Polycystic ovary syndrome (PCOS)

With PMOS, you may have periods more often, less often or not at all.

It’s normal to have irregular cycles for the first year after you start having periods, and during perimenopause.

A PMOS diagnosis is often missed until after adolescence because normal changes that happen at that time, like irregular periods, make it hard to detect.

Learn more about how to treat and manage irregular periods.

PMOS can cause excess hair growth on your face and body. The hair is usually thicker and darker than normal. It may grow on the:

• chest
• stomach
• back
• upper arms
• thighs.

PMOS can cause scalp hair loss in a male-like pattern (hair that recedes at the front and thins on top).

Explore treatments for hair loss.

With PMOS, you may have:

• pimples (acne)
• dark, velvety patches of skin.

Explore treatments for skin conditions.

Anxiety and depression are common symptoms of PMOS. This could be due to hormonal changes, but more research is needed to understand how certain hormones affect mental health.

It can be hard to manage your weight when you have PMOS, and you may gain weight with this condition.

Learn more about how to achieve and maintain a healthy weight.

It’s common for PMOS symptoms, for example, excess body hair and weight, to cause self-esteem and body image issues. This can be distressing, especially if you don’t know where to get support.

In this short video, psychologist, Dr Leah Brennan, talks about common experiences for women with PMOS, including anxiety, depression and body image.

For more information about body image, visit the Butterfly Foundation website.

PMOS can cause infertility or delays in getting pregnant. It can also increase the risk of complications during pregnancy.

If you have PMOS symptoms, see your doctor. They will review your medical history and check for things like:

• irregular or absent periods
• acne
• excess body hair
• alopecia.

You must have 2 out of 3 of the following signs to be diagnosed with PMOS:

• high levels of androgen hormones
• irregular or absent periods
• multiple immature follicles (small fluid-filled sacs) in the ovaries, seen on an ultrasound, or high levels of anti-müllerian hormone (AMH) found in a blood test.

An ultrasound on your belly or via your vagina (if you are sexually active) checks the number of follicles in each ovary. Having 20 or more follicles in each ovary is a sign of PMOS. Ultrasounds are not usually recommended for women under 20 years of age.

To diagnose PMOS, other conditions that can cause similar symptoms may need to be ruled out. For example:

• thyroid disease
• stress
• eating disorders
• ovarian tumours.

Your doctor will check for these by reviewing your medical history, doing a physical examination and organising some basic blood tests.

Read about Lorna’s long journey to a PMOS diagnosis.

It may take time to get a diagnosis of PMOS in teenage years because your periods may not have settled into a regular pattern.

If you have irregular periods and other symptoms of PMOS, see your doctor. If they think you may be at risk of PMOS, they will monitor you for up to 8 years after you start having periods.

A healthy lifestyle can help manage PMOS symptoms and reduce long-term health risks.

Healthy eating and regular physical activity can improve:

• metabolism
• fertility
• emotional wellbeing
• hormonal symptoms
• weight management.

It’s helpful to work with a range of health professionals to make a plan that’s right for you. For example, a dietitian, exercise physiologist and psychologist. You can also use behavioural strategies, such as goal setting, to support lifestyle changes.

There’s no evidence that any specific diet or type of activity is best for PMOS.

Anti-obesity medicines or bariatric surgery could be considered by some women to help manage weight.

Psychological therapy can support emotional wellbeing and a healthy lifestyle.

Risks of abdominal obesity

A good way to assess your health is to check your waist circumference. You can also ask your doctor to check your cholesterol, blood pressure and blood glucose.

To measure your waist circumference accurately, measure yourself without clothing and position a tape measure around your body roughly in line with your belly button.

Breathe out normally, making sure the tape is snug but not too tight, and take the measurement.

The recommended waist circumference for adult women is 80 cm or less.

Measuring your BMI

Body mass index (BMI) is another way to measure a healthy weight. But it doesn’t consider muscle and fat mass or where fat is stored in your body. BMI = weight (kg) ÷ height (m) squared.

Example:

Sally weighs 90 kg and is 1.67 m tall. Her BMI is 32.3
90 ÷ (1.67 x 1.67) = 32.3

• A BMI of 18.5 to 24.9 is classified as a healthy weight.
• A BMI of 25 to 29.9 is classified as overweight.
• A BMI of 30 or more is classified as obese.

The Pill is usually the first choice of medicines to treat symptoms of irregular periods.

Hormonal contraceptives may have some side effects. For example:

• mood changes
• weight gain or loss
• bloating
• sore breasts
• irregular bleeding.

Metformin can be helpful to manage weight, hormonal and metabolic symptoms of PMOS, in combination with lifestyle strategies. Metformin has few serious side effects.

Talk to your doctor about the benefits and risks of taking these medicines before making a decision.

Some women find laser therapy helps with excess hair (hirsutism).

Anti-androgens, such as spironolactone, can be helpful to treat excess hair, in combination with the Pill.

You can also try over-the-counter treatments. For example:

• waxing – for excess hair
• minoxidil (foam or tablets) – to prevent hair loss
• topical creams or gels – to help with acne.

Ask your doctor about the best treatment for you.

Symptoms of PMOS, such as excess hair growth and acne, can impact your mood, self-esteem and body image.

Stress, anxiety and depression are common in women with PMOS. These conditions are often overlooked and left untreated. But mental health is just as important as physical health.

If you have constant and extreme negative thoughts that stop you from doing everyday activities, see your doctor.

They may refer you to a psychologist for support. If therapy isn’t working, talk to your doctor about medicines that may help. It’s important to talk to your health care team about the benefits and risks of taking certain medicines.

In this short video, psychologist Dr Leah Brennan talks about common experiences for women with PMOS, including anxiety depression and body image.

If you have PMOS and are planning a pregnancy, it’s important to have a healthy lifestyle, before conception and during pregnancy, to optimise fertility and lower health risks.

A medicine called letrozole is the main medical treatment for infertility in PMOS. Other options include:

• clomiphene (with or without metformin)
• gonadotrophins
• ovarian surgery.

In vitro fertilisation (IVF) may be an option if other treatments haven’t been successful.

Pregnant women with PMOS have a higher risk of complications during pregnancy, although the risk depends on factors such as age, BMI and other health conditions.

More monitoring and support may be needed in some situations.

Healthy eating and regular physical activity can be helpful to:

• manage weight
• improve fertility
• improve health during pregnancy.

Inositol is a supplement that affects insulin. Some studies of women with PMOS suggest it could be helpful for regular menstrual cycles, insulin resistance, and androgen hormone levels but the evidence is low quality.

It’s important to be aware that inositol and other over-the-counter supplements aren’t regulated as strictly as medicines, so the quality, strength, and cost could vary.

Natural therapies should only be prescribed by a qualified health practitioner who is trained in their use. If you choose to use natural therapies, it’s important to tell your doctor so they keep it in mind when prescribing medicines.

Learn more about natural therapies.