Irregular cycles, poor skin, weight challenges?
Polycystic Ovary Syndrome (PCOS)
Irregular cycles, poor skin, weight challenges?
Polycystic Ovary Syndrome (PCOS)
Recently, Polycystic Ovary Syndrome (PCOS) was renamed to Polyendocrine Metabolic Ovarian Syndrome (PMOS). The rebrand was announced by the leading medical journal The Lancet in May 2026. We are proud to share that our very own Fertility Medical Director, Dr Michael Costello, was one of the key members of the renaming process and an author of the The Lancet publication.
It’s estimated that Polyendocrine Metabolic Ovarian Syndrome (PMOS) affects 1 in 8 women worldwide. Many spend years confused, dismissed or misdiagnosed. We’d like to help change that.
PCOS isn’t just about ovaries. One of the biggest misunderstandings is that those with the condition must have multiple follicles on their ovaries. This is not the case! It’s a complex endocrine, metabolic and ovarian condition. It really does extend far beyond missed periods, weight gain, and hair removal solutions. There are long-term considerations for fertility as well as metabolic and cardiovascular impacts. Not everyone experiences these, but risks are higher if the condition is not well managed.
What impacts can PCOS have long term?
Higher rates of Type 2 Diabetes, insulin resistance and weight challenges are all long‑term effects linked to this condition. The metabolic effects of the condition also increase the risk of high blood pressure and high cholesterol. This means a higher likelihood of heart disease over time.
As weight increases, so does the risk of obstructive sleep apnoea (snoring and follow-on effects). Chronic low‑grade inflammation associated with PCOS can affect long‑term health impacts in many areas.
Women with PCOS often experience irregular or absent periods and ovulation, which can make falling pregnant more challenging, though certainly not impossible. The good news is that high-quality studies show that over a woman’s lifetime, those with PCOS achieve similar overall birthrates to other women.
As well as making fertility unpredictable, infrequent or absent periods increase the risk of endometrial lining thickening. Unfortunately, this can have some association with endometrial cancer. Sadly, the risk of endometrial cancer is 2-5 times higher and occurs in younger women with PCOS compared to those without.
Frustratingly, mental health can also be affected by PCOS. Many women with this complex condition live with greater mental health challenges.
It’s estimated that rates of depression can be 2.5 times higher than those in the population, and that 30% of those with PCOS suffer from depression and anxiety or disordered eating and reduced quality of life.
This is driven by a combination of hormonal, metabolic and psychosocial factors.
Higher rates of Type 2 Diabetes, insulin resistance and weight challenges are all long‑term effects linked to this condition. The metabolic effects of the condition also increase the risk of high blood pressure and high cholesterol. This means a higher likelihood of heart disease over time.
As weight increases, so does the risk of obstructive sleep apnoea (snoring and follow-on effects). Chronic low‑grade inflammation associated with PCOS can affect long‑term health impacts in many areas.
Women with PCOS often experience irregular or absent periods and ovulation, which can make falling pregnant more challenging, though certainly not impossible. The good news is that high-quality studies show that over a woman’s lifetime, those with PCOS achieve similar overall birthrates to other women.
As well as making fertility unpredictable, infrequent or absent periods increase the risk of endometrial lining thickening. Unfortunately, this can have some association with endometrial cancer. Sadly, the risk of endometrial cancer is 2-5 times higher and occurs in younger women with PCOS compared to those without.
Frustratingly, mental health can also be affected by PCOS. Many women with this complex condition live with greater mental health challenges.
It’s estimated that rates of depression can be 2.5 times higher than those in the population, and that 30% of those with PCOS suffer from depression and anxiety or disordered eating and reduced quality of life.
This is driven by a combination of hormonal, metabolic and psychosocial factors.
Do I have PCOS?
PCOS looks different for everyone; that’s why it can be so tricky to diagnose. If you’re ticking 3 or more of these signs or symptoms, it’s worth exploring further.
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Irregular, infrequent, or absent periods
Cycles can be long, unpredictable, or sometimes skipped altogether because ovulation isn’t happening regularly.
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Difficulty getting pregnant (due to irregular ovulation)
Ovulation may not occur each month, making it harder to time conception even when trying consistently.
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Acne or oily skin
Higher androgen levels can make the skin produce more oil, leading to breakouts that feel persistent or hard to manage.
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Excess facial or body hair growth
Some people notice thicker or darker hair on the face, chest, stomach, or back due to hormone imbalances.
