PCOS Explained: Symptoms, Diagnosis & Management

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.

What is PCOS?

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 name can be misleading

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.

Recognising the common symptoms

Symptoms vary and can change over time. Common features include:

• Irregular or absent periods: Long gaps between periods, unpredictable cycles or fewer periods than expected.
• Unwanted hair growth: Coarser hair on the face, chest, abdomen or other areas.
• Acne and oily skin: Sometimes persisting beyond adolescence.
• Scalp hair thinning: Often around the crown or parting.
• Difficulty conceiving: Usually related to infrequent or absent ovulation.
• Metabolic changes: These may include difficulty managing weight or darkened, thickened skin around the neck or armpits.

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.

How is PCOS diagnosed?

In adults, diagnosis generally requires at least two of three features, after excluding other conditions:

1. Irregular ovulation, often reflected in irregular or absent periods.
2. Evidence of excess androgens, through symptoms such as unwanted hair growth or appropriate blood testing.
3. Polycystic ovarian appearance on ultrasound.

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.

Diagnosis is different in teenagers

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.

Why care extends beyond periods

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.

Treatment should match your priorities

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.

Managing acne and unwanted hair

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.

PCOS does not mean you cannot become pregnant

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.

Everyday habits and emotional support matter

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.