Women’s health can be a complicated affair, but it’s important to get a handle on it. Polycystic ovarian syndrome (PCOS) is one topic that’s often misunderstood, mismanaged and misdiagnosed. Despite this, PCOS can have a major impact on our lives, with side effects ranging from excess hair, insulin resistance and low moods. And it’s fairly common, with at least 10% of women living with it.

Confusingly, polycystic ovaries (PCO) – also common – isn’t the same thing as PCOS. And while having cysts on your ovaries can be one symptom of PCOS, it’s not always down to that: you can have PCOS without cysts showing up in that area. So, what’s the difference between PCO and PCOS, and how can we tell which condition we have (and how best to treat it)?

Polycystic ovarian syndrome is thought to affect one in ten women in the UK – but this figure doesn’t take into account how misdiagnosed it can be. It’s estimated that around 75% of women living with PCOS haven’t been diagnosed, so in fact the figures are probably much higher.

Essentially, PCOS is a syndrome (meaning a collection of symptoms) that affects how a woman’s ovaries work. “PCOS is a metabolic syndrome which includes polycystic ovaries as one of the key characteristics,” explains Dr Zoe Watson, GP and founder of women’s health platform Wellgood Wellbeing. “In adults, PCOS can be diagnosed if you have two out of three of the criteria present. Having polycystic ovaries is only one of these.”

“The name PCOS is definitely a misnomer,” agrees Dr Aziza Sesay, GP and women’s health advocate. “You don’t have to have cysts in your ovaries to be diagnosed. The three criteria are: irregular periods, symptoms of raised androgen hormones and having multiple cysts on the ovaries.”

It’s important to remember that you can be diagnosed if you present with two of the symptoms, meaning that your irregular periods combined with weight gain or excessive hair growth could be enough, provided other causes of menstrual disturbance and hyperandrogenism have been excluded, notes Dr Watson.

Other symptoms can include fertility issues, weight gain, thinning hair or hair loss and oily skin or acne. According to the NHS, if you do have signs or symptoms of PCOS, these will usually become apparent during your teens or early 20s, and you’ll need at least one medical test to be diagnosed, alongside physical symptoms – usually a blood test showing higher levels of androgen hormones, and/or an ultrasound scan showing the presence of cysts. 

The key word here is ‘syndrome’

“Remember PCOS is a syndrome, which means it’s a condition characterised by a set of associated symptoms,” advises Dr Sesay. “The hormonal imbalances will cause a variety of symptoms, which can include irregular, heavy, painful periods; weight gain; excessive hair growth, and so on.”

Having ovarian cysts doesn’t necessarily mean you also have PCOS, which may come as a relief if you’ve been diagnosed with one. Ovarian cysts are common and are considered to be normal. Usually causing no symptoms, they often disappear on their own – meaning you’ll often be none the wiser. Every month, the ovaries release a mature egg from their many follicles. If, for some reason, the follicle doesn’t ‘break’ and release an egg, it will form a small cyst. PCO can be diagnosed if a woman has at least one ovary with 12 or more small cysts.

“PCO is simply the presence of polycystic ovaries (ie ovaries with lots of small cysts on the surface,” explains Dr Watson. “In the absence of any of the other symptoms such as menstrual issues or excessive body hair, it’s found in up to a third of women of reproductive age.” 

You’ll only become aware of the presence of a cyst if it becomes large enough to cause pelvic pain, bloating or menstrual symptoms – although if you are struggling with any of these, it’s important to consult your GP to rule out any serious underlying causes.

In contrast, PCOS can have a major impact on an individual’s life. “It affects so many women and much more awareness is needed around it,” stresses Dr Sesay. “Too many women suffer in silence, are misdiagnosed or inadequately managed. If you’re concerned about symptoms, make an appointment to see your GP.”

Images: Getty