PCOS Explained: Irregular Periods, Acne, Hair Loss & Weight — What's Really Happening?
The engine underneath: insulin and androgens
In PCOS, the body's cells respond sluggishly to insulin, so the pancreas makes more of it. High insulin prods the ovaries to produce extra androgens — and those androgens disrupt ovulation. Instead of one egg maturing and releasing each month, several follicles start and stall: the 'polycystic' look on ultrasound (they're immature follicles, not true cysts, and they don't need removing). In this video I walk through how this one mechanism produces each of the symptoms women get dismissed with for years.
The symptom pattern
- Irregular, infrequent, or absent periods — cycles longer than ~35 days, or fewer than 8 periods a year.
- Acne that persists past the teens, often along the jawline; oily skin.
- Hirsutism — coarse hair on the face, chest, or abdomen — alongside thinning at the hairline or crown.
- Weight gain centred on the waist, and unusual difficulty losing it.
- Difficulty conceiving, because ovulation is irregular — though many women with PCOS do conceive, sometimes with help.
- Also associated: skin tags, dark velvety skin patches (acanthosis nigricans), low mood, and sleep apnoea.
Diagnosis and what helps
Diagnosis usually needs two of three: irregular ovulation, signs or blood tests showing high androgens, and polycystic-looking ovaries on ultrasound — after other causes are excluded. Management targets the insulin engine: regular movement (muscle is insulin's best friend), meals that pair carbohydrates with protein and fibre, sleep, and — where prescribed — medicines such as metformin or specific contraceptives for cycle and skin control. Because PCOS raises lifetime risk of type 2 diabetes and heart disease, regular blood-sugar and cholesterol checks matter even when you feel fine. With PCOS, pregnancy deserves early planning too: folic acid, blood-sugar screening, and a word with your provider before you conceive.
Common questions
Can PCOS go away?
The tendency is lifelong, but symptoms often ease with weight changes, after pregnancy, and as hormones shift with age. Well-managed PCOS can become a background condition rather than a daily battle.
Do the 'cysts' need surgery?
No — the ultrasound appearance is of many small immature follicles, not cysts that need removal. Surgery is not a standard PCOS treatment.
Can I still get pregnant with PCOS?
Very often, yes. Because ovulation is irregular it may take longer, and treatments exist to induce ovulation if needed. Many women with PCOS conceive naturally — don't assume infertility, and don't assume contraception is unnecessary.
From Conception to Birth: Your Baby's Journey
With the body understood, follow life from the very beginning: conception to birth.