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Hair thinning or hair loss on the scalp
Androgens can shrink hair follicles on the scalp, causing gradual thinning or widening of the part line.
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Weight gain or difficulty losing weight
Insulin resistance can make weight changes feel frustrating, even with healthy habits.
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Darkened skin patches often on neck, underarms, or groin
These velvety, darker patches can appear when insulin levels are elevated.
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Skin tags
Small, soft skin growths often appear in areas where the skin folds, especially when insulin levels are elevated.
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Mood changes, anxiety, or low mood
Hormonal shifts, sleep changes, and the stress of managing symptoms can all influence emotional well-being.
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Fatigue or low energy
Low energy can stem from disrupted hormones, poor sleep, or the body working harder to regulate insulin.
It’s important to remember that not all PCOS looks the same. Check out this simple breakdown of what this means for you. How the condition affects your body may change as you get older and the signs and severity can vary widely from person to person
Get personalised insights into your PCOS profile
Celery Health is designed to make navigating PCOS easier with support that meets you where you are
Irregular or absent periods
Irregular or absent periods are common in PCOS, often because ovulation doesn’t occur regularly. Some women also experience very long cycles of more than 35 days or fewer than eight periods a year.
Signs of higher androgen (male) hormones
Signs of higher androgen (male-type) hormone levels can also appear, such as acne, excess facial or body hair, or thinning hair on the scalp. Androgen levels may also be elevated on blood tests.
Polycystic (not actually cysts) ovaries on ultrasound
Polycystic ovaries may appear on ultrasound as larger ovaries with many small follicles, even though these aren’t true cysts! They’re actually just immature ovarian follicles at various rates of growth. It’s important to note that a pelvic ultrasound is not always required for a diagnosis, as a blood test measuring Anti-Mullerian Hormone (AMH) can be used instead of a pelvic ultrasound.
Irregular or absent periods
Irregular or absent periods are common in PCOS, often because ovulation doesn’t occur regularly. Some women also experience very long cycles of more than 35 days or fewer than eight periods a year.
Signs of higher androgen (male) hormones
Signs of higher androgen (male-type) hormone levels can also appear, such as acne, excess facial or body hair, or thinning hair on the scalp. Androgen levels may also be elevated on blood tests.
Polycystic (not actually cysts) ovaries on ultrasound
Polycystic ovaries may appear on ultrasound as larger ovaries with many small follicles, even though these aren’t true cysts! They’re actually just immature ovarian follicles at various rates of growth. It’s important to note that a pelvic ultrasound is not always required for a diagnosis, as a blood test measuring Anti-Mullerian Hormone (AMH) can be used instead of a pelvic ultrasound.
Treatment options for PCOS
PCOS treatment works best when tailored to your goals and underlying drivers. Most people benefit from a combination of lifestyle support and targeted medical care, depending on priorities like cycle health, fertility, metabolic health, skin, weight, or long-term cardiovascular health prevention.
Lifestyle remains a first-line therapy in PCOS. Insulin resistance remains one of the biggest issues with PCOS. In fact, it’s estimated that up to 80% of those PCOS sufferers with a higher BMI have insulin resistance. Changes with nutrition and movement can have an enormous impact on improving insulin sensitivity and reducing the effects of PCOS.
Dietary changes improve insulin sensitivity in PCOS. There is strong evidence in the benefits of the Mediterranean Diet, and a whole‑food, low‑glycaemic, higher‑protein eating pattern can reduce insulin spikes and support more predictable energy and appetite. Including a diet rich in antioxidants helps reduce oxidative stress, which is also impactful in chronic low-grade inflammation.
Resistance training and aerobic exercise (as simple as regular walking) also help stabilise blood glucose and improve metabolic health, including reducing androgen (male hormone) levels. These changes do not need to be restrictive. They simply create a steadier hormonal environment for your body to work with.
Celery Health works with dietitians and Exercise Physiologists who specialise in this area. Whilst many of those with PMOS are now engaging with medical therapies such as injectable weight loss medications, it’s important to remember that if you’re planning on conceiving, you’re advised to cease your GLP1-agonists 6-8 weeks before conceiving. Diet and lifestyle become even more important over this time. Get in touch if you’d like to know more.
There is strong evidence that Metformin is effective in improving the metabolic effects of PCOS.
Metformin is commonly used in PCOS to improve insulin sensitivity, metabolic health, and slow the progression to Type 2 Diabetes in those with altered glycemic control.
It’s important to remember that Metformin isn’t used primarily in fertility treatment with PCOS, but it may support cycle regularity and ovulation in some people. So warning! If you’re not planning on conceiving, you should consider birth control backup.
