You have irregular periods, perhaps a bit more hair growth than you'd expect, and you're wondering if there could be something hormonal going on. Or maybe you've been trying to get pregnant without success, and your doctor has mentioned PCOS as a possible explanation.
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, affecting an estimated 10–15% of women worldwide. The good news is that most people with PCOS can get pregnant — often it just takes a little extra knowledge and the right support.
What Is PCOS?
PCOS (polycystic ovary syndrome) is a hormonal disorder that affects how the ovaries function. The name can be misleading — it's not just about cysts on the ovaries. The condition involves an imbalance of several hormones that affect ovulation, menstruation, and metabolism.
With PCOS, the ovaries produce more androgens (male sex hormones) than normal. This can disrupt the maturation of eggs, causing ovulation to become irregular or stop altogether. Without ovulation, pregnancy is not possible.
The term "polycystic" refers to the ovaries potentially containing many small, immature follicles (egg sacs) visible on ultrasound. These are not dangerous cysts — they are immature eggs that have not been released.
Symptoms of PCOS
PCOS presents differently from person to person. Some have obvious symptoms, while others discover the condition only when they start trying to conceive. The most common symptoms are:
Menstrual irregularities
- Irregular periods — cycle length that varies greatly from month to month
- Infrequent periods — more than 35 days between cycles (oligomenorrhea)
- Absent periods — no period for 3 months or more (amenorrhea)
- Heavy bleeding — when a period does arrive, it can be heavier than usual
Skin changes and hair growth
- Hirsutism — increased hair growth on the face, chest, abdomen, or back
- Acne — breakouts, especially along the jawline and on the back
- Oilier skin and hair — overproduction of sebum
- Hair thinning — thinning hair on the scalp (androgenic alopecia)
Other symptoms
- Weight gain — particularly around the abdomen, with difficulty losing weight
- Insulin resistance — the body responds less effectively to insulin
- Fatigue — persistent tiredness and low energy
- Mood swings — increased risk of anxiety and depression
You don't need to have all of these symptoms to have PCOS. Many people with PCOS are at a healthy weight and have few outward signs of the condition.
How Is PCOS Diagnosed?
To receive a PCOS diagnosis, the international Rotterdam criteria are used. You must meet at least two of three criteria:
- Irregular or absent ovulation — documented through irregular periods
- Elevated androgen levels — either measured in blood tests or visible signs (hirsutism, acne)
- Polycystic ovaries on ultrasound — 12 or more follicles in one ovary, or enlarged ovaries
Evaluation by your doctor
Your doctor will typically:
- Take a medical history — asking about your menstrual pattern, hair growth, weight, and family history
- Order blood tests — hormones (testosterone, LH, FSH, SHBG), blood sugar, insulin, thyroid, and cholesterol
- Perform an ovarian ultrasound — to look for polycystic ovaries
- Measure BMI and blood pressure — for an overall health assessment
Before your appointment, it can be helpful to have a record of your menstrual pattern. Use an ovulation calendar to log your cycle and identify patterns over time.
Treatment of PCOS
PCOS treatment is tailored to each person's symptoms and life situation. There is no cure for PCOS, but symptoms can be effectively managed.
Lifestyle changes
Lifestyle modifications are the first-line treatment and can have a major impact — especially if overweight:
- Weight loss — even a 5–10% reduction in body weight can restore regular ovulation and improve hormonal balance
- Physical activity — 150 minutes of moderate activity per week (brisk walking, cycling, swimming) improves insulin sensitivity
- Diet — a balanced diet focusing on whole grains, vegetables, lean proteins, and healthy fats. Limit refined sugar and white flour
- Regular meals — keeping blood sugar levels stable throughout the day
Medical treatment
- Hormonal birth control — regulates menstruation and reduces androgen levels. Relevant for those not trying to conceive
- Metformin — improves insulin sensitivity and can restore ovulation in some people
- Spironolactone — can reduce unwanted hair growth and acne (not used when trying to conceive)
Fertility-focused treatment
For those who want to become pregnant, there are specific treatment pathways (see the next section).
PCOS and Pregnancy
Many people with PCOS become pregnant naturally, particularly with the right lifestyle changes. But because ovulation can be irregular or absent, it may take longer.
Step-by-step approach when trying to conceive
Step 1: Lifestyle changes Start with the lifestyle modifications described above. In people with PCOS and excess weight, even moderate weight loss can restore spontaneous ovulation.
Step 2: Ovulation induction If lifestyle changes alone are not enough, your doctor may prescribe medications to stimulate ovulation:
- Letrozole — now considered the first-line medication for ovulation induction in PCOS
- Clomiphene (Clomid) — an alternative that has been used for a long time
Treatment is monitored with ultrasound to check the number of mature follicles.
Step 3: IVF If ovulation induction is unsuccessful after several attempts, IVF may be the next step. People with PCOS often respond well to IVF treatment.
Coverage for IVF varies by country and insurance plan. Check with your healthcare provider or insurer for the options available to you.
Risks during pregnancy
People with PCOS have a somewhat increased risk of:
- Gestational diabetes
- Preeclampsia (pregnancy-induced hypertension)
- Preterm birth
Careful monitoring by a midwife or OB-GYN is therefore especially important. Many people with PCOS have entirely uncomplicated pregnancies and births.
Long-Term Health With PCOS
PCOS is not just a fertility issue. The condition affects long-term health, and regular follow-up is important:
- Type 2 diabetes — increased risk due to insulin resistance. Regular blood sugar checks are recommended
- Cardiovascular disease — increased risk, especially with excess weight and metabolic syndrome
- Endometrial cancer — prolonged absence of periods increases risk. Hormonal birth control or progesterone can provide protection
- Mental health — higher rates of anxiety and depression. Don't hesitate to discuss this with your doctor
Track Your Cycle
Are you monitoring your ovulation? Use an ovulation calendar to map your cycle and identify patterns. Have you just gotten a positive pregnancy test? Calculate your due date with our due date calculator.
Frequently Asked Questions
Can I get pregnant with PCOS?
Yes, absolutely. Most people with PCOS can get pregnant, either naturally or with medical assistance. Lifestyle changes alone can restore ovulation in many. With modern fertility treatment, success rates are good.
Does PCOS go away after pregnancy?
No, PCOS is a chronic condition that does not go away on its own. However, symptoms can vary throughout life, and many people find they become milder with age. Lifestyle modifications remain important throughout life.
Can I prevent PCOS?
PCOS has a strong genetic component and cannot be fully prevented. However, a healthy lifestyle with regular physical activity, a balanced diet, and a stable weight can significantly reduce the severity of symptoms.
Should I take supplements with PCOS?
Some studies suggest that inositol, vitamin D, and omega-3 fatty acids may have a positive effect on PCOS. The WHO and AAP recommend discussing any supplements with your doctor, as effectiveness varies and not all supplements are well-documented.