PCOS Symptoms, Diagnosis & Treatment: A Complete Guide for Women in London
PCOS (polycystic ovary syndrome) is a hormonal condition affecting around 1 in 10 women of reproductive age in the UK. It is one of the most common causes of irregular periods and female infertility. If you have been experiencing irregular cycles, unexplained weight gain, excess hair, or acne, PCOS may be the reason — and effective treatment is available from a private gynaecologist in London.
- PCOS affects 1 in 10 UK women and is one of the most underdiagnosed hormonal conditions.
- Irregular periods, acne, excess hair, and weight gain are the four most common symptoms.
- PCOS is the leading cause of anovulatory infertility but most women with PCOS can conceive with the right support.
- Diagnosis requires a blood test and ultrasound. No single symptom alone confirms PCOS.
- Treatment is highly personalised: the approach for someone wanting to conceive differs from someone managing symptoms long-term.
- Mr Mahantesh Karoshi offers comprehensive PCOS assessment and management at his London clinic. No GP referral needed.
PCOS in Numbers: The Scale of the Condition
These figures illustrate how widespread PCOS is and why early, accurate diagnosis matters.
What Is PCOS?
Polycystic ovary syndrome is a hormonal condition in which the ovaries produce an excess of androgens (male hormones such as testosterone). This hormonal imbalance disrupts the normal process of ovulation, preventing eggs from maturing and being released regularly.
The name is slightly misleading. Not all women with PCOS have cysts on their ovaries, and having ovarian cysts does not automatically mean you have PCOS. The condition is defined by a cluster of hormonal and metabolic features rather than by cysts alone.
PCOS sits at the intersection of reproductive health, hormonal health, and metabolic health. It has implications beyond periods and fertility — including long-term risks related to insulin resistance, type 2 diabetes, and cardiovascular health if left unmanaged.
What Are the Symptoms of PCOS?
PCOS presents differently in different women. Some have several symptoms. Others have only one or two but meet the diagnostic criteria on blood tests and ultrasound. The most common symptoms are listed below.
It is important to note that having polycystic-appearing ovaries on an ultrasound scan without any of the other features does not mean you have PCOS. Equally, a woman can have PCOS with a completely normal-looking ultrasound if the blood test and menstrual history meet the diagnostic criteria.
What Causes PCOS?
The exact cause of PCOS is not fully understood, but several contributing factors are well established.
Insulin Resistance
Approximately 70% of women with PCOS have some degree of insulin resistance, meaning their cells do not respond effectively to insulin. The body compensates by producing more insulin, and elevated insulin levels stimulate the ovaries to produce excess androgens. This creates the hormonal cascade that drives most PCOS symptoms.
Elevated Androgens
Higher than normal levels of testosterone and other androgens are present in most women with PCOS. These excess androgens are responsible for acne, excess facial and body hair, and scalp hair thinning. They also directly interfere with the ovulation process.
Genetic Factors
PCOS has a significant hereditary component. If your mother, sister, or aunt has PCOS, you are at higher risk of developing it. However, having a family history does not mean PCOS is inevitable, and the condition can present very differently between family members.
Hypothalamic-Pituitary Dysregulation
In PCOS, the brain’s signalling to the ovaries is disrupted. The pituitary gland releases LH (luteinising hormone) in abnormally high pulses, which stimulates the ovaries to produce more androgens rather than progressing through normal ovulation.
Low-Grade Chronic Inflammation
Research has identified that many women with PCOS show markers of low-grade chronic inflammation, which further stimulates androgen production and contributes to insulin resistance.
How Is PCOS Diagnosed?
PCOS is diagnosed using the Rotterdam criteria, which requires at least two of the following three features to be present:
- Irregular or absent ovulation — reflected in irregular, infrequent, or absent periods
- Elevated androgens — confirmed either by blood test (raised testosterone or DHEAS) or by physical symptoms such as hirsutism and acne
- Polycystic-appearing ovaries on ultrasound — typically 12 or more small follicles in one or both ovaries, or increased ovarian volume
Diagnosis is not based on symptoms alone and requires proper investigation. At Mr Karoshi’s London gynaecology clinic, a thorough assessment is carried out to confirm the diagnosis and assess the full picture.