If you are working on conception, Metformin can be used as an ‘add-on’ adjuvant to simple fertility therapies such as Letrozole when insulin resistance is present.
Metformin is relatively cheap compared to weight-loss medication.
The oral contraceptive pill is a first-line therapy for menstrual irregularity and the reduction of hyperandrogenism (the presence of high male hormones). It’s used to reduce androgen‑related symptoms such as acne and excess hair growth, and to provide predictable bleeding patterns, which also help reduce thickening of the endometrial lining.
The OCP is not a treatment to take if you want to conceive or want to track ovulation patterns with PCOS.
Taking the OCP is a very personal decision and isn’t for everyone, particularly if you’re working towards preconception and fertility goals.
GLP‑1 agonists/ weight loss injectables (Ozempic/ Wegovy/ Saxenda) medications are a very effective treatment option for people with significant insulin resistance, Type 2 Diabetes or weight‑related challenges.
For women with PCOS, normal blood sugar levels and a BMI of 30 or above, they are a very appropriate therapy in combination with lifestyle changes. GLP-1 agonists affect satiety and appetite, and it’s generally recommended that doses start low and be increased slowly to avoid side effects.
Current evidence indicates that, for those with PCOS, weight loss improves cycle regularity, ovulation, insulin sensitivity and rates of natural conception. This is very important if you are planning to have a baby in the next 6-12 months. These drugs support weight loss and indirectly also reduce testosterone levels and hyperandrogenism.
If you’re not planning on conceiving, don’t forget to consider other contraception techniques and remember the OCP may not be absorbed readily if using a GLP-1 agonist.
Finally, the evidence is still out on GLP-1 agonists and the effects on a growing foetus, so those who are actively trying to conceive or starting IVF should stop 6-8 weeks beforehand to metabolise or ‘wash out’ the drug.
These medications are not for everyone, but they can be incredibly useful tools when weight challenges and metabolic drivers are a major part of your symptoms. If you’d like to learn more, reach out to speak with one of our specialist team members.
For those with PCOS trying to conceive, Letrozole is a first-line ovulation induction agent commonly used and has excellent evidence around live birth rates in women with PCOS.
Letrozole stimulates FSH release and improves follicle growth and ovulation. Live birth rates are significant when used in women with PCOS as a first-line fertility treatment. Clomiphene is used as a second-line agent, and it remains an effective alternative.
The best fertility treatment options for those with PCOS depend on age, ovulation pattern, metabolic health and any additional fertility factors. An expert endocrinology fertility specialist can help determine the most appropriate pathway if you’re known to have PCOS and want to conceive.
Some medications target individual symptoms. For example, spironolactone is often used to treat acne or excess hair growth because it reduces the effects of androgens on the skin and hair follicles.
These treatments are usually added when symptoms are more severe or when other options have not been enough on their own.
Celery Health works with endocrinologists who specialise in managing PCOS and helping you become symptom-free.
Evidence suggests that certain supplements – particularly myo-inositol and omega-3 fatty acids can improve insulin sensitivity and metabolic markers in PCOS. Vitamin D (when deficient) shows increased insulin sensitivity and may support menstrual regularity. NAC and CoQ10 show additional supportive benefits, such as improved egg quality in IVF populations and reduced oxidative stress. There is evidence that lipid profiles improve, as do oxidative stress markers. However, for their standalone effects on fertility outcomes compared with medications, there is no strong evidence, which is important if you have PCOS and are actively trying to conceive.
Supplements should be viewed as great adjuncts, not replacements for evidence-based medical and lifestyle treatment of PCOS, especially if you’re trying to fall pregnant.
PCOS is not your fault It's not just about weight, and you don't need to fix everything overnight.
It can feel overwhelming, but support is available, and early guidance can make a real difference.
It’s worth seeking help if you’re not actually sure if you even have PCOS. Alternatively, if symptoms are affecting your periods, fertility, skin, weight, energy and overall wellbeing, it’s time to get in touch.
Celery Health helps connect those with PCOS with the right team. Depending on your individual assessment, this may include hormone doctors (endocrinologists), specialist gynaecologists or even lifestyle and providers who can help you understand what’s going on and guide you through the next steps.
The good news is that new treatments are emerging and many are already showing really encouraging results.
Lifestyle is super important and can help immensely. Celery works with coaches and dietitians who have a major role in improving PCOS symptoms and health.
