Polycystic ovary syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS): Symptoms, Diagnosis, Management

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal conditions in women — 1 in 10 women of childbearing age. Despite how common it is, it’s often misunderstood, misdiagnosed or left untreated for years.

At Happiher, we believe every woman deserves personalised, compassionate care for PCOS — not a one-size-fits-all approach. As a private gynaecologist in London, I help women manage PCOS with evidence-based treatments, lifestyle support and clear expert guidance.

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects how the ovaries work. PCOS affects women during their childbearing years and causes hormonal imbalances and reproductive health issues. Women with PCOS may have:

• Irregular or no periods

• High androgens (male hormones)

• Multiple small fluid-filled sacs (follicles) in the ovaries (seen on ultrasound)

Not all women with PCOS have cysts on their ovaries and not all ovarian cysts mean you have PCOS — diagnosis is based on a combination of features.

PCOS Introduction

PCOS Symptoms: Irregular Menstrual Periods

PCOS can look different for every woman but common signs include:

• Irregular, infrequent or no periods

• Missed periods

• Excess body hair growth (hirsutism) especially on the face, chest or back

• Unwanted hair growth on other parts of the body

• Acne or oily skin

• Thinning hair on the scalp

• Difficulty losing weight or unexplained weight gain

• Fertility challenges (ovulation difficulties)

• Mood swings, low mood or anxiety

Because symptoms vary, PCOS is often missed especially if women don’t fit a “typical” profile. Many women have PCOS but are undiagnosed and up to 70% have not been diagnosed in some studies.

What causes PCOS? Insulin Resistance

The exact cause of PCOS isn’t fully understood but several factors play a role:

• Insulin resistance (where the body’s cells don’t respond properly to insulin leading to high insulin levels)* Hormonal imbalance (higher levels of luteinising hormone or male hormones called androgens)

• Genetic factors (PCOS tends to run in families)

The pituitary gland regulates ovulation and hormone levels by producing follicle-stimulating hormone (FSH) and luteinising hormone (LH). Imbalances in the pituitary gland can cause PCOS.

These imbalances can disrupt normal ovulation and cause irregular cycles and other symptoms.

How is PCOS diagnosed?

At Happiher, we diagnose PCOS holistically, looking at the whole picture.

Diagnosis may include:

• Detailed consultation about periods, symptoms, family history and lifestyle

• Pelvic ultrasound uses sound waves to assess ovaries and check for multiple follicles

• Blood tests to check hormone levels (androgens, LH, FSH, insulin, thyroid function)

• Blood tests to check cholesterol and triglyceride levels

• Physical exam to assess symptoms related to PCOS

Diagnosis is based on the Rotterdam criteria, meaning two of the following three must be present:

1. Irregular periods or no ovulation

2. High androgens (symptoms or blood test evidence)

3. Multiple follicles in the ovaries (polycystic appearance)

We need to rule out other causes of symptoms before confirming PCOS.

Is PCOS serious?

PCOS is manageable but without treatment it can lead to serious health problems such as:

• Infertility

• Type 2 diabetes

• High blood pressure

• High cholesterol and cardiovascular risk

• Sleep apnoea

• Endometrial cancer (due to prolonged unopposed oestrogen)

Women with PCOS are also at higher risk of miscarriage and pregnancy complications.

• Infertility

• Type 2 diabetes

• High blood pressure

• High cholesterol and cardiovascular risk

• Sleep apnoea

• Endometrial cancer (due to prolonged unopposed oestrogen)

That’s why early diagnosis and ongoing support matters so much.

PCOS related health conditions

PCOS is linked to several health conditions that can impact the overall health of women with the condition. One of the main concerns is insulin resistance where the body’s cells don’t respond to insulin properly and blood glucose levels rise. This can lead to type 2 diabetes. Women with PCOS are also more likely to have high blood pressure and metabolic syndrome, a cluster of conditions that increase the risk of heart disease and stroke.

