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PCOS: Signs, Tests and Treatment Options
Polycystic ovary syndrome explained: common signs, how PCOS is diagnosed, the tests your clinician may order, long-term health risks and treatment options.
Key takeaways
- PCOS affects an estimated 6–13% of women of reproductive age, and many don’t know they have it.
- Diagnosis usually requires two of three features: irregular ovulation, signs of high androgens and polycystic ovaries on ultrasound or a high AMH level.
- Treatment targets your goals, from regular periods and clearer skin to fertility and long-term health.
On this page
Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions in women of reproductive age. The World Health Organization estimates it affects 6–13% of them, and many aren’t diagnosed. Despite the name, you don’t need ovarian cysts to have PCOS; the “cysts” are actually small, immature follicles.
Common signs
- Irregular or missed periods, such as cycles longer than 35 days or fewer than eight periods a year
- Excess hair growth on the face, chest or back
- Acne that persists into adulthood
- Thinning scalp hair
- Weight gain or difficulty losing weight
- Difficulty getting pregnant, because ovulation is irregular
- Darkened skin patches, often on the neck or armpits, a sign of insulin resistance
How PCOS is diagnosed
Most clinicians use criteria endorsed by the 2023 international PCOS guideline. In adults, PCOS is diagnosed when you have two of these three features, after other causes are ruled out:
| Feature | How it’s assessed |
|---|---|
| Irregular or absent ovulation | Your cycle history |
| High androgens | Symptoms such as excess hair or acne, or a blood test |
| Polycystic ovaries | Ultrasound, or a high AMH blood level in adults |
For teenagers, both irregular cycles and high androgens are needed, and ultrasound isn’t used in the first eight years after periods start, because many normal teen ovaries look polycystic.
Tests your clinician may order
- Blood tests for testosterone and other hormones
- Tests to rule out other causes, such as thyroid disease, high prolactin, pregnancy and adrenal conditions
- A pelvic ultrasound in some cases
- Screening for related risks: blood sugar (often an oral glucose tolerance test), cholesterol and blood pressure
- Questions about mood and sleep, as depression, anxiety and sleep apnea are more common with PCOS
Long-term health risks
PCOS raises the risk of insulin resistance, type 2 diabetes, high cholesterol and diabetes in pregnancy. Infrequent periods can let the uterine lining build up, which raises the risk of endometrial hyperplasia and cancer over time. Regular check-ups and treatment reduce these risks.
Treatment options
Treatment depends on your goals.
- Healthy habits: regular activity and balanced eating help insulin resistance and cycles, whatever your weight.
- Combined birth control pills regulate periods, protect the uterine lining and improve acne and hair growth. A hormonal IUD or cyclic progestin can protect the lining too. See our birth control guide.
- Metformin can help with insulin resistance and cycle regularity.
- Anti-androgen medicines, such as spironolactone, reduce excess hair and acne. They must be used with reliable contraception, because they can harm a developing pregnancy.
- Fertility treatment: letrozole is usually the first-line medicine to trigger ovulation, with further options if needed.
Bring your questions to your next visit; our list of questions to ask your gynecologist has a section on diagnoses. Pelvic pain is not a typical PCOS symptom, so if it’s your main problem, read about endometriosis symptoms too.
Frequently asked questions
Can you get pregnant with PCOS?
Yes. Many people with PCOS conceive naturally or with treatment to help ovulation.
Does PCOS go away?
It’s a lifelong condition, but symptoms often change with age, and treatment can manage them well.
Do I need to lose weight to treat PCOS?
Not necessarily. Healthy habits help at any size, and if weight loss is appropriate, even modest changes can improve cycles and insulin resistance.
Sources
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