Specialist diagnosis and management of polycystic ovaries, with personalised treatment plans tailored to your symptoms and fertility goals.
Polycystic ovaries (PCO) affect an estimated 5–10% of women in the UK. The condition occurs when developing egg follicles fail to release an egg and instead form multiple small fluid-filled cysts on the ovaries. This can affect your menstrual cycle, hormone balance, fertility, and long-term health. With the right diagnosis and treatment, symptoms can be effectively managed.
Irregular or absent periods
Difficulty conceiving
Weight gain
Acne
Excess facial or body hair, or thinning hair on the scalp
Polycystic ovaries are diagnosed through a combination of clinical assessment, blood tests, and pelvic ultrasound scan. Blood tests check testosterone and other hormone levels, and can exclude conditions with similar symptoms such as thyroid dysfunction. A diagnosis is confirmed when at least two of the following are present: multiple cysts or enlarged ovaries on ultrasound, irregular or absent periods, or blood and symptom indicators of raised male sex hormones.
Treatment depends on your symptoms, weight, and whether you are trying to conceive:
Lifestyle changes including weight management and a low glycaemic index diet
Combined oral contraceptives to reduce testosterone and improve skin and hair symptoms
Metformin to reduce insulin resistance and improve ovulation
Clomifene to stimulate ovulation for women trying to conceive
Laparotomy where a cancerous cyst cannot be excluded
Intrauterine insemination (IUI), hormone therapy, or IVF where initial fertility treatment is unsuccessful
Laparoscopic ovarian drilling to reduce testosterone-secreting ovarian tissue
At London Pregnancy Care and Gynaecology, care is delivered by experienced consultant specialists with a focus on personalised treamtent, continuity of care, and clear, supportive guidance.
The exact cause is not fully understood, but several factors appear to contribute. The condition can run in families. Insulin resistance — where the body struggles to regulate blood sugar — causes elevated insulin levels, which in turn trigger the ovaries to produce excess testosterone, disrupting ovulation. Being overweight worsens insulin resistance and can make symptoms more pronounced.
Symptoms typically begin in the teens or early twenties and can include irregular or absent periods, difficulty conceiving, weight gain, acne, excess hair on the face and stomach, and thinning of the hair on the scalp. Not all women with polycystic ovaries will experience all of these symptoms, and severity varies considerably.
As well as affecting fertility, polycystic ovaries are associated with an increased risk of type 2 diabetes and heart disease, largely due to the role of insulin resistance in the condition. Women who have two or fewer periods per year also have a higher risk of developing womb cancer. Regular health check-ups are recommended to monitor for these conditions.
Diagnosis requires at least two of the following: the presence of at least 12 cysts on the ovaries or enlarged ovaries on ultrasound scan, irregular or absent periods, and symptoms or blood test results indicating elevated male sex hormones. Blood tests may also assess glucose and lipid levels to identify insulin resistance and cardiovascular risk factors.
Lifestyle has an important role in managing polycystic ovaries. Losing weight if you are overweight can significantly reduce insulin resistance and improve both symptoms and fertility. Regular exercise helps with insulin sensitivity even independent of weight loss, and a diet based on low glycaemic index carbohydrates can help to regulate insulin levels.
Combined oral contraceptives can reduce testosterone production and help with skin and hair symptoms. Metformin improves insulin sensitivity, reducing testosterone levels and often restoring more regular ovulation. For women with acne, both over-the-counter and prescription treatments are available. For those trying to conceive, clomifene is typically the first-line option to stimulate ovulation, though it is usually prescribed for no more than six months.
If fertility treatment with clomifene is unsuccessful, laparoscopic ovarian drilling is a keyhole surgical procedure that removes the testosterone-secreting tissue on the ovaries. As testosterone levels fall following the procedure, ovulation typically resumes. Your consultant will advise whether this approach is appropriate for your circumstances.
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