What PCOS actually is
PCOS is a hormonal disorder characterised by elevated androgens (male hormones), irregular ovulation, and — in many but not all cases — small follicle cysts on the ovaries. The name is a bit misleading: you don't need cysts to have PCOS, and having ovarian cysts doesn't mean you have PCOS. Diagnosis is based on at least two of three criteria: irregular cycles, elevated androgens (on a blood test or visible as acne/excess hair), and polycystic ovaries on ultrasound.
Common symptoms
Irregular or absent periods are the most common sign, but PCOS shows up differently in different people. Other symptoms include acne (particularly along the jawline), excess facial or body hair (hirsutism), thinning scalp hair, difficulty losing weight, and skin tags or dark patches around the neck and armpits. Not everyone will experience all of these — some people have very mild presentations and discover PCOS only when trying to conceive.
What causes it
PCOS has a strong genetic component — if your mother or sister has it, your risk is higher. Insulin resistance is central to most cases: when cells don't respond well to insulin, the pancreas produces more of it, and excess insulin signals the ovaries to produce more androgens. This hormonal cascade disrupts normal ovulation. Lifestyle factors like chronic stress, poor sleep, and a high-glycaemic diet can worsen insulin resistance and amplify symptoms.
What to do next
If you suspect PCOS, the first step is a blood panel (day 2–5 of your cycle) to check LH, FSH, testosterone, prolactin, and fasting insulin, along with a pelvic ultrasound. There is no cure, but PCOS is very manageable. Lifestyle changes — particularly reducing refined carbohydrates and improving sleep — can restore regular cycles in many people. Your gynaecologist may also recommend hormonal therapy, metformin, or other medications depending on your goals (cycle regulation vs. fertility vs. symptom management).