Blood Tests Used in PCOS Diagnosis
A targeted panel of blood tests forms the backbone of PCOS investigation:
- Total and free testosterone — to confirm androgen excess
- DHEAS (dehydroepiandrosterone sulphate) — another androgen marker
- LH and FSH ratio — elevated LH relative to FSH is characteristic of PCOS
- Fasting insulin and glucose — to assess insulin resistance
- HbA1c — long-term blood sugar marker
- Thyroid function (TSH) — to rule out thyroid disorders, which can mimic PCOS
- Prolactin — elevated prolactin can cause similar symptoms and must be excluded
- AMH (anti-Mullerian hormone) — typically elevated in PCOS; also reflects ovarian reserve
Pelvic Ultrasound
A transvaginal ultrasound provides the clearest view of the ovaries and uterus. In PCOS, the ovaries typically appear enlarged and contain multiple small follicles arranged around the periphery — the so-called “string of pearls” appearance. The ultrasound also checks the womb lining thickness and rules out other structural causes of the presenting symptoms.
Concerned you may have PCOS?
Mr Mahantesh Karoshi offers comprehensive PCOS assessment at his London clinic. Blood tests, ultrasound, and a clear diagnosis in one place. No GP referral needed.
Book a Consultation ↗ Menstrual Disorders ServicePCOS vs Other Conditions: Key Differences
Several conditions share symptoms with PCOS and must be ruled out during assessment. This table clarifies the key distinctions.
| Condition | Shared Symptoms with PCOS | Key Distinguishing Feature | Diagnosed By |
|---|---|---|---|
| PCOS | Irregular periods, acne, excess hair | Raised androgens, polycystic ovaries on scan | Rotterdam criteria |
| Hypothyroidism | Irregular periods, weight gain, fatigue | Low thyroid hormone, TSH raised | Blood test |
| Hyperprolactinaemia | Irregular periods, fertility problems | Elevated prolactin, may cause milk production | Blood test |
| Congenital adrenal hyperplasia | Excess hair, acne, irregular periods | Raised 17-hydroxyprogesterone | Blood test |
| Cushing’s syndrome | Weight gain, irregular periods, acne | Elevated cortisol, specific fat distribution | Cortisol tests |
| Endometriosis | Irregular periods, fertility issues | Pelvic pain, laparoscopic diagnosis | Ultrasound / laparoscopy |
How Is PCOS Treated in London?
There is no single cure for PCOS, but symptoms and health risks can be very effectively managed. Treatment is highly individualised and depends on which symptoms are most troublesome, whether you are trying to conceive, and your overall health picture. Mr Karoshi builds a personalised plan for every patient.
Lifestyle Changes: The Foundation of PCOS Management
Even a 5% reduction in body weight in women who are overweight can restore ovulation and significantly improve insulin sensitivity, period regularity, and androgen levels. A diet that limits refined carbohydrates and processed sugar, combined with regular exercise, is central to long-term PCOS management. Mr Karoshi provides evidence-based dietary and lifestyle guidance as part of every PCOS consultation.
The Combined Oral Contraceptive Pill (For Cycle Regulation)
For women not trying to conceive, the combined pill is a first-line treatment for PCOS. It suppresses androgen production, regulates periods, reduces acne, and slows excess hair growth. It also protects the endometrium by ensuring regular shedding, which reduces the long-term risk of endometrial hyperplasia associated with infrequent periods in PCOS.
Metformin (For Insulin Resistance)
Metformin is an insulin-sensitising medication originally used in type 2 diabetes. In PCOS, it reduces circulating insulin levels, which in turn reduces androgen production. It can restore ovulation in some women, improve period regularity, support weight management, and reduce the long-term risk of developing type 2 diabetes. It is suitable for women both trying to conceive and not.
Anti-Androgen Medications (For Excess Hair and Acne)
Medications such as spironolactone or cyproterone acetate block the effect of androgens on the skin and hair follicles. They reduce excess facial and body hair, improve acne, and can slow scalp hair thinning. They are typically used alongside the combined pill and are not suitable during pregnancy.
