Polycystic ovary syndrome is often reduced to "irregular periods and cysts on a scan". In practice it is a whole-body hormonal and metabolic condition, and treating only the periods misses most of it.
How it is actually diagnosed
Two of the following three are required: irregular or absent ovulation, clinical or biochemical signs of excess androgens, and polycystic ovarian morphology on ultrasound. Note that the scan alone is not enough — many women with polycystic-looking ovaries do not have PCOS at all.
The insulin connection
Around 70% of women with PCOS have insulin resistance regardless of their weight. High insulin drives the ovaries to make more androgens, which blocks ovulation and worsens acne and hair growth. This is why metabolic treatment often fixes the gynaecological symptoms.
What genuinely helps
- Resistance training: improves insulin sensitivity more reliably than cardio alone
- 5–10% weight loss: restores ovulation in a majority of overweight patients
- Lower glycaemic-load meals: not a zero-carbohydrate diet, but fewer refined carbohydrates
- Metformin or inositol: where insulin resistance is documented
- Combined pills or anti-androgens: for cycle regulation, acne and hirsutism when pregnancy is not the goal
If you are trying to conceive
Most women with PCOS do conceive. Letrozole-based ovulation induction is now the first-line treatment and works better than the older clomiphene approach. IVF is needed only in a minority.
The long view
PCOS raises the lifetime risk of type 2 diabetes, high blood pressure, fatty liver and endometrial cancer. An annual metabolic check and ensuring at least four periods a year are the two things that protect you over decades.
