Model uterus and IUD

Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is one of the most common hormonal conditions affecting people with ovaries. It can show up in very different ways — from irregular periods, acne, and excess hair growth, through to difficulties getting pregnant or concerns about long-term health. While the name suggests “cysts on the ovaries,” the condition is really about hormone imbalance and how the ovaries, metabolism, and reproductive system interact.

Common features

Not everyone with PCOS will have the same symptoms, but it often includes:

  • Irregular or absent periods
  • Acne or oily skin
  • Excess hair growth on the face, chest, or abdomen
  • Thinning hair on the scalp
  • Weight gain or difficulty losing weight
  • Fertility challenges

Some people only notice mild changes, while others find it has a big impact on their wellbeing.

What causes PCOS?

PCOS doesn’t have a single cause — it’s thought to arise from a mix of genetic, hormonal, and metabolic factors. It’s linked to:

  • Higher levels of androgens (“male” hormones that everyone produces)
  • Insulin resistance, which can make weight management harder
  • A family history of PCOS or type 2 diabetes

It’s not your fault, and lifestyle alone doesn’t explain why PCOS develops.

How is PCOS diagnosed? – The Rotterdam Criteria

The Rotterdam criteria (2003) is used to diagnose PCOS. A diagnosis is made if you have two out of the following three features (and other possible causes have been excluded):

  1. Irregular or absent ovulation
    – Periods that are very irregular, widely spaced, or missing altogether.

  2. Higher levels of androgens (“male” hormones)
    – This can show up as acne, unwanted hair growth, thinning hair on the scalp, or be confirmed on blood tests.

  3. Polycystic ovaries on ultrasound
    – Ovaries that are enlarged and/or have many small follicles (sometimes called “cysts”), which is a reflection of how the ovaries are working.

You only need two of the three features for a diagnosis — so it’s possible to have PCOS even if your ultrasound looks normal.

Why it matters

PCOS isn’t just about periods or fertility. It can also increase the risk of:

  • Type 2 diabetes and insulin resistance
  • High cholesterol and cardiovascular disease
  • Endometrial hyperplasia (thickening of the womb lining)
  • Emotional health concerns such as anxiety or low mood

Recognising and managing PCOS early can reduce these risks and improve quality of life.

What I offer

I provide a personalised approach to diagnosis and management, which may include:

  • A detailed history and consultation
  • Blood tests (hormones, cholesterol, glucose/insulin)
  • Transvaginal ultrasound (to assess ovarian appearance and endometrium)
  • Support with fertility planning and options
  • Medical treatments (such as hormonal contraception, metformin, or ovulation induction where appropriate)
  • Guidance on lifestyle strategies that can make a real difference

Together, we’ll focus on what matters most to you — whether that’s regular cycles, skin and hair symptoms, fertility, or long-term health.

Dr Sam Holford

Struggling with PCOS?

As an Auckland specialist, I offer compassionate care to manage symptoms, irregular periods, and fertility. Let's talk.

Book an appointment

FAQs

Do I have to have cysts on my ovaries to have PCOS?
No, it's a common misconception. The diagnosis of PCOS is based on having at least two of three key features: irregular periods, high androgen levels (or symptoms like acne/excess hair), and polycystic ovaries on ultrasound. You can have PCOS without having the typical "cysts" on your ovaries.
Can PCOS be cured?
There is no cure for PCOS, but it is a very manageable condition. Treatment focuses on managing the symptoms that are most concerning to you, whether that's irregular periods, skin issues, or fertility, as well as reducing long-term health risks like diabetes.
I have PCOS and want to get pregnant. Is this possible?
Yes, absolutely. Many people with PCOS conceive naturally. For those who have trouble, there are very effective treatments available, such as ovulation induction, which uses medication to help you release an egg regularly. We can create a plan to support your fertility goals.
Do I need to lose weight to manage my PCOS?
While weight management can be helpful for some people with PCOS, especially if insulin resistance is a factor, it's not the only or most important strategy. The focus should be on sustainable, healthy lifestyle habits rather than just weight loss. We work on a holistic plan that's right for your body.

Useful resources

Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.