the ovaries to produce more androgens.
The causes are complex, with genetic and other factors involved. PCOS can occur at any body size, and weight alone cannot establish or exclude the diagnosis.
The “polycystic” part of PCOS creates confusion. The small structures seen on an ultrasound are usually follicles, which contain developing eggs, rather than the abnormal ovarian cysts people commonly imagine.
You can have PCOS without this ultrasound appearance. You can also have polycystic-looking ovaries without having the syndrome.
This distinction matters because an ultrasound result alone should not determine the diagnosis. PCOS is identified through a combination of findings, after other explanations have been considered.
Symptoms vary and can change over time. Common features include:
Not everyone experiences all these features. Acne or irregular periods alone do not necessarily mean PCOS.
Severe pelvic pain should not automatically be attributed to PCOS. It deserves assessment for other causes.
In adults, diagnosis generally requires at least two of three features, after excluding other conditions:
In suitable adults, an anti-Müllerian hormone, or AMH, blood test can sometimes replace ultrasound when assessing the third feature. AMH should not be used as a stand-alone diagnostic test.
If irregular cycles and clear androgen excess are already present, ultrasound or AMH may not be necessary.
Your clinician may investigate thyroid disease, raised prolactin and certain adrenal conditions that can resemble PCOS. Pregnancy should also be considered when periods stop.
Hormonal contraception can complicate interpretation of androgen tests. Discuss testing with your doctor rather than stopping contraception yourself.
Irregular periods and acne are common during puberty, making diagnosis more challenging.
Adolescent diagnosis requires both menstrual irregularity that is abnormal for the time since periods began and evidence of androgen excess, after excluding other causes.
Ultrasound and AMH are not recommended for diagnosing PCOS in adolescents because normal developmental changes can resemble the condition.
Someone who has suggestive features but does not meet the criteria may need follow-up. Symptoms can still be treated while the diagnosis remains uncertain.
PCOS is associated with increased risks of type 2 diabetes, abnormal cholesterol, high blood pressure and sleep apnoea. These risks deserve attention even if pregnancy is not a current goal.
Assessment should include blood pressure, cholesterol and blood glucose. A 75-g oral glucose tolerance test is the most accurate way to assess glucose regulation in PCOS. Fasting glucose or HbA1c may be alternatives when this is impractical, although they can miss some abnormalities.
Tell your clinician if you snore heavily, wake unrefreshed or experience marked daytime sleepiness.
Long gaps without ovulation can also allow the uterine lining to thicken excessively. Discuss absent periods lasting around three months, unless prescribed treatment is intentionally suppressing bleeding.
There is no single treatment that addresses every aspect of PCOS.
If pregnancy is not your goal, a combined oral contraceptive pill may help regulate bleeding and manage acne or unwanted hair growth. Suitability depends on your medical history, including clot risk and migraine history.
Other options for protecting the uterine lining include prescribed courses of progestogen or an appropriate hormonal intrauterine system.
Metformin may be offered for metabolic concerns and can improve cycle patterns in some people. It is not required for everyone. Digestive side effects are common initially, and longer-term treatment may warrant vitamin B12 monitoring.
Ask what each medicine is intended to improve and when its effect should be reviewed.
Skin and hair symptoms can affect confidence and deserve treatment in their own right.
Options include acne treatments, hormonal contraception, laser hair reduction or electrolysis. An anti-androgen medicine such as spironolactone may be considered in selected patients.
Effective contraception is important when taking anti-androgens because they can harm a developing fetus.
Hair growth responds slowly, so treatment often needs several months before meaningful improvement becomes apparent. Laser treatment should be performed by a suitably qualified practitioner experienced with your skin tone.
Infrequent ovulation can make conception harder, but many people with PCOS conceive naturally or with treatment.
When infertility results from absent ovulation and there are no other infertility factors, letrozole is generally the first-line medicine for inducing ovulation. Treatment requires medical supervision.
A fertility assessment may also examine sperm, fallopian tubes and other factors rather than assuming PCOS explains everything.
If periods are very irregular or absent, seek advice early when planning pregnancy. You do not necessarily need to wait a year.
Pregnancy remains possible with irregular cycles, so contraception is still needed if you do not wish to conceive.
Regular activity and sustainable eating habits support metabolic health. Include foods such as beans, lentils, vegetables, fruit, wholegrains and protein sources that suit your budget.
No single “PCOS diet” has proved superior. Benefits from healthy habits can occur without weight loss. If weight management is a goal, care should provide practical support and avoid blame.
Be cautious with promises to “reverse PCOS”. Evidence for supplements such as inositol remains limited, especially for fertility outcomes.
Anxiety, depression and body-image concerns also deserve attention. In South Africa, start with your GP or local clinic, bringing your menstrual history, medication list and main concerns. Your care plan should explain the diagnosis, address your priorities and include follow-up.
Healthy eating does not require perfection — just a reliable framework you can repeat.
Swap refined grains for wholegrains, add a vegetable to each meal, and keep hydrated. Little changes compound.
The prostate is a small gland that tends to enlarge with age. Most changes are benign, but awareness matters.
From around age 45–50, discuss PSA testing with your doctor. Family history may mean starting earlier.
A plant-rich diet, regular activity and a healthy weight all support prostate health over the long term.
You’re waking at 3am, your periods have become unpredictable, and the patience you once had seems harder to find. Perhaps you’re forgetting words in meetings or suddenly feeling uncomfortable during sex. You might blame stress, ageing or an overloaded schedule.
Perimenopause could be part of the explanation.
