While you’ve probably heard of PCOS, chances are you don’t know much about it. According to statistics from The Royal Australian College of General Practitioners, 70% of those with PCOS will go undiagnosed. Dr Preeya Alexander explains how the common syndrome affects women and how she works with patients to overcome the problem.

Polycystic ovarian syndrome (PCOS) is often misunderstood but it’s very common, 12–21% of women of reproductive age will experience PCOS. Despite the small acronym the diagnosis has lots of implications.

In fact the syndrome has very little to do with the ovaries at all and more to do with the body’s metabolism and how it deals with insulin and sugar. And whilst most people’s minds jump to hairy overweight women when they think of PCOS – take a look at Victoria Beckham – a very slender woman who has struggled with the condition. There may be friends or family members who you do not know have the syndrome – remember how they said to never judge a book by its cover?

I’ve included the 5 main facts you should know about PCOS:

  1. The disorder has three characteristic features and you only need two to be diagnosed with the condition. Irregularities of menstrual cycle, signs of high levels of testosterone and cysts on the ovaries are some of the criteria –the ovaries are not essential to diagnosis and so everyone harping on about them can be very misleading! More insulin leads to more testosterone, which can lead to excessive hair growth and acne – an annoying effect, which as you can imagine seriously effects body confidence.
  1. The ‘cysts’ everyone refers to are actually follicles in the ovary. People often ask me “what will happen to the cysts? Do they get surgically removed or burst?” The truth is the ultrasound is just looking for follicles in the ovary not the cysts you are likely visualizing, and they certainly do not need removal– instead think tiny small structures like pearls that contain an egg. The image of a huge ovary with pimples all over it isn’t necessarily correct!
  1. Insulin resistance is the main issue. This means that the body needs more insulin than normal to keep the blood sugar levels normal. This is why PCOS patients have a much higher risk of diabetes (gestational and type 2 diabetes)– in fact their risk is 4-8 fold higher.
  1. Patients with PCOS can have problems with fertility – with irregular ovulation and menstrual cycles patients will sometimes need assistance to conceive or take longer than an average couple.
  1. Sufferers are at a higher risk of depression and anxiety so mental health is another aspect to the condition.

So there you have it – it’s a lot more complex than most people think.

For most women losing 5 to 10% of their body weight when diagnosed has amazing benefits for regulating their menstrual cycle, improving fertility and reducing diabetes risk. So the minute we diagnose someone a lifestyle review is high on the agenda.

I find working with my PCOS patients to help them lose weight incredibly rewarding– motivating and reviewing their lifestyle often has a great effect on controlling their symptoms. My heart beams when we see the clear difference (lower sugars, a new pregnancy, regular periods) as a result of their hard work!

Of course, for some weight loss can be very hard to achieve (or not enough on it’s own) and that’s when medications are needed. Between the contraceptive pill and a diabetes medication like Metformin – there are many other ways to manage PCOS.

The cysts on the ovaries business is the least of one’s worries – and to put everyone’s mind at ease 1 in 4 women of reproductive age have polycystic ovaries without having the syndrome. In fact you can be diagnosed with the syndrome without even having the cysts. So when you hear the acronym from now on think insulin, sugar, diabetes and fertility issues – not such a small acronym after all is it?

If you’re concerned about irregular menstrual periods, excessive hair growth or fertility issues speak to your GP.


Dr Preeya Alexander is a General Practitioner working in Melbourne. She is passionate about preventative health and believes strongly in educating patients so they have the tools needed to drive their own positive health changes. Preeya health blog, the Wholesome Doctor, covers a range of issues from nutrition and weight management to pregnancy and child health. Preeya can be followed on Instagram (@thewholesomedoctor).