Ovulation Induction (For Women Trying to Conceive)
For women with PCOS who want to become pregnant, the primary goal of treatment shifts to stimulating ovulation. First-line options include letrozole or clomifene citrate, taken for a few days at the start of the cycle. These medications stimulate follicle development and trigger ovulation. Mr Karoshi monitors the response carefully to optimise timing and minimise the risk of multiple pregnancy.
Inositol Supplementation
Myo-inositol and D-chiro-inositol are naturally occurring compounds that improve insulin signalling. Research supports their use in PCOS to improve ovulation rates, insulin sensitivity, and androgen levels. They are available as supplements and are a reasonable adjunct to other treatments, particularly in women with insulin resistance who prefer non-pharmacological approaches.
PCOS Treatment Options: At a Glance
| Treatment | Best For | Key Benefit | Fertility Compatible? |
|---|---|---|---|
| Lifestyle change | All women with PCOS | Improves all symptoms, reduces long-term risk | Yes |
| Combined pill | Cycle regulation, acne, hair | Regulates periods, lowers androgens | Not while taking it |
| Metformin | Insulin resistance, weight | Restores ovulation, protects against diabetes | Yes |
| Anti-androgens | Excess hair, acne | Reduces androgen effects on skin | Not safe in pregnancy |
| Letrozole / Clomifene | Trying to conceive | Induces ovulation | Designed for this |
| Inositol | Insulin resistance, fertility | Improves ovulation and sensitivity | Yes |
PCOS and Fertility: What You Need to Know
PCOS is the most common cause of anovulatory infertility in the UK. Anovulatory means the ovaries are not releasing an egg regularly, making conception naturally more difficult. However, this does not mean women with PCOS cannot have children.
The majority of women with PCOS who receive appropriate treatment are able to conceive. Key points to understand:
- Ovulation induction with letrozole is effective in the majority of women with PCOS
- Weight loss alone can restore spontaneous ovulation in women with overweight-related PCOS
- IVF is available for women who do not respond to simpler treatments, though careful monitoring is required to avoid ovarian hyperstimulation syndrome (OHSS)
- Early specialist assessment significantly improves outcomes — the sooner PCOS is properly managed, the better the fertility prospects
In Mr Karoshi’s own words: “A PCOS diagnosis can feel overwhelming, particularly for women who are trying to conceive. My role is to demystify it. PCOS is highly manageable. The right plan, tailored to where you are in your life right now, makes an enormous difference to both symptoms and fertility outcomes.”
PCOS and Long-Term Health: What Are the Risks?
PCOS is not just a reproductive condition. Without proper management, it carries long-term health implications that extend beyond the menstrual cycle.
- Type 2 diabetes: Women with PCOS are 3 to 5 times more likely to develop type 2 diabetes. Insulin resistance is central to this risk and can be actively reduced through lifestyle changes and metformin.
- Cardiovascular disease: Elevated androgens, insulin resistance, and associated metabolic factors increase cardiovascular risk over time. Regular monitoring of blood pressure, cholesterol, and glucose is recommended.
- Endometrial hyperplasia and cancer: Infrequent periods in PCOS mean the womb lining is not shed regularly. This can lead to endometrial thickening (hyperplasia) and, in rare cases, endometrial cancer. Ensuring the lining sheds at least every 3 to 4 months is an important protective measure.
- Mental health: Anxiety, depression, and reduced self-esteem are significantly more common in women with PCOS. The symptoms — excess hair, acne, weight changes — have a real emotional impact that deserves acknowledgment and support.
- Sleep apnoea: More common in women with PCOS, particularly those with insulin resistance and higher BMI.
Speak With a PCOS Specialist in London
Mr Karoshi provides a complete PCOS assessment and builds a management plan tailored to your symptoms, your goals, and your life. Private appointments, no referral needed.
Speak With a Specialist ↗ Menstrual Disorders ServiceWhen Should You See a Gynaecologist About PCOS?
You should seek a specialist assessment if any of the following apply to you.
