If you think you have polycystic ovary syndrome (PCOS), it’s important you see your doctor. They can help coordinate your care and refer you to specialists where needed.
An early diagnosis and support from a team of specialists can help manage the symptoms of PCOS and reduce the risk of long-term health problems.
On this page, you’ll find information about how PCOS is diagnosed and treatments for common PCOS symptoms.
How is PCOS diagnosed?
Diagnosing PCOS in teenage years
Treatments for PCOS
Treatment for hair and skin conditions
Treatment for stress, anxiety and depression
Managing your weight
PCOS and natural therapies
If you have PCOS symptoms, see your doctor. Your doctor will review your medical history and assess your physical symptoms, weight and BMI (body mass index). They may also recommend certain tests to rule out other conditions.
PCOS may be diagnosed if you have 2 or more of the following symptoms:
A blood test for anti-müllerian hormone (AMH) level can be done instead of an ultrasound.
If you have irregular or no periods and high androgen levels, you don’t need to have an ultrasound to confirm PCOS.
Ultrasounds are not recommended for women under 20 years of age.
Your doctor may ask you to do different tests before they confirm a PCOS diagnosis. The tests will depend on your individual symptoms.
Blood tests for testosterone and free androgen index (FAI) can identify high androgen levels.
Your doctor might recommend blood tests to check the levels of other reproductive hormones that affect your periods. For example, oestrogen (the female sex hormone) or the follicle-stimulating hormone (FSH).
You may also have blood tests to exclude conditions with similar symptoms to PCOS.
If you are taking the contraceptive pill, you will need to stop for 3 months before you do blood tests to check your hormone levels.
Your doctor or specialist may perform an abdominal ultrasound to check for signs of PCOS. For example, partly developed eggs on your ovaries, enlarged ovaries or a thickened uterus lining.
If you are sexually active, your doctor may organise an internal ultrasound (via your vagina). This will give a much clearer picture of your ovaries than an abdominal ultrasound.
Your doctor may want to do some other tests to assess your risk of developing heart disease and type 2 diabetes.
For example:
If you have PCOS, you will need a cholesterol and diabetes test every few years, and a blood pressure check every year. You will need to do these tests more often if you have risk factors, such as a family history of diabetes or previous abnormal cholesterol tests, or if you are planning to get pregnant.
It’s hard to diagnose PCOS in young women in the first few years after their periods start as it takes about 2 years for periods to settle into a regular pattern.
If this doesn’t happen and your periods are either very close together or far apart, it may be due to PCOS. If you are bothered by other PCOS symptoms, for example, excess hair growth or acne, you may be assessed for PCOS. But your doctor might prefer to monitor symptoms as a first step.
Lorna Berry was given her diagnosis at age 32 but only after a long and drawn-out medical journey. Read Lorna's story.
Depending on your situation, you might need different treatments for PCOS symptoms. Diet and lifestyle changes can also help. Your doctor can help coordinate your care and refer you to specialists where needed.
With PCOS, high levels of androgens (male-type hormones) and insulin can disrupt your monthly cycle of ovulation and periods. This means your periods may be irregular or they may stop altogether.
The average menstrual cycle is 28 days, but ‘normal’ cycles can range from 21 to 35 days. An irregular cycle can be shorter or longer than a normal cycle. When menstrual cycles lengthen, ovulation can stop or only happen occasionally.
A healthy lifestyle is the most effective approach to managing PCOS symptoms, including irregular periods. A healthy lifestyle includes eating a balanced diet, staying within a healthy weight, being as active as possible and reducing or stopping harmful habits such as smoking and excessive drinking.
Learn more about how physical activity and diet can help improve PCOS symptoms.
Your doctor might recommend different medicines to re-establish regular periods.
Depending on your symptoms and health, your doctor may suggest:
The Pill reduces the production of hormones such as testosterone and other androgens (male-type hormones), which may improve symptoms such as excess hair.
The oestrogen and progesterone in hormonal contraception override your body’s menstrual cycle.
Hormonal contraceptives may have some side effects. For example:
There may also be some risks, especially if you smoke, have high blood pressure or are extremely overweight.
Metformin reduces insulin resistance and the production of androgens in the ovaries. It is more likely to benefit women with PCOS who have a heavier weight.
Metformin is not as effective as the Pill at making periods more regular. But it has a more of a positive effect on cholesterol levels and insulin than the Pill. It also helps with weight loss and reduces the risk of diabetes in people at high risk. Metformin has few serious side effects.
In some cases, metformin can also improve how the ovaries work, re-establish regular periods and increase fertility.
It is important to discuss these medicines, their side effects and risks with your doctor before making any decisions.
Excess hair on your face and body, scalp hair loss (alopecia) and acne are symptoms of PCOS.
It’s good to know that there are many treatment options you can try if you are concerned about these symptoms.
You can wax your excess hair, use laser hair removal or electrolysis. Laser hair removal is more likely to reduce hair growth over time, but you need regular treatments which can be costly.
Some dermatologists specialise in laser hair removal for women with PCOS. They can recommend the best treatment for your hair and skin type.
