The short version.

PCOS is a long-term hormonal and metabolic condition, and it affects far more than the ovaries. The “cysts” in the name are small fluid-filled follicles, not true cysts.

Treatment is built around what matters most to you: regular periods, skin and hair, fertility, or your long-term health.

What PCOS is.

In PCOS, the ovaries make higher levels of androgens, hormones that everyone has, but that can cause acne, extra hair growth and irregular periods when levels are high. Insulin resistance, where the body doesn’t respond well to insulin, is also common and can add to the hormonal picture.

The exact cause isn’t known. Genes appear to play a role, and researchers are also studying environmental factors. The 2023 international guideline describes PCOS as a long-term condition with effects well beyond reproductive health.

Symptoms to know.

Symptoms vary widely, and you don’t need all of them.

In teens, irregular periods are common for the first two to three years after the first period, so diagnosis is handled carefully. Symptoms can still be treated while a diagnosis is being worked out.

Getting diagnosed.

No single test can diagnose PCOS. A diagnosis is made when you have at least two of three features: irregular ovulation, signs of excess androgens (symptoms or blood tests), and polycystic ovarian morphology, shown on ultrasound or, since the 2023 guideline, by a high anti-Müllerian hormone (AMH) level in adults.

1. A conversation about your history. Your periods, skin and hair changes, weight changes, sleep, mood and family history.
2. A physical exam. The guideline advises providers to ask your permission before weighing you and to explain why.
3. Blood tests. Androgen levels, and tests to rule out other conditions that can look similar.
4. Ultrasound or an AMH test, to look for polycystic ovarian morphology in adults.
5. Screening for related conditions, including blood sugar, mood and sleep.

Before your appointment

• Track your cycle for a few months: start dates and how long each cycle lasts.
• Note acne, hair growth or thinning, sleep and mood.
• Write down your family history of PCOS, diabetes or heart disease.
• Decide what matters most to you: periods, skin and hair, fertility, or long-term health.

Questions worth asking

• Could this be PCOS, and what else should we rule out?
• Which tests do you recommend?
• Should I be screened for diabetes, mood and sleep problems?
• Which treatments fit my goals?
• How would PCOS be managed if I become pregnant?
• Do you take a weight-inclusive approach to care?

Managing PCOS.

There is no cure, but symptoms respond well to treatment. The right plan depends on your main concerns and whether you want to become pregnant.

Everyday support

• Find a routine you can keep. The guideline found no single diet or exercise plan that works better than the others in PCOS. Regular movement, balanced eating and good sleep all help.
• Expect weight-inclusive care. The guideline calls for providers to minimize weight bias and stigma.
• Be cautious with supplements. The evidence on inositol is limited, so ask your provider before starting it.
• Track your symptoms so you can see what is changing.

Fabric, chemicals and PCOS.

BPA is the endocrine-disrupting chemical most studied in PCOS. A meta-analysis of nine studies found higher BPA levels in women with PCOS, and a 2024 systematic review found a positive association in 19 of 22 studies, mainly with high androgen levels.

These are associations, and researchers can’t yet say whether chemicals contribute to PCOS or whether PCOS changes how the body handles them. For parabens and triclosan, there is not yet enough evidence either way.

Researchers note that most exposure to these chemicals comes through food, and many small choices add up. What you wear against your skin is one of the easiest to choose. Where it’s easy, keep unnecessary exposure low:

• Choose fresh food over heavily packaged food, and glass or stainless containers where you can.
• Choose certified organic cotton, such as GOTS and OEKO-TEX, for what you wear closest to your skin.
• Wash new underwear before wearing it, and use a fragrance-free detergent.

To learn more, read Fabric School and the chemical guide.

When to get care.

Sources.

1. Teede et al. (2023). Recommendations from the international evidence-based guideline for the assessment and management of PCOS. European Journal of Endocrinology.
2. Forslund et al. (2024). International evidence-based guideline on assessment and management of PCOS: a Nordic perspective.
3. RACGP newsGP. PCOS guidelines shine light on neglected condition.
4. Summary of the 2023 international evidence-based PCOS guideline.
5. Pharmacological management of PCOS symptoms (review).
6. American Academy of Pediatrics. Polycystic ovary syndrome.
7. The association between bisphenol A and PCOS: a systematic review and meta-analysis. Gynecological Endocrinology.
8. Bisphenol A and polycystic ovary syndrome in human: a systematic review. International Journal of Gynecology & Obstetrics (2024).
9. Srnovršnik et al. (2023). PCOS and endocrine disruptors (bisphenols, parabens, and triclosan): a systematic review. Life.

This guide is for educational purposes only and is not medical advice, diagnosis or treatment. Talk to a qualified healthcare provider about your symptoms and options.