PCOS Symptoms
Current Guidance Update
Rotterdam Criteria
PCOS is diagnosed when any 2 of the following 3 criteria are present: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology.
PCOS Prevalence
PCOS affects approximately 6–12% of women of reproductive age, making it one of the most common endocrine disorders worldwide.
Holistic Management
PCOS care should address reproductive health, metabolic risk factors, and psychological well-being through an individualized and comprehensive approach.
First-Line Treatment
Lifestyle modification remains the first-line management strategy for PCOS, with emotional health support integrated into routine clinical care.
Introduction
PCOS Symptoms & Diagnostic Criteria
Diagnosis is based on the Rotterdam Criteria after excluding other possible causes. The condition affects menstrual health, hormone balance, metabolism, fertility, and psychological well-being.
Diagnostic Criteria
PCOS is diagnosed when a woman meets at least 2 of the following 3 criteria after exclusion of other diagnoses:
- Oligo or anovulation
- Clinical or biochemical hyperandrogenism
- Polycystic ovarian morphology on ultrasound
Menstrual Symptoms
- Oligomenorrhoea — infrequent periods beyond 35-day cycles
- Amenorrhoea — absent periods for 3 or more months
- Irregular and unpredictable menstrual cycles
- Heavier than normal bleeding when periods occur
Androgenic Symptoms
- Hirsutism affecting approximately 70% of androgen-excess women
- Cystic acne, especially around the jawline and chin
- Androgenic alopecia (scalp hair thinning)
- Seborrhoea (excess oily skin)
Metabolic Symptoms
- Insulin resistance present in 65–80% regardless of weight
- Central adiposity affecting 60–80% of women
- Acanthosis nigricans indicating insulin resistance
- Dyslipidaemia and metabolic abnormalities
Reproductive and Psychological Impact
PCOS is the most common identifiable cause of ovulatory dysfunction and anovulatory infertility and is associated with an increased risk of recurrent miscarriage.
The 2023 International PCOS Guidelines emphasize the significant psychological burden of the condition, with depression and anxiety occurring 3–4 times more frequently than in women without PCOS. Body image concerns and disordered eating are also common and should be addressed as part of comprehensive care.
Frequently Asked Questions
Can I have PCOS if my periods are regular?
Yes. Approximately 20% of women with PCOS have regular cycles, with the diagnosis based on hyperandrogenism and polycystic ovaries.
Does having cysts on my ovaries mean I have PCOS?
Not necessarily. Polycystic ovarian morphology alone, present in 20–25% of all women, is insufficient for diagnosis without meeting 2 of 3 Rotterdam criteria.
Will PCOS go away?
PCOS is a lifelong condition, though manifestations change across life stages; metabolic risks persist even after menstrual irregularity resolves.
Conclusion
PCOS is a complex, multi-system condition deserving comprehensive, individualised clinical attention — the entry point to management strategies that meaningfully improve fertility, metabolic health, and quality of life.
Sources & References
This article draws on guidance current at the time of writing from the following bodies and publications:
- ESHRE/ASRM Rotterdam Criteria (reaffirmed 2023)
- ACOG (2018, updated 2023)
- FIGO (2023 PCOS International Guidelines)
- Teede HJ et al. (2023 PCOS Guideline)
General reference bodies for women's health guidance:
RCOG
rcog.org.ukACOG
acog.orgFIGO
figo.orgWHO
who.intNICE
nice.org.uk⚠ IMPORTANT DISCLAIMER
This article is provided for general knowledge and reference purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. No medication, treatment, or change to your healthcare should be undertaken based on this content without first consulting a qualified doctor. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
