Polycystic ovary syndrome (PCOS) is a common hormonal and metabolic condition. In newer international guidance, the condition is also referred to as polyendocrine metabolic ovarian syndrome (PMOS), but the term PCOS is still widely recognized by patients and clinicians.
PCOS can affect menstrual cycles, ovulation, androgen levels, fertility, skin and hair, and long-term metabolic health. It is also linked with a higher risk of insulin resistance and type 2 diabetes. Having PCOS does not mean you will definitely develop diabetes or infertility.
Common Symptoms of PCOS
- Irregular, infrequent, or absent periods
- Excess facial or body hair
- Acne or oily skin
- Thinning scalp hair
- Difficulty becoming pregnant because of irregular ovulation
- Weight gain or difficulty managing weight in some people
- Darkened, velvety skin patches, which can be associated with insulin resistance
Symptoms vary widely. Some people have only a few features.
How PCOS Is Diagnosed
There is no single test that diagnoses PCOS. In adults, diagnosis usually considers whether at least two of the following are present after other causes have been excluded:
- Irregular or absent ovulation
- Clinical or blood-test evidence of higher androgen levels
- Polycystic-appearing ovaries on ultrasound; in appropriate adults, anti-Müllerian hormone (AMH) may sometimes be used as an alternative within the diagnostic algorithm
If irregular cycles and clear hyperandrogenism are already present, ultrasound or AMH may not be needed. Diagnosis in adolescents is different and should be made cautiously because normal puberty can mimic PCOS features.
PCOS, Insulin Resistance, and Diabetes Risk
Insulin resistance is common in PCOS, although not everyone with PCOS has it. PCOS is associated with a higher risk of impaired glucose regulation and type 2 diabetes. This is why clinicians may recommend periodic blood-sugar testing based on individual risk factors.
PCOS does not mean diabetes is inevitable. Healthy eating, regular physical activity, good sleep, avoiding smoking, and appropriate medical care can support long-term metabolic health. For more detail on symptoms, screening, pregnancy, and diabetes care in women, see our Diabetes in Women guide.
How Is PCOS Treated?
There is no single treatment that is right for everyone. Care should be based on symptoms, metabolic risks, pregnancy plans, personal preferences, and other health conditions.
Lifestyle Support
Healthy eating and regular physical activity are recommended for overall health in PCOS. There is no single “PCOS diet” proven to be best for everyone. Weight-management support may be useful for some people, but care should avoid stigma and focus on health rather than appearance.
Irregular Periods and Androgen Symptoms
For people who are not trying to become pregnant, combined hormonal contraceptives are commonly used for irregular periods and symptoms related to excess androgens, when medically appropriate. Other medicines may sometimes be considered depending on symptoms and pregnancy plans.
Metformin
Metformin can be useful for some people with PCOS, particularly for metabolic features such as insulin resistance or increased diabetes risk. It is not a universal treatment for every PCOS symptom and should be prescribed based on individual circumstances.
PCOS and Fertility
Many people with PCOS can become pregnant naturally or with treatment. If ovulation is irregular and pregnancy is desired, current international guidance generally considers letrozole the preferred first-line medicine for ovulation induction when appropriate. Other fertility treatments may be considered if first-line approaches are unsuccessful or unsuitable.
Do not start fertility medicines without medical supervision.
PCOS and Pregnancy
Pregnancy with PCOS can be healthy, but the condition is associated with a higher risk of some complications, including gestational diabetes and high blood pressure disorders. Pre-pregnancy care can help review medicines, blood pressure, blood sugar, folic-acid needs, and other health factors.
Metformin is not routinely recommended for every pregnant person with PCOS; whether it should be continued or used during pregnancy depends on individual clinical circumstances.
Mental Health and Sleep Matter Too
PCOS is associated with higher rates of anxiety, depression, body-image concerns, and sleep apnea. These are important parts of care and should not be dismissed as “just hormones.” Tell a healthcare professional if mood, sleep, or eating concerns are affecting your quality of life.
When to Seek Medical Advice
Talk with a healthcare professional if you have persistently irregular periods, symptoms of excess androgens, trouble becoming pregnant, or signs of high blood sugar such as unusual thirst and frequent urination. Seek urgent care for severe abdominal pain, heavy bleeding with dizziness or fainting, or symptoms of a medical emergency.
Reliable Sources
- Monash University: International Evidence-Based PCOS/PMOS Guideline
- American Society for Reproductive Medicine: International Guideline Recommendations
- NIDDK: PCOS and Diabetes
This article is for general education and is not a diagnosis or a substitute for individual medical care.