Irregular periods, difficulty getting pregnant, and excessive hair growth (hirsutism) are a few common symptoms of polycystic ovary syndrome (PCOS). PCOS symptoms can also differ in severity and many people have it without knowing. Even though there’s no cure for PCOS, there are many helpful ways to manage your symptoms — from following healthy lifestyle habits to taking medication.
Polycystic ovaries are one of the main features of PCOS. This is when your ovaries contain many fluid-filled sacs (follicles) surrounding your eggs. These cysts aren’t harmful but can lead to hormonal imbalances — which can affect your menstrual cycle. Despite its name, you don’t actually have cysts, and not everyone with PCOS will have polycystic ovaries.
You can check for polycystic ovaries by getting an ultrasound — your GP will request one if it’s appropriate.
Irregular or absent periods
If your ovaries aren’t producing eggs (ovulating) each month, you might have irregular periods or they might be absent. On average, the length of your menstrual cycle lasts around 28 days — but it’s normal for it to be slightly shorter or longer. If you're unsure how long your cycle is, you could keep a diary each month to help you understand what's normal for you.
If you’re concerned about your periods, you should seek advice from your GP. You should also keep a diary for at least 3 months to track your symptoms — this will help you notice any changes in your cycle.
High levels of male hormones — testosterone
Hyperandrogenism is one of the key features of PCOS. It’s a medical condition characterised by high levels of “male” hormones (androgens) — like androstenedione and testosterone. While they’re called male hormones, they’re essential for women's health too. But your androgen levels can become too high if you have PCOS.
The main causes of hyperandrogenism include:
- hyperinsulinaemia — raised insulin levels
- problems with your adrenal glands
- hyperprolactinemia — high levels of a hormone called prolactin
- adrenal hyperplasia — low levels of cortisol and high levels of androgens
- Cushing’s syndrome
Raised androgen levels can lead to:
- heavy periods
- excess body hair (hirsutism)
- hair loss on your scalp
- oily skin and acne
Plus, high testosterone levels can contribute to mood swings or changes in your mental health.
If you have PCOS, you might experience heavier bleeding during your period. This condition is called menorrhagia and is usually caused by an imbalance of “female” hormones — like oestrogen and progesterone.
You might have menorrhagia if during your period you:
- change your sanitary products every 2 hours or more frequently
- pass blood clots larger than the size of a 10p coin
- lose more than 80 ml (half a small cup of water) of blood in less than 7 days
- bleed for more than 7 days
- bleed through your clothes or bedding
- use two types of sanitary products together — like tampons and pads
If you’re worried about heavy periods, you should go to your GP for advice or request a gynaecology referral.
Heavy bleeding doesn’t always indicate PCOS, and most women have a good idea of what is the average amount of blood for them.
Find out more about the different types of female hormones and their functions.
Excessive hair growth (hirsutism)
Hirsutism is relatively common and affects up to 10% of women. PCOS is one of the most common causes of hirsutism because it raises your male hormone levels (androgens) — like testosterone. Higher levels of androgens stimulate your hair follicles, which is what increases your hair growth.
Hirsutism typically affects the following areas of your body:
- face — like on your upper lip, chin, and neck
- lower back
Getting diagnosed with hirsutism usually involves getting a blood test to check your testosterone levels. You can do this at home by using a PCOS blood test.
Find out more about the causes and treatment of hirsutism.
Female pattern hair loss or thinning hair
Some people with PCOS experience female pattern hair loss (FPHL). This condition usually affects the middle of your scalp and is caused by excess androgen levels.
Hair loss or thin hair from PCOS is usually treated with anti-androgens — taken as oral medication, or applied with a topical treatment like minoxidil to your scalp. It’s usually most effective to use both types of treatment together. If you’re concerned about your hair, you should speak to your GP for advice.
PCOS doesn’t always cause hair loss and thinning hair — it could be linked to another medical condition, like an overactive thyroid.
Find out more about the causes of hormonal imbalances.
Some people with PCOS find managing their weight difficult — this can often result from insulin resistance.
Insulin is a hormone that regulates your blood sugar levels. If you’re insulin resistant, your body compensates by producing more insulin. This means your body absorbs too much glucose (sugar) which can result in weight gain — this can make PCOS symptoms worse, as having excess fat causes your body to produce even more insulin.
High insulin levels can also lead to your ovaries producing too much testosterone — this interferes with the normal development of the follicles, preventing ovulation. Insulin resistance and carrying excess weight also increases your risk of type 2 diabetes and heart disease.
Losing weight with PCOS can be more difficult, but there’s a range of things you can do to help you manage your weight.
Find out more about how PCOS affects your weight.
Oily skin and acne
PCOS often leads to acne as it causes your ovaries and adrenal glands to produce excess androgens, which stimulates oil production.
Acne typically affects the following areas of your body:
- face — usually on your jawline, cheeks, and chin
If you think you have acne, you should speak to your GP for advice. Depending on the severity of your acne, they might prescribe you oral medication or a topical cream to apply to the affected areas. Usually, a combination of both treatments is the most effective. And in some cases, your GP might refer you to a dermatologist.
Difficulty getting pregnant
Some people with PCOS have difficulty with fertility — but most people can still get pregnant.
The main reason you might have difficulty getting pregnant is because of how PCOS affects ovulation. A hormonal imbalance might prevent the development and release of a mature egg. If this happens, you don’t ovulate and fertilisation can’t happen.
If a mature egg becomes fertilised, imbalanced hormone levels might also mean the lining of your womb doesn’t build up properly — so a fertilised egg can’t implant.
There’s a range of fertility treatments for PCOS that are very effective, but not everyone with PCOS needs them to get pregnant.
Find out more about how PCOS affects fertility and the treatments available.
How to get tested for PCOS
PCOS is based on 3 main features — irregular periods, excess androgens, and polycystic ovaries.
You only need 2 out of 3 symptoms for a PCOS diagnosis, which usually involves:
- answering questions about your menstrual cycle — it’s a good idea to keep a diary of your symptoms each month
- a blood test to check your hormone levels — like testosterone
- an ultrasound scan — to check if your ovaries have a lot of follicles in them
Only two of these are needed for your doctor to diagnose PCOS, so you might not necessarily need an ultrasound scan.
You can check or monitor your hormone levels by using a home PCOS blood test.