Here's a peculiar thing about polycystic ovary syndrome: roughly one in ten UK women have it, yet if you asked a random sampling of people at your local Tesco what it is, you'd likely get blank stares, creative guesses involving actual cysts, and perhaps someone confidently describing an entirely different condition.
It's a bit like being in a very large, somewhat confused club where half the members don't know they're members, and the other half wish the membership benefits were better explained.
But here's what really deserves more attention: PCOS isn't just about periods and fertility. It's quietly raising your cholesterol levels, affecting how your body handles sugar, and potentially setting you up for heart health concerns decades down the line. The sort of metabolic connections that deserve more than a hurried explanation in a ten-minute GP appointment.
What PCOS Actually Is (And Isn't)
Polycystic ovary syndrome is a hormonal condition that affects how your ovaries work. Despite the name, it's not really about cysts - those small follicles on your ovaries are actually normal egg sacs that haven't developed properly. Calling them cysts is a bit like calling a bud a flower. Technically accurate from a distance, but missing some important developmental context.
The real issue is hormonal: women with PCOS typically produce higher levels of androgens (often called "male hormones," though that's a misnomer - everyone has them, it's just a question of quantity). This hormonal imbalance disrupts ovulation and creates a cascade of other effects throughout the body.
Think of it as your endocrine system having a rather enthusiastic debate with itself about the proper hormone levels. Spoiler: the debate never quite reaches a conclusion.
The Three Faces of PCOS
To be diagnosed with PCOS under the Rotterdam criteria (the diagnostic standard most UK doctors use), you need to have at least two of these three features:
1. Irregular Periods
Infrequent periods, absent periods, or unpredictable cycles. If your menstrual cycle is more "guidelines" than "schedule," this might be why. Some women with PCOS have fewer than eight periods a year. Others have periods that show up like an unreliable friend - sometimes there, sometimes not, always keeping you guessing.
2. High Androgen Levels
This can show up as excess facial or body hair (hirsutism), acne, or male-pattern baldness. Or it might simply appear in blood test results showing elevated testosterone levels. Not everyone with PCOS has visible signs - your androgens might be having their party entirely behind the scenes.
3. Polycystic Ovaries
Visible on an ultrasound scan. Your ovaries contain multiple small follicles (at least 12 in each ovary, by current standards). However - and this is important - you can have polycystic ovaries without having PCOS, and you can have PCOS without having polycystic ovaries. Because apparently, medical terminology enjoys keeping us on our toes.
Why It Matters Beyond Periods and Fertility
If you're thinking "Well, irregular periods sound annoying but manageable," you're not wrong. But PCOS is a bit like that friend who always brings uninvited guests to the party. It rarely shows up alone.
The Insulin Resistance Connection
Here's where it gets interesting from a metabolic health perspective: about 70% of women with PCOS also have insulin resistance. This means your body needs to produce more insulin than usual to keep your blood sugar levels stable. That extra insulin doesn't just float around harmlessly - it can trigger your ovaries to produce more androgens, creating a rather unhelpful feedback loop.
It's also why women with PCOS have a higher risk of developing type 2 diabetes later in life. Your body is essentially working overtime, and eventually, it might decide to stage a walkout.
The Cholesterol Plot Twist
Women with PCOS are more likely to have higher LDL cholesterol (the less helpful kind) and lower HDL cholesterol (the protective kind). Combined with insulin resistance, this creates a metabolic environment that's not exactly ideal for long-term heart health.
The risk of cardiovascular disease is higher in women with PCOS - though whether that's directly due to PCOS itself or the cluster of metabolic factors that tend to accompany it is still being debated by people far cleverer than us in academic journals.
Weight and PCOS: It's Complicated
Many women with PCOS struggle with weight management, but not all - about 30% of women with PCOS are at a normal weight. The condition can make it harder to lose weight due to insulin resistance, but weight gain can also make PCOS symptoms worse. It's one of those maddening chicken-and-egg situations that makes you want to write strongly worded letters to evolution.
What You Can Actually Do About It
Right, let's get to the practical bit. Because knowing you have PCOS is only useful if you know what to do with that information.
The Food-First Approach
Since insulin resistance is such a central feature of PCOS, managing blood sugar levels through diet can make a meaningful difference. This doesn't mean draconian restrictions or eliminating entire food groups - it means being a bit strategic:
- Focus on fiber - particularly soluble fiber like oat beta-glucan, which slows sugar absorption and supports healthy cholesterol levels. Yes, we're biased, but we're also correct.
- Balance your carbohydrates with protein and healthy fats to avoid blood sugar spikes
- Consider the Mediterranean approach - plenty of vegetables, whole grains, fish, nuts, and olive oil. Research suggests this eating pattern may help with both PCOS symptoms and cardiovascular risk factors.
Movement Matters
Regular physical activity improves insulin sensitivity and can help manage weight, reduce inflammation, and improve cholesterol levels. You don't need to become a marathon runner - consistent, moderate exercise is what counts. Even a daily walk does meaningful work.
Medical Support
Your GP can offer various treatments depending on which PCOS symptoms bother you most:
- Combined contraceptive pills to regulate periods and reduce androgen levels
- Metformin to improve insulin resistance
- Anti-androgen medications for excess hair growth
- Fertility treatments if you're trying to conceive
There's no one-size-fits-all approach, which is both frustrating and liberating. You and your doctor can tailor treatment to what matters most to you.
The Long Game: Why It's Worth Paying Attention Now
Here's the thing about PCOS: many women are diagnosed in their 20s or 30s, often when trying to conceive. But the metabolic implications - the cholesterol, the insulin resistance, the cardiovascular risk - those build slowly over years.
Taking steps now to manage these factors isn't about being perfect or following some restrictive protocol. It's about playing the long game with your health. Small, consistent actions compound over time, like interest in a savings account, but for your cardiovascular system.
Supporting your body with regular movement, strategic nutrition choices (including functional foods that actually do something useful), and appropriate medical care when needed - this is how you shift the odds in your favor.
You're Not Alone in This
One in ten UK women have PCOS. That's roughly 1.5 million women across the country. Your colleague who always brings homemade lunch might have it. The woman at your yoga class might have it. Your sister might have it. It's common enough that you almost certainly know multiple people living with it, even if they haven't mentioned it.
The symptoms can feel isolating, and the long-term health implications can feel overwhelming. But knowledge is power - particularly when it comes to your metabolic health. Understanding what PCOS actually is, how it affects your body beyond your ovaries, and what you can do about it puts you firmly in the driver's seat.
And if you're wondering about the cholesterol connection and what it means for your heart health? We'll be diving deeper into that in upcoming articles. Because this conversation is just getting started.
References
- Royal College of Obstetricians and Gynaecologists. (2023). Polycystic Ovary Syndrome: Long-term Consequences. Green-top Guideline No. 33.
- NHS. (2024). Polycystic ovary syndrome. Available at: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/
- Barber, T.M., et al. (2023). Polycystic ovary syndrome: insight into pathogenesis and a common association with insulin resistance. Clinical Medicine, 23(1), 1-5.
- Verity PCOS. (2024). About PCOS. Available at: https://www.verity-pcos.org.uk/
- Wild, R.A., et al. (2023). Cardiovascular Disease and Diabetes in Women with Polycystic Ovary Syndrome. Endocrine Reviews, 44(2), 323-343.
- Teede, H.J., et al. (2023). Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Human Reproduction, 38(9), 1655-1679.
- British Heart Foundation. (2024). PCOS and heart health. Available at: https://www.bhf.org.uk/