Another serious concern is the increased risk of endometrial cancer due to prolonged periods without ovulation which can lead to a build up of the uterine lining. Pregnancy complications such as gestational diabetes and hypertension are also more common in women with PCOS. Given these risks women with PCOS need to work closely with their healthcare providers to manage these related health conditions and prevent long term complications.

Mental Health and PCOS

The emotional and psychological impact of PCOS is huge and often overlooked. Many women with PCOS struggle with depression and anxiety partly due to physical symptoms like excess hair growth, acne and weight gain. The hormonal imbalance in PCOS can also cause mood swings and emotional distress and affect mental health.

Women with PCOS need to seek comprehensive support which may include counseling, therapy or joining support groups. Lifestyle changes such as a healthy diet and regular exercise can also play a big role in improving mental health and reducing the risk of depression and anxiety. Addressing these mental health concerns is a big part of managing PCOS and improving overall quality of life.

Metabolic Syndrome and PCOS

Metabolic syndrome is a cluster of conditions that increase the risk of heart disease and stroke and women with PCOS are at higher risk due to the hormonal imbalance and insulin resistance associated with the condition. Symptoms of metabolic syndrome include high blood pressure, elevated cholesterol levels and insulin resistance. Managing metabolic syndrome involves lifestyle changes such as a healthy diet and regular exercise. These changes can help lower blood pressure, improve cholesterol levels and increase insulin sensitivity. In some cases metformin may be prescribed to manage insulin resistance and reduce long term complications. Lifestyle changes like weight loss can also improve PCOS symptoms and increase fertility. Proactive management of metabolic syndrome is key for women with PCOS to stay healthy.

Treatment Options for PCOS

Polycystic ovarian syndrome (PCOS) is a common condition related to hormonal imbalances in the ovaries and menstrual cycle. It can cause irregular periods and other problems for those affected.

There’s no cure for PCOS but symptoms can be managed with a combination of lifestyle changes, medication and supportive therapies to improve symptoms.

• Birth control pills or other hormonal birth control to regulate cycles and manage symptoms

• Laser hair removal for excess hair growth

• Hair removal treatments can also help manage excess hair growth in women with PCOS

At Happiher, treatment is tailored to your goals — whether that’s regulating periods, managing symptoms or supporting fertility, we have options to treat PCOS symptoms.

Lifestyle Management

• Nutrition advice for blood sugar control

• Exercise programmes to improve insulin sensitivity

• Weight management (even a 5-10% weight loss can restore ovulation and lower blood glucose levels)

• A 5-10% weight loss can also regulate menstrual cycles in women with PCOS

Medical Treatments

Medical treatments can help improve symptoms and manage PCOS.

• Hormonal birth control to regulate cycles and protect the uterine lining

• Anti-androgen medications to reduce excess hair and acne

• Insulin-sensitising drugs (like metformin) if insulin resistance and high insulin levels are present

• Ovulation induction therapies (if fertility is a goal)

• Clomiphene, a fertility drug, can help women with PCOS ovulate to improve chances of pregnancy

Surgical Options

In rare cases laparoscopic ovarian drilling may be offered if medical ovulation induction isn’t successful. This surgical procedure can improve fertility in women with PCOS. At Happiher, Dr Kaur’s expertise in minimally invasive gynaecology ensures safe, advanced surgical care when needed.

Alternative Therapies

While there’s no cure for PCOS, alternative therapies such as acupuncture, herbal supplements and mind-body therapies may help manage symptoms. Some women with PCOS find that practices like yoga and meditation reduce stress and improve overall well-being. However, it’s essential to consult with a healthcare provider before starting any alternative therapies as some may interact with medications or have adverse effects. Alternative therapies should complement, not replace, conventional medical treatment, offering a holistic approach to managing PCOS symptoms.