- Your periods are consistently irregular, infrequent, or absent
- You have excess facial or body hair that has developed or worsened
- You have persistent acne that has not responded to standard treatments
- You have unexplained weight gain particularly concentrated around the abdomen
- You are trying to conceive and your periods are irregular
- You have been told you have polycystic ovaries but have not had a full PCOS assessment
- You have a family history of PCOS, type 2 diabetes, or cardiovascular disease
- You are experiencing mood changes, anxiety, or low mood alongside other PCOS symptoms
“Mr Karoshi is an exceptional gynaecologist who is kind, supportive and highly experienced. He managed my menopause and fibroid care with great expertise and clarity. I felt completely confident throughout the process and truly supported at every step.”
Sophia Bennett — verified Doctify patient
Why Choose Mr Mahantesh Karoshi for PCOS Care in London?
Finding a private gynaecologist in London who understands the full complexity of PCOS — the hormonal, metabolic, fertility, and emotional dimensions — makes a real difference to how well it is managed.
Mr Mahantesh Karoshi
Consultant Gynaecologist, London — MBBS, MD, FRCOG- 33+ years of clinical experience in obstetrics and gynaecology
- Fellow of the Royal College of Obstetricians and Gynaecologists (FRCOG)
- Specialist in PCOS, hormonal health, menstrual disorders, and fertility
- Advanced expertise in fibroids, adenomyosis, and minimally invasive treatment
- Outstanding Patient Experience Award – 2025 and 2026
- Published researcher and international educator in women’s health
Mr Karoshi takes a comprehensive view of PCOS. His consultations are thorough, unhurried, and tailored to each patient’s specific situation, goals, and stage of life. His London clinic offers full assessment, blood testing, ultrasound, and personalised management in one place.
Frequently Asked Questions About PCOS
What is PCOS?
PCOS (polycystic ovary syndrome) is a hormonal condition in which the ovaries produce excess androgens. This disrupts ovulation and causes a range of symptoms including irregular periods, acne, excess hair, and weight gain. It affects around 1 in 10 UK women of reproductive age.
What are the main symptoms of PCOS?
The most common symptoms are irregular or absent periods, excess facial or body hair (hirsutism), acne particularly around the jaw and chin, weight gain especially around the abdomen, scalp hair thinning, and difficulty conceiving. Not all women experience all symptoms.
How is PCOS diagnosed?
PCOS is diagnosed using the Rotterdam criteria: at least two of the following three must be present — irregular ovulation, elevated androgens on blood tests or physical signs, and polycystic-appearing ovaries on ultrasound. A blood test and pelvic ultrasound are the primary diagnostic tools.
Can PCOS cause infertility?
PCOS is the leading cause of anovulatory infertility in the UK. However, the majority of women with PCOS can conceive with appropriate support including ovulation induction, lifestyle changes, and where needed, IVF. Early specialist assessment significantly improves outcomes.
How is PCOS treated in London?
Treatment depends on your symptoms and fertility goals. Options include lifestyle changes, the combined pill for cycle regulation, metformin for insulin resistance, anti-androgen medications for hair and acne, and ovulation induction for women trying to conceive. Mr Karoshi creates an individualised plan at his London clinic.
Does PCOS go away?
PCOS does not go away entirely, but symptoms often improve significantly with the right management. Many women find that lifestyle changes and appropriate treatment bring their cycles and symptoms back towards normal. Symptoms frequently improve after the menopause.
Do I need a GP referral to see Mr Karoshi about PCOS?
No. You can book a private PCOS consultation directly at Mr Karoshi’s London clinic without a GP referral. Full assessment, blood tests, and ultrasound are available in one place.
Conclusion
PCOS is one of the most common hormonal conditions in women, yet it remains significantly underdiagnosed. Many women live with unexplained symptoms for years before receiving a clear answer. An accurate diagnosis changes everything — it explains symptoms that previously had no name and opens the door to treatments that actually work.
Whether you are trying to manage acne and irregular periods, working towards pregnancy, or concerned about long-term health risks, effective PCOS management requires a personalised approach from a specialist who understands the full complexity of the condition.
Mr Mahantesh Karoshi offers comprehensive PCOS assessment and management at his London clinic. His consultations are thorough, evidence-based, and built around your individual circumstances. If you have been waiting for answers, now is the time to get them.
Contact Mr Mahantesh Karoshi Today
Get a clear diagnosis and a treatment plan that is built around your life. Book a private PCOS consultation in London today. No GP referral needed.
Book Now ↗ Learn About Menstrual Disorders