Management usually focuses on your specific symptoms and goals. You might be most focused on falling pregnant or losing weight or improving mental health. This may include lifestyle changes, cycle regulation, support for ovulation, skin and hair treatments and strategies to reduce long‑term health risks.
Mental health support is also important especially if anxiety, low mood or body image concerns are part of your experience. The right plan is individualised and often requires a team approach.
Which tests actually matter?
PCOS can be tricky to diagnose because there isn’t a single test for it and the criteria differ between adults and teenage girls.
Diagnosis usually involves looking at symptoms, medical history and blood tests. For adults, a pelvic ultrasound may also be useful.
In 2023, the Rotterdam Criteria was replaced by the International Guideline Diagnostic Criteria for PCOS. Important changes were made to how PCOS is diagnosed, ensuring clearer guidelines for doctors.
If you’ve been tested but you’re not really sure what your results mean, thats where we come in. We help you decode along the way.
Education and early awareness
Understanding the condition starts with knowing what’s happening in your body and that’s where early awareness makes a huge difference! We help you learn what PCOS actually is, how it affects your hormones and why symptoms can look so different from person to person.
Our education is designed to take the confusion out of the condition by breaking down complex hormonal processes into simple explanations you can actually use.
You’ll learn how symptoms develop, what early signs to look for and how these can change over time. This knowledge helps you feel more prepared when speaking with healthcare professionals and gives you the language to advocate for yourself.
Whether you’re newly diagnosed, exploring symptoms for the first time or wanting to understand your long‑term health, our team and resources support you in building a strong foundation of awareness and confidence in your own body.
No one explained your hormones properly (until now)
Fertility challenges can feel like one of the most overwhelming parts of PCOS no matter if you’re trying to conceive now or simply planning ahead.
We guide you through how ovulation works, how the hormonal fluctuations can influence your cycle and what these patterns might mean for your fertility journey.
You’ll gain a clearer understanding of what’s typical, what might need attention and how to recognise signs that your body is preparing to ovulate.
Our support helps you make sense of the many factors that influence fertility with PCOS, from cycle tracking and lifestyle considerations to understanding when it might be time to seek medical input.
The goal is to help you feel informed, empowered and less alone in the process. With the right knowledge, you can approach your fertility decisions with more certainty and a better sense of what steps may support your goals.
Workplace and wellbeing support
PCOS doesn’t just affect your physical health. It can influence your energy, mood, sleep and overall well-being, All of which can carry over into your work life.
We offer practical strategies to help you manage symptoms in a way that supports your productivity and protects your mental health. This might include pacing techniques, managing fatigue, understanding and navigating fluctuating symptoms or building routines that work with your body rather than against it.
We also provide guidance on how to approach workplace conversations if you choose to share your experience, along with tools to help you manage stress and maintain balance throughout the day.
Our focus is on helping you feel supported both personally and professionally, so you can show up in your work life without feeling like you’re constantly pushing against your symptoms.
Education and early awareness
Understanding the condition starts with knowing what’s happening in your body and that’s where early awareness makes a huge difference! We help you learn what PCOS actually is, how it affects your hormones and why symptoms can look so different from person to person.
Our education is designed to take the confusion out of the condition by breaking down complex hormonal processes into simple explanations you can actually use.
You’ll learn how symptoms develop, what early signs to look for and how these can change over time. This knowledge helps you feel more prepared when speaking with healthcare professionals and gives you the language to advocate for yourself.
Whether you’re newly diagnosed, exploring symptoms for the first time or wanting to understand your long‑term health, our team and resources support you in building a strong foundation of awareness and confidence in your own body.
No one explained your hormones properly (until now)
Fertility challenges can feel like one of the most overwhelming parts of PCOS no matter if you’re trying to conceive now or simply planning ahead.
We guide you through how ovulation works, how the hormonal fluctuations can influence your cycle and what these patterns might mean for your fertility journey.
You’ll gain a clearer understanding of what’s typical, what might need attention and how to recognise signs that your body is preparing to ovulate.
Our support helps you make sense of the many factors that influence fertility with PCOS, from cycle tracking and lifestyle considerations to understanding when it might be time to seek medical input.
The goal is to help you feel informed, empowered and less alone in the process. With the right knowledge, you can approach your fertility decisions with more certainty and a better sense of what steps may support your goals.
Workplace and wellbeing support
PCOS doesn’t just affect your physical health. It can influence your energy, mood, sleep and overall well-being, All of which can carry over into your work life.