You can use minoxidil to prevent hair loss. The liquid or foam is massaged into your scalp. Some dermatologists prescribe minoxidil tablets. Side effects include scalp dryness and itchiness.
You can treat acne with creams or gels that reduce pore blocking, oil production and inflammation. Ask your doctor which products they recommend.
Dermatologists may prescribe isotretinoin to help with acne. This should only be prescribed for women who are not trying to get pregnant, as the medicine can cause birth defects. Side effects include dry skin and eczema.
It is widely accepted that diets with a high glycaemic load (GL) contribute to acne. Glycaemic load is the effect of carbohydrates on blood sugar levels. A high-GL diet can increase oil production in skin cells, causing acne. The Australasian College of
Dermatologists recommends a low-GL diet to help manage acne.
Learn more about eating a balanced diet.
Certain medicines reduce the production of testosterone and other androgens in the body, which may improve symptoms such as excess hair, scalp hair loss and acne.
For example:
As with all medicines, there may be risks and side effects, so ask your doctor about the best treatment for you.
Symptoms of PCOS, such as excess hair growth and acne, can make you feel self-conscious, reduce your self-esteem and affect your body image and mood.
Stress, anxiety and depression are common in women with PCOS. These conditions are often overlooked and left untreated. But mental health is just as important as physical health.
Having a healthy lifestyle (a balanced diet and physical activity) is an effective way to improve your mood and reduce negative feelings. There are also many natural and complementary therapies you can try.
But if you have constant and extreme negative feelings and thoughts that stop you from doing everyday activities, see your doctor. They may refer you to a counsellor or psychologist for support. In Australia, you can get Medicare rebates for seeing a psychologist.
If counselling and other therapies aren’t working, talk to your doctor about medicines that may help.
In this short video, psychologist, Dr Leah Brennan, talks about common experiences for women with PCOS, including anxiety depression and body image.
With PCOS, weight gain is a common concern. You might find it hard to lose weight or maintain a healthy weight. If you have a heavier weight, even a small weight loss can make a difference.
Weight loss helps your ovaries to function better and may result in normal hormone production, which will improve symptoms.
Research suggests that a weight reduction of 5% to 10% can:
With PCOS, excess weight is more likely to be stored around your belly (abdomen).
Abdominal obesity is associated with:
Body mass index (BMI) is one way to measure a healthy weight, but it doesn’t consider muscle and fat mass or where fat is stored in your body.
A better 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.
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
You can lose weight by eating healthy food and doing more physical activity. It’s not easy to make changes to your lifestyle but there are many practical things you can do to achieve your weight-loss goals.
Talk to your doctor about the effectiveness, risks, side effects and costs before using medicines for weight loss.
You may be able to have bariatric surgery to reduce the size of your stomach so you feel full after eating small amounts of food.
Weight-loss surgery is only an option if you meet certain criteria, including:
Talk to your doctor about the benefits, risks and costs involved with surgery. Also, let your doctor know if you are planning to get pregnant in the future.
More than 70% of women with PCOS in Australia use natural therapies to improve their symptoms and general wellbeing.
Natural therapies are part of a broad range of complementary and alternative medicines and therapies (CAM). Natural therapies include supplements (vitamins, minerals and fish oils), herbal medicine (tea, tablets and liquids) and nutrition. CAM also includes things like relaxation, mindfulness, meditation, aromatherapy, acupuncture and yoga.
There haven’t been many large studies about the effectiveness of natural and complementary therapies in managing PCOS symptoms.
Note that complementary and alternative medicines should be prescribed by a health practitioner trained in their use. It’s important to tell your doctor if you use these, as some herbal remedies can affect other prescribed medicines.
Learn more about natural therapies, including supplements (vitamins, minerals and fish oil) and herbal medicine used to treat various health conditions.
With PCOS, higher levels of insulin in the body increase the production of androgens (male-type hormones) in the ovaries. This can affect the function of the ovaries, including ovulation, which may cause periods to stop or become irregular.
Some studies found that inositol supplements may be effective for regulating menstrual cycles in people with PCOS. But further studies are needed. Inositol is a vitamin-like substance that is found in many foods, for example, grains, nuts and fruit, and can be taken as a supplement.
Small studies showed that cinnamon (a herb) may improve the way insulin works in the body but there is not enough evidence to support this.
A few small studies have also explored whether chromium (a mineral found in foods like broccoli, beef, green beans and potatoes) improves the actions of insulin in the body, but more evidence is needed.
Very small studies have looked at the effects of omega-3 fats in improving insulin sensitivity in people with PCOS, but more research is needed in this area.
High levels of androgens can cause excess hair growth on the face and body, and severe acne (pimples).
There have been some studies into the effectiveness of chromium in treating excess hair growth and acne, but larger studies are needed in this area.
Small studies have looked at how spearmint tea might help reduce hair growth, but more research is needed to better understand the benefits.
Tea tree oil products rubbed onto the skin may help with acne, but research about its effectiveness is limited.
Low doses of vitamin D in women with a vitamin D deficiency may improve glucose metabolism. It may also improve total cholesterol, LDL (bad) cholesterol and triglycerides in people with PCOS.
This content has been reviewed by a group of medical subject matter experts, in accordance with Jean Hailes policy.
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