PCOS and Fertility

While PCOS is a leading cause of ovulatory infertility, many women with PCOS conceive naturally or with minimal support. Effective treatment plans, including lifestyle changes and medical interventions, can improve chances of a healthy pregnancy.

At Happiher, we support women through:

• Natural cycle monitoring

• Ovulation induction therapies

• Referral to fertility specialists if needed

• In vitro fertilisation (IVF) as a potential assisted reproductive technology

We believe fertility discussions around PCOS should be hopeful and proactive — not fearful, and options like vitro fertilisation can be part of a comprehensive treatment plan.

Living with PCOS

PCOS affects more than just physical health — it can impact self-esteem, mental health and body image. Many women with PCOS struggle with depression and anxiety, partly due to physical symptoms like excess hair growth, unwanted hair, acne and weight gain. Unwanted hair growth can also contribute to emotional distress and impact self-esteem.

At Happiher, we offer not just medical treatment but emotional and psychological support too — helping women feel empowered, understood and in control. Some treatments for PCOS can cause side effects like pelvic pain which should be managed with the help of healthcare providers.

Preventing Complications

Women with PCOS are at higher risk of developing complications such as metabolic syndrome, high blood pressure and endometrial cancer. To prevent these complications, it’s essential to maintain a healthy weight, exercise regularly and eat a balanced diet. Losing even a small amount of weight can improve insulin sensitivity and reduce complications. Regular check-ups with a healthcare provider are crucial for monitoring potential complications and treating any issues that arise.

Latest Research on PCOS

Research on PCOS is ongoing, new studies are being published all the time. Recent research has focused on insulin resistance and androgen excess in PCOS. Other studies have looked at new medications and therapies such as IVF for women with PCOS. Researchers are also developing new diagnostic tools and treatments including genetic testing and personalised medicine. Staying up to date with the latest research will help women with PCOS understand their diagnosis and make informed decisions about their treatment.

Before Your Appointment

Before you see a healthcare provider, make sure to prepare by writing down any symptoms, medications and medical conditions. Women with PCOS should be ready to discuss their periods, weight changes and other symptoms. A physical exam including a pelvic exam may be performed to check for signs of PCOS such as ovarian cysts and excess hair growth. Blood tests including blood glucose and cholesterol tests may also be ordered to check for insulin resistance and other health conditions. Being prepared for the appointment will ensure women with PCOS get the best possible care and treatment for their condition.

Pelvic Exam and PCOS

A pelvic exam is an essential part of diagnosing and managing PCOS. During this exam a healthcare provider will check for abnormalities in the reproductive organs including the ovaries and uterus. The exam may also involve a blood test to measure hormone levels such as follicle stimulating hormone (FSH) and luteinising hormone (LH) which can give insight into the hormonal imbalances of PCOS.

An ultrasound may also be performed to look for ovarian cysts and other abnormalities. This comprehensive approach helps in accurately diagnosing PCOS and any related health conditions. Regular pelvic exams are important for monitoring the condition and adjusting treatment plans as needed.

Why Choose Happiher for PCOS Care?

Looking for a PCOS specialist in London? Happiher offers:

• Private, thoughtful consultations

• Expert hormone and ultrasound assessments

• Personalised lifestyle and medical management plans

• Holistic support for physical and emotional health

• Locations across London at Chelsea & Westminster, The Lister and The Wellington Hospital

You deserve a care plan that fits your body, your goals and your life — not a one-size-fits-all approach.

Next Steps

Knowing the causes and symptoms of PCOS empowers women to take control of their health and reduce the risk of long term complications. For women with PCOS the next steps are to book in with their healthcare provider, make lifestyle changes to manage symptoms and see a therapist or support group to manage mental health. With the right treatment and support women with PCOS can manage their symptoms and improve their overall health.

Last Word

PCOS may be common but your experience is unique — and so is the care you need. Whether you’re managing symptoms, planning for fertility or just looking for answers, Happiher is here to support you with expertise, compassion and personal care.