Polycystic ovary syndrome (PCOS) is a hormonal condition affecting 8–13% of women of reproductive age. It is characterised by elevated androgens (male-type hormones), irregular or absent ovulation, and — in many but not all cases — multiple small follicles on the ovaries visible on ultrasound. It is the most common cause of ovulatory infertility.
Why diagnosis takes so long
The average time from first symptoms to PCOS diagnosis is 2–3 years in most healthcare systems. Several factors contribute: symptoms are nonspecific and overlap with thyroid disorders, hyperprolactinaemia and other conditions; guidelines vary internationally on diagnostic criteria; and some women's symptoms — such as irregular periods — are incorrectly normalised by clinicians.
The Rotterdam Criteria (2003) — the most widely used diagnostic framework — require two of three features: irregular or infrequent ovulation, elevated androgens (by blood test or clinical signs), and polycystic ovarian morphology on ultrasound. A diagnosis does not require all three.
Common symptoms
- Irregular menstrual cycles — fewer than 8 periods per year, or cycles longer than 35 days
- Excess facial or body hair (hirsutism) — along the jaw, chin, upper lip or chest
- Acne — particularly along the jawline and chin in adult women
- Hair thinning or male-pattern hair loss on the scalp
- Difficulty conceiving due to infrequent ovulation
- Weight gain — particularly around the abdomen — though PCOS affects lean women too
- Darkened skin patches (acanthosis nigricans) around the neck, armpits or groin — a sign of insulin resistance
- Mood symptoms — depression and anxiety are significantly more prevalent in women with PCOS
The blood tests your doctor will order
A PCOS workup typically includes a panel of hormone tests, ideally taken on days 2–5 of the menstrual cycle (or at any time if cycles are very irregular).
| Test | What it measures | Finding in PCOS |
|---|---|---|
| Testosterone (total and free) | Androgen excess | Often elevated |
| LH and FSH | Ovulatory function | LH:FSH ratio often > 2:1 |
| AMH (Anti-Müllerian Hormone) | Ovarian reserve / follicle count | Often significantly elevated |
| Fasting glucose and insulin | Insulin resistance | Elevated fasting insulin common |
| TSH | Thyroid function | To exclude thyroid cause |
| Prolactin | Pituitary function | To exclude hyperprolactinaemia |
PCOS and metabolic health
Up to 70% of women with PCOS have insulin resistance — their cells require higher-than-normal insulin to process glucose. This drives elevated androgen production from the ovaries and increases the long-term risk of type 2 diabetes, high blood pressure and cardiovascular disease.
Metabolic risk is highest in women with PCOS who also have elevated BMI — but lean women with PCOS still carry above-average metabolic risk. All women with PCOS should have a fasting glucose and lipid panel checked regularly.
"PCOS is a metabolic and hormonal condition that requires a whole-patient approach, not just symptom management."
Dr. Lina Haddad, CMO, Looms
Management options
There is no single cure for PCOS, but symptoms and long-term risks are highly manageable. Lifestyle change — particularly weight loss of 5–10% in those who are overweight — can restore ovulation and reduce androgen levels. For women not trying to conceive, the combined oral contraceptive pill reduces androgens and regulates periods. Metformin improves insulin sensitivity. Spironolactone addresses hirsutism and acne.
Because the condition spans reproductive, metabolic and psychological domains, the most effective care involves a GP or gynaecologist, ideally with access to endocrinology and dietitian support.