PCOS (Polycystic Ovary Syndrome)

PCOS is a common but often confusing condition that can affect your hormones, cycles, ovulation, and overall wellbeing. Symptoms such as irregular periods, acne, excess hair growth, or difficulty conceiving can feel overwhelming, but gaining clarity is an important first step. Through thoughtful assessment and personalised care, I help you understand your hormonal patterns and create a tailored plan that supports symptom control, cycle regulation, metabolic health, and long-term fertility—so you can feel more balanced, informed, and supported.

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“Exploring and understanding PCOS is a step toward rediscovering balance, supporting your health, honouring your body, and moving forward with confidence and ease.”

Understanding PCOS

PCOS is a complex endocrine condition with reproductive, metabolic and psychological dimensions. Management requires comprehensive assessment across multiple body systems, guided by international PCOS guidelines.

PCOS typically involves:

  • Ovulatory dysfunction (irregular or absent ovulation)

  • Androgen excess (acne, hair growth, elevated testosterone)

  • Polycystic ovarian morphology

Symptoms vary widely, making personalised care essential.

Diagnostic Accuracy Is Key

Diagnosis follows Rotterdam/International guidelines and includes:

  • Detailed cycle history

  • Biochemical androgens (testosterone, SHBG, free androgen index)

  • Ovarian ultrasound (international cut-offs)

  • Exclusion of mimicking disorders (thyroid dysfunction, hyperprolactinaemia, CAH)

  • Metabolic screening

Hormonal Management

Cycle Regulation

For symptom control or endometrial protection.

Hormonal options:

  • Combined pill 

  • Progesterone-only methods

  • Cyclical progesterone

Non-hormonal 

  • Nutritional support - dietary changes, inositol

  • Regular aerobic exercise

Hyperandrogenism Management

  • OCP

  • Anti-androgens (spironolactone, cyproterone - with appropriate contraception)

  • Dermatology input when required

Metabolic Health & Insulin Resistance

Metabolic assessment includes:

  • Fasting glucose

  • OGTT (gold standard in PCOS)

  • Lipid profile

  • Blood pressure

  • Body composition

Evidence-based lifestyle interventions focus on:

  • Resistance and aerobic training

  • Structured nutritional strategies (Mediterranean-style patterns preferred)

  • Sleep and stress optimisation

Metformin may be recommended for:

  • Impaired glucose tolerance

  • Insulin resistance

  • Adjunct to ovulation induction

Fertility in PCOS

Ovulatory dysfunction is a common driver of subfertility, and outcomes with treatment are excellent.

Options include:

  1. Ovulation induction (Letrozole first-line; Clomiphene second-line)

  2. IUI in selected couples

  3. IVF when induction is unsuccessful or other factors coexist

  4. Ovarian drilling is rarely used; laparoscopy is considered only in select circumstances

  5. Individualised ovarian stimulation to minimise risk of OHSS

Fertility considerations

  • Monitoring protocols are tailored to reduce OHSS

  • Trigger choice (agonist vs hCG) is carefully selected

  • Freeze-all cycles may be used in high-risk responders

  • Weight-neutral fertility support models are prioritised

Mental Health in PCOS

PCOS is associated with:

  • Higher rates of anxiety and depression

  • Body image concerns

  • Increased disordered eating risk

This is incorporated into care through supportive counselling and multidisciplinary input when needed.

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