Our friends over at FUTURE WOMAN are as passionate about women’s hormone health as we are. Their Co-founder & Director of Nutrition, Francesca Lyon, highlights five key things to think about when it comes to PCOS.

Despite its name, Polycystic Ovarian Syndrome (PCOS) has nothing to do with cysts. The “cysts” seen on an ultrasound are actually undeveloped follicles, which can be a normal presence in the ovaries. PCOS is the most common endocrine and metabolic condition in women of reproductive age, affecting 4–20% of women worldwide.

A more accurate name for PCOS is Anovulatory Androgen Excess (AAE), which is essentially a condition of androgen excess and typically also has symptoms such as irregular or missing cycles. This androgen excess is a mandatory criterion for a correct diagnosis, helping to avoid misdiagnosis with other conditions like hypothalamic amenorrhoea (HA).

FUTURE WOMAN testing provides critical insights for PCOS that go beyond standard diagnosis, helping to ensure accuracy and target the specific drivers of your symptoms.

1. Correct diagnosis requires more than just an ultrasound

A PCOS diagnosis requires ruling out other conditions, but symptoms like missing periods and polycystic ovaries on a scan can also be signs of Hypothalamic Amenorrhoea (HA). The key difference is that PCOS is a disorder of androgen excess, while HA is characterised by low overall hormones.

NHS testing is often limited to testing the androgen testosterone, but FUTURE WOMAN tests multiple androgens (like DHEA-S and androstenedione) and their metabolites, which is crucial for a correct diagnosis.

An ultrasound alone cannot confirm or rule out a PCOS diagnosis, and relying on it can lead to overdiagnosis or misdiagnosis. Current medical guidelines state a diagnosis requires meeting at least two of the following three criteria, but this can lead to many wrong diagnoses:

·       Signs of raised androgens (clinically or on blood tests)

·       Irregular or no periods

·       Polycystic ovaries on an ultrasound scan

2. Identify your PCOS type

PCOS is not a single disease but a disorder with different underlying drivers. Identifying your specific type or drivers is crucial because treatment should be tailored to the root “cause”. There are three distinct types:

·       Insulin-resistant

·       Inflammatory

·       Adrenal

There is also a PCOS picture that can develop post-pill and this is often referred to as the 4th type of PCOS, although it can be temporary.

Testing helps identify your specific type so treatment can be tailored to the root cause. For instance, Adrenal PCOS is defined by high DHEA-S with normal testosterone — a distinction that can be identified with the FUTURE WOMAN Advanced Hormone Test.

3. Understand androgen metabolism

Even with normal testosterone levels, you can still experience symptoms of PCOS like acne and hair loss. This is why so many women get confused as to why they “don’t have PCOS” but have all of the symptoms.

This may be due to a preference for something called the 5α-reductase pathway, which converts testosterone into a form that is three times more potent (5α-DHT). This metabolic preference can only be detected through urine testing, which is a core part of the FUTURE WOMAN method.

4. Key symptoms are driven by hormonal imbalances, but pain is not one of them

The hormonal imbalances in PCOS lead to a range of symptoms. High androgens are responsible for many classic signs. However, one symptom that is not associated with PCOS is pain. If you are experiencing pelvic pain, it may indicate another condition, like endometriosis.

Common PCOS symptoms include:

·       Irregular or missing periods

·       Fertility issues, as PCOS is the most common cause of anovulatory subfertility

·       Hirsutism (excess body and facial hair growth)

·       Head hair loss (androgenic alopecia)

·       Acne, especially around the jawline and chin

·       Weight gain, particularly around the abdomen (often called “PCOS belly”)

·       Sugar cravings and other signs of insulin resistance like skin tags

·       Mood changes, including higher rates of anxiety and depression

5. PCOS can impact fertility and pregnancy, but lifestyle changes can help

There is a 70–80% likelihood of fertility issues for women with PCOS, primarily because high androgen and luteinising hormone (LH) levels prevent regular ovulation. Without ovulation, it is impossible to conceive naturally.

For those who do conceive, PCOS is associated with increased risks during pregnancy, such as a higher chance of miscarriage, gestational diabetes, and pre-eclampsia. These complications are often linked to high insulin and testosterone levels.

The good news is that addressing the root drivers of PCOS — such as insulin resistance and inflammation — through diet, supplements, and lifestyle changes can help restore ovulation, improve fertility outcomes, and mitigate pregnancy risks.

To find out more about testing and personalised support, head to: www.future-woman.com

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