What is PCOS?

PCOS is a hormonal and metabolic condition marked by a combination of excess androgen activity, disrupted ovulation, and, in many cases, multiple small follicles visible on ovarian imaging. Despite the name, polycystic ovaries aren't required for diagnosis, and not all women with PCOS have them.

PCOS is diagnosed using the Rotterdam criteria, which require two of the following three features:

1. Irregular or