We offer practical strategies to help you manage symptoms in a way that supports your productivity and protects your mental health. This might include pacing techniques, managing fatigue, understanding and navigating fluctuating symptoms or building routines that work with your body rather than against it.
We also provide guidance on how to approach workplace conversations if you choose to share your experience, along with tools to help you manage stress and maintain balance throughout the day.
Our focus is on helping you feel supported both personally and professionally, so you can show up in your work life without feeling like you’re constantly pushing against your symptoms.
Most importantly, and often confusingly, you do not need to have ovarian cysts to have PCOS! Likewise, people who have polycystic‑appearing ovaries don’t necessarily have PCOS. Confusing isn’t it??
FAQs
PCOS symptoms vary widely, but many people experience irregular periods, acne, excess facial or body hair, scalp hair thinning, weight changes or difficulty losing weight.
Some also notice mood changes, low energy, or sleep problems. Not everyone has all symptoms and symptoms can change over time.
Because it’s a complex condition, it’s often slow to get a diagnosis. That’s why it’s always good to seek help from PCOS experts early if you’re worried it may be affecting you.
Frustratingly there’s no single test for the condition. Diagnosis is based on a combination of symptoms, medical history, blood tests and for adults, sometimes a pelvic ultrasound. Doctors also need to rule out other conditions that mimic PMOS/ PCOS.
As mentioned above, most guidelines require 2 out of 3 features for a diagnosis.
The hormone blood tests include total testosterone/ free testosterone (FAI)/ sex hormone binding globulin (SHGB)/ LH and FSH/ DHEA-S/ prolactin and thyroid function testing. These tests confirm hyperandrogensim and rule out other causes like thyroid disease and pituitary disorders.
Metabolic and Insulin tests are often checked as PMOS/ PCOS is often linked to insulin resistance. A fasting glucose/ fasting insulin/ HbA1c/ lipid profile and sometime OGTT are done in order to assess for Diabetes and cardiometabolic risk, which is higher in PMOS.
An ultrasound may be used to look at ovarian appearance. Typical findings may include many small follicles in the ovary or enlarged ovarian volume. Modern criteria often define PCOS as >20 follicles per ovary or increased ovarian volume. It’s important to remember that an ultrasound is not always required especially if irregular cycles and high androgens are already present.
Anti-Mullerian Hormone (AMH) is sometimes used as an alternative marker of ovarian follicle load. It’s often elevated in PCOS and can support diagnosis when an ultrasound is not available or inappropriate. AMH is never used alone in the diagnosis of PMOS/ PCOS.
The criteria differ between adults and teenagers, which is why a personalised assessment is important.
Short answer – No!
PMOS or PCOS is one of the most common causes of ovulatory infertility because it disrupts the regular release of an egg (ovulation). However, many people with PMOS/ PCOS conceive naturally or with minimal treatment.
Up to 70-80% of people with PMOS/ PCOS have irregular or absent ovulation, but this is different to permanent ‘infertility’.
With lifestyle changes and ovulation induction treatments, most people with the condition can achieve pregnancy.
Irregular cycles and other signs of PCOS also occur in other conditions. The more serious include thyroid disease, congenital adrenal hyperplasia, high prolactin levels and rare androgen-secreting tumours. This is why it’s really important to have a complete medical review if you’re concerned you may be suffering from PCOS.
The takeaway from diagnosis is that PMOS/ PCOS doesn’t fit one single test and needs to combine symptoms (cycle changes/ acne/ hair growth) with blood tests, AMH, sometimes ultrasound as well the exclusion of other conditions.
Celery Health provides education, early awareness and solutions with the support of hormone and fertility specialists as well as whole body holistic practitioners.
We connect you with passionate healthcare experts in PCOS, fertility and hormones to help guide you to the next steps. Workplace and wellbeing support is important to us to ensure care is available and valued across the board.
You can start with a Celery Health quiz as you begin to understand your symptoms. You can also make enquiries and arrange appointments directly for personalised care.
- Myo-inositol (± D-chiro inositol) Improves ovulation, insulin resistance, cycle regularity. This supplement has the strongest evidence in cycle regularity but has no strong evidence around improving fertility outcomes
- Vitamin D – Improves metabolic and hormone markers and insulin sensitivity, if deficient.
- Omega-3 (EPA/DHA) – Improves insulin resistance and triglycerides.
- NAC (N-acetylcysteine) – May support ovulation and insulin resistance, though stronger studies are needed.
- CoQ10 – Some evidence suggests CoQ10 supports insulin sensitivity and mitochondrial/ egg quality and mitochondrial function.