What is PCOS?

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders affecting women of reproductive age and yet it’s also one of the most misunderstood.

Despite the name, PCOS is not just about “cysts in the ovaries.” It is a complex metabolic and hormonal condition that affects how the ovaries function, how the body responds to insulin and how certain hormones are produced and regulated. For many women, it shows up as irregular periods. For others, it may first appear as acne, weight gain or difficulty conceiving.

Understanding PCOS properly is the first step toward managing it effectively.

In a typical menstrual cycle, the ovaries release one mature egg each month. In PCOS, hormonal imbalance interferes with this process.

There are three main underlying features:

1. Irregular ovulation - The ovaries may not release an egg regularly.

2. Excess androgens - Higher-than-normal levels of “male” hormones like testosterone.

3. Insulin resistance - The body doesn’t respond efficiently to insulin, leading to higher insulin levels.

Not everyone with PCOS will have ovarian cysts. The term “polycystic” refers to the appearance of multiple small follicles seen on ultrasound; these are immature follicles, not dangerous cysts.

Symptoms vary widely from person to person. Some women experience mild signs; others struggle with multiple issues.

The most common symptoms include:

• Irregular, infrequent or missed periods

• Heavy menstrual bleeding

• Hirsutism

• Persistent acne, especially along the jawline

• Thinning hair or hair loss on the scalp

• Weight gain or difficulty losing weight

• Darkening of skin around the neck or underarms (a sign of insulin resistance)

• Difficulty conceiving

Because symptoms overlap with other conditions, PCOS is sometimes diagnosed late, especially if periods are only mildly irregular.

The exact cause is not fully understood, but research points to a combination of factors:

Around 60-70% of women with PCOS have some degree of insulin resistance. When insulin levels are high, the ovaries are stimulated to produce more androgens, which disrupt ovulation.

Higher levels of luteinizing hormone (LH) and androgens interfere with normal egg maturation.

PCOS often runs in families. If someone’s mother or sister has it, then the risk is higher.

Emerging research suggests that persistent inflammation may contribute to excess androgen production.

Doctors typically use the Rotterdam criteria, which require at least two of the following three features:

• Irregular or absent ovulation

• Clinical or biochemical signs of excess androgens

• Polycystic ovaries on ultrasound

Blood tests are usually done to measure hormone levels, thyroid function, prolactin and blood sugar markers to rule out other conditions.

Because PCOS affects multiple systems, diagnosis often requires looking beyond just the ovaries.

Many women discover they have PCOS when trying to conceive. Irregular ovulation can make timing difficult.

However, PCOS does not mean infertility. With proper management, including cycle tracking, metabolic support and medical guidance where necessary, many women with PCOS conceive successfully.

The key is restoring more regular ovulation rather than focusing only on the ovaries.

PCOS is not just a reproductive issue. If unmanaged, it can increase the risk of:

• Type 2 diabetes

• High cholesterol

• High blood pressure

• Sleep apnea

• Endometrial hyperplasia

• Anxiety and depression

This is why early management is important, even if pregnancy is not a concern.

There is no “one-size-fits-all” approach. Management focuses on improving insulin sensitivity, balancing hormones and reducing inflammation.

• Prioritise protein at every meal

• Include fibre-rich foods (vegetables, seeds, legumes)

• Reduce ultra-processed carbohydrates

• Pair carbs with protein or healthy fats to avoid blood sugar spikes

Small changes in meal timing and composition can significantly improve symptoms.

Resistance training improves insulin sensitivity more effectively than long hours of cardio. Muscle acts like a glucose sponge - the more it is built, the better the metabolic response becomes.

Chronic stress raises cortisol, which can worsen hormonal imbalance. Breathwork, restorative yoga or even slow evening walks can make a measurable difference.

Poor sleep worsens insulin resistance. Aim for 7-8 hours of consistent sleep.

Even a 5-10% reduction in body weight can improve ovulation in overweight individuals. However, not all women with PCOS are overweight; lean PCOS exists, too.

Emerging research links PCOS with chronic low-grade inflammation. Alongside diet and lifestyle changes, cannabinoids are being studied for their interaction with the body’s endocannabinoid system. When used responsibly and under professional guidance, cannabinoid-based formulations may complement lifestyle strategies aimed at supporting overall hormonal and metabolic balance.

PCOS can affect body image, mood and self-esteem. Acne, hair growth and weight changes can be distressing. Women with PCOS have higher rates of anxiety and depression. Seeking psychological support when needed is just as important as addressing physical symptoms.

PCOS is a complex hormonal and metabolic condition - not just a gynaecological issue. It affects cycles, skin, metabolism, fertility and long-term health.

The good news is that it is manageable. With early diagnosis, consistent lifestyle support and informed medical care, many women regulate their cycles, improve symptoms and protect their long-term health. Understanding our body is powerful. And with PCOS, knowledge truly changes outcomes.