This transition can affect far more than your menstrual cycle. Understanding it helps you recognise changes and seek care, while avoiding the assumption that every new symptom must be hormonal.
Perimenopause is the transition around the end of your reproductive years, when ovarian hormone production becomes less predictable and ovulation happens less consistently.
Oestrogen does not simply decline in a straight line. Levels can fluctuate considerably, while changes in ovulation also affect progesterone production. This helps explain why symptoms may come and go.
The transition commonly begins in the 40s, although timing varies. It can last several years.
Menopause refers to your final menstrual period, confirmed retrospectively after 12 consecutive months without a period, provided another condition or treatment does not explain the absence. Hormonal contraception can make this harder to establish.
Postmenopause is the phase that follows. Symptoms do not necessarily disappear when that milestone is reached.
Clinicians commonly distinguish between the early and late menopausal transition using menstrual patterns.
Early transition: Your previously predictable cycle becomes more variable. The recognised staging framework uses a persistent difference of at least seven days between consecutive cycle lengths. Periods may initially become closer together.
Late transition: Longer gaps develop, including intervals of at least 60 days without a period. Ovulation becomes increasingly unpredictable, and hot flushes or night sweats may become more noticeable.
The final menstrual period: You cannot know immediately that a particular period was your last. That becomes clear only after the following 12 months.
These stages describe reproductive changes, rather than a fixed timetable of symptoms. Someone in early transition may struggle considerably, while someone approaching menopause may have relatively few difficulties.
A change in your usual bleeding pattern is an important clue. Periods may become shorter, longer, heavier, lighter or less predictable.
Other common symptoms include:
You do not need to experience every symptom. Some women notice mainly menstrual changes; others find sleep or emotional symptoms more disruptive.
The impact matters as much as the symptom list. Repeatedly losing sleep or struggling at work warrants attention.
Losing your train of thought can feel unsettling, particularly when your work depends on concentration. Cognitive complaints are common during the menopause transition and are usually mild. Brain fog alone does not establish that someone has dementia.
Sleep disruption can compound concentration difficulties, while hormonal changes may increase vulnerability to depression, especially in women with a previous history.
However, persistent depression, severe anxiety or worsening cognitive difficulties need their own assessment. Hormones may contribute without explaining everything.
Describe what has changed, how often it happens and how it affects daily life. “I’m struggling to finish tasks and waking four times every night” gives your clinician useful information.
Often, diagnosis begins with your age, symptoms and menstrual history.
NICE guidance recommends identifying perimenopause without laboratory testing in otherwise healthy people aged 45 or older who have newly developed hot flushes or night sweats alongside menstrual changes.
A single hormone result can be misleading because levels fluctuate. A “normal” reading does not necessarily exclude the transition.
Testing may be appropriate between 40 and 45, or when symptoms suggest premature ovarian insufficiency before 40. Other investigations may assess alternative explanations, such as thyroid disease or anaemia.
Your clinician should explain what each proposed test will clarify. An expensive hormone panel is not automatically more informative than a careful consultation.
You do not have to wait until menopause to discuss treatment.
Menopausal hormone therapy, often called HRT, is the most effective treatment for troublesome hot flushes and night sweats. It can also improve sleep when symptoms are causing repeated waking.
Systemic oestrogen is available in forms including tablets, patches and gels. If you still have a uterus, a progestogen is generally needed alongside systemic oestrogen to protect its lining.
Treatment should reflect your symptoms, medical history and preferences. A history of hormone-sensitive cancer, blood clots, cardiovascular disease, liver disease or unexplained bleeding can affect suitability and may require specialist advice.
Benefits and risks also vary by formulation and duration. Oral oestrogen carries a higher clot risk than oestrogen delivered through the skin.
Ask what improvement to expect, which side effects to watch for and when treatment will be reviewed.
For vaginal dryness, moisturisers provide ongoing relief, while lubricants reduce friction during sex. Low-dose vaginal oestrogen may help persistent vaginal and urinary symptoms and has much lower systemic absorption than systemic hormone therapy.
Menopause-specific cognitive behavioural therapy can help manage the distress associated with hot flushes, sleep difficulties and certain mood symptoms.
Prescription non-hormonal medicines can also help selected patients. Their suitability depends on symptoms, other medication and availability.
Herbal products marketed for menopause have inconsistent evidence, and some interact with medicines. Custom-compounded hormones have not been shown to be safer or more effective than approved products. Discuss what you are taking before adding another supplement or treatment.
Regular movement supports bone, muscle and cardiovascular health. Include resistance exercise and weight-bearing activity such as walking.
Eat a varied diet with adequate protein and calcium-rich foods. Keep a consistent sleep routine and make the bedroom comfortable.
Alcohol, caffeine or spicy foods may aggravate symptoms for some people. Track your own response rather than imposing unnecessary restrictions.
These habits support health, but persistent symptoms may still need treatment.
Irregular periods do not mean ovulation has stopped completely. HRT is not contraception.
Discuss contraception alongside symptom treatment. Some hormonal contraceptives can address both needs, depending on your age and health history.
Certain methods also alter bleeding, making menstrual patterns less useful for identifying menopause. Get individual advice before stopping contraception.
Arrange assessment for very heavy or prolonged bleeding, bleeding between periods or after sex, or any bleeding after 12 months without periods. Seek urgent care if heavy bleeding causes faintness, severe weakness or breathlessness.
In South Africa, start with your GP or local primary healthcare clinic. Bring a record of periods, symptoms and medication.
Leave with a clear plan covering treatment, contraception, any necessary investigations and follow-up. Perimenopause may be a natural transition, but support can make a meaningful difference to daily life.