Polycystic Ovarian Syndrome (PCOS)

Dr Jenny Cook | Sydney Gynaecologist & Advanced Laparoscopic Surgeon

What Is PCOS?

Polycystic Ovarian Syndrome (PCOS) is a common reason why women may experience difficulty conceiving. It refers to a hormonal imbalance that arises as a result of irregular ovulation.

To diagnose PCOS, the Rotterdam criteria are used. At least two out of three of the following must be present:

Ultrasound findings – 12 or more follicles in one or both ovaries. In PCOS, these follicles (small cystic areas where eggs are found) are often seen around the outside of the ovaries.
Hormonal abnormalities – may include: AMH (Anti-Mullerian Hormone) greater than 24 pmol/L, Increased androgen profile, Increased LH (Luteinising Hormone)
Symptoms – such as irregular cycles (one or more cycles per year longer than 35 days), oily skin, acne, hirsutism (excess hair growth), or hair thinning.

Long-Term Complications of PCOS

PCOS is associated with some long-term health risks, which can be managed with regular monitoring and preventive care:

Increased risk of Non-Insulin Dependent Diabetes (NIDDM)

A useful investigation is measuring fasting insulin and glucose levels. These may be elevated in women with PCOS.
Diet and exercise are essential to reduce insulin resistance and lower this risk.

Increased risk of Endometrial Hyperplasia

Endometrial hyperplasia refers to a thickening of the uterine lining (endometrium).
It can present with heavy and irregular bleeding.
The risk increases if a woman has fewer than 9 menstrual periods per year.
Preventive treatment includes using the OCP or a Mirena IUCD, both of which help protect the endometrium.

PCOS is common and manageable, with the right support, you have options.

Symptoms and Treatment of PCOS

The treatment of PCOS depends on the symptoms that are most troublesome for you.

Fertility challenges

If difficulty conceiving is the main issue, ovulation induction can be used to stimulate regular ovulation. This may involve medications such as clomid, metformin, or letrozole. In some cases, IVF may also be an option.

Irregular cycles, oily skin, or acne

If these symptoms are the main concern, the oral contraceptive pill (OCP) is often recommended. The OCP corrects the underlying hormonal imbalance and helps regulate cycles and improve skin.

Lifestyle and diet

Some women develop PCOS because of being overweight. Addressing diet — particularly by minimising processed carbohydrates — along with regular exercise can help restore regular ovulation.

Take control of your PCOS with the right support.

PCOS can feel overwhelming, but with accurate diagnosis, tailored treatment, and lifestyle guidance, it is very manageable. Together, we can create a plan that supports your fertility and long-term health.