Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal conditions affecting women of reproductive age – yet it remains widely misunderstood. Many women live with symptoms for years before receiving a diagnosis, while others are diagnosed without a clear explanation of what that actually means.
Understanding PCOS is the first step toward managing it effectively. While the condition can affect fertility, metabolism, skin, mood, and long-term health, awareness is growing – and with it, better tools for early recognition and management.
What Is PCOS?
PCOS is a complex hormonal and metabolic condition that affects how the ovaries function (1,2).
Most clinicians diagnose PCOS using the Rotterdam Criteria, which require two of the following three features (2):
1. Irregular or Absent Ovulation/ Ovarian Dysfunction
Ovulation occurs when the ovary releases an egg during the menstrual cycle. In PCOS, ovulation may occur infrequently or not at all (1).
This can lead to:
- Irregular menstrual cycles
- Long gaps between periods
- Difficulty predicting ovulation
- Fertility challenges in some women (1)
Irregular ovulation is often one of the earliest signs of PCOS.
2. Elevated Androgens (Male-Type Hormones)
Women naturally produce small amounts of androgens, such as testosterone. However, women with PCOS often have higher-than-normal androgen levels (1).
Elevated androgens can lead to symptoms such as:
- Acne
- Excess facial or body hair (hirsutism)
- Thinning hair or hair loss on the scalp (1)
3. Polycystic Ovarian Appearance
Despite the name, PCOS does not actually mean ovarian cysts.
Instead, the ovaries may contain many small immature follicles – fluid-filled sacs that contain eggs that did not mature enough to be released during ovulation (1,6).
On ultrasound, this can create the appearance of multiple small cysts arranged around the edge of the ovary.
It’s important to note that not all women with PCOS have polycystic ovaries, and some women without PCOS can have a similar ultrasound appearance (1).
How Common Is PCOS – and Why Awareness Matters
PCOS affects an estimated 8–13% of women of reproductive age worldwide, making it one of the most common endocrine disorders in women (1). Despite this, up to 70% of cases remain undiagnosed (1).
One of the reasons PCOS is often missed is that symptoms vary widely between individuals. Some women experience irregular menstrual cycles and fertility challenges, while others may primarily notice skin issues, weight changes, or metabolic concerns (1).
PCOS also sits at the intersection of several important areas of health, including:
- Hormonal regulation
- Metabolic health
- Reproductive health
- Cardiovascular risk (1)
Without proper awareness, women may treat individual symptoms – such as acne or irregular periods – without recognising the underlying hormonal pattern driving them.
Greater awareness helps women seek earlier assessment, receive appropriate medical support, and better understand how lifestyle, nutrition, and metabolic health influence their symptoms.
The Root Drivers of PCOS
PCOS is not caused by a single factor. Instead, it is driven by a network of hormonal and metabolic disruptions that interact with one another, in which four key biological drivers are often involved.
Insulin Resistance
One of the most important underlying mechanisms in PCOS is insulin resistance.
Insulin is the hormone that helps move glucose (sugar) from the bloodstream into cells where it can be used for energy. When cells become less responsive to insulin, the body compensates by producing higher levels of insulin (5).
High insulin levels can have several downstream effects:
- Stimulating the ovaries to produce more androgens
- Disrupting normal ovulation
- Promoting fat storage, particularly around the abdomen
- Increasing long-term risk of metabolic conditions such as type 2 diabetes (4)
Research suggests up to 70–80% of women with PCOS have some degree of insulin resistance, even if they are not overweight (3,4).
Hormonal Imbalance
PCOS involves a disruption of the delicate hormonal communication between the brain, ovaries, and endocrine system (6).
Two hormones produced by the brain play a key role:
- Luteinising hormone (LH)
- Follicle-stimulating hormone (FSH)
Normally, these hormones work together to regulate ovulation. In PCOS, the balance between them shifts – often resulting in higher LH relative to FSH (6).
This imbalance can encourage the ovaries to produce more androgens and excess follicles, while preventing follicles from fully maturing, contributing to irregular ovulation (6).
Chronic Low-Grade Inflammation
Emerging research suggests that chronic low-grade inflammation may contribute to the hormonal and metabolic disruptions seen in PCOS (6).
Inflammation can:
- Worsen insulin resistance
- Stimulate androgen production
- Affect ovarian function (6)
This inflammatory pattern is subtle and often not detected through routine tests, but it may be influenced by factors such as diet, stress, sleep quality, and body composition (6).
Metabolic Health
PCOS is increasingly understood as a metabolic as well as reproductive condition.
Many women with PCOS experience changes in metabolic markers, including:
- Higher fasting insulin levels
- Elevated triglycerides
- Lower HDL (“good”) cholesterol
- Increased risk of impaired glucose tolerance (6)
Over time, this can increase the risk of type 2 diabetes, metabolic syndrome, and cardiovascular disease if not addressed (6).
Importantly, these metabolic changes can occur in women of all body sizes, highlighting that PCOS is not simply a weight-related condition.
Managing Polycystic Ovary Syndrome
PCOS has no cure, but treatments can improve quality of life, support fertility, reduce risks such as endometrial hyperplasia or cancer, and help prevent long-term cardiovascular issues. Early healthcare support is key to managing symptoms and protecting overall well-being.
Healthy lifestyle habits – like balanced nutrition and regular physical activity – benefit all women with PCOS, even without weight loss. Medical options may include combined oral contraceptives to regulate cycles and reduce acne or excess hair, and androgen receptor blockers for hair or skin concerns, with choices guided by individual preferences. For fertility, interventions range from lifestyle and medication to ovulation-stimulating procedures, surgery, or assistive reproductive technologies like IVF, with careful monitoring due to higher pregnancy risks (1).
PCOS is a complex and often misunderstood condition, but with the right knowledge and support, it can be effectively managed. Recognising the signs early, understanding the underlying drivers, and taking a proactive approach to hormonal and metabolic health can make a meaningful difference to both short- and long-term outcomes.
While every woman’s experience with PCOS is unique, a personalised, informed approach to care empowers women to take control of their health, support their fertility if desired, and improve overall quality of life.
Important note: As of May 2026, PCOS has been renamed PMOS – Polyendocrine Metabolic Ovarian Syndrome. Medical experts changed the name to move away from a misleading label and to better reflect the condition's hormonal, endocrine, and metabolic nature. Read more here.
This content is for informational purposes only and does not constitute medical advice. Always consult with your healthcare provider before starting any new supplement, especially if you are pregnant, nursing, have a medical condition, or are taking prescription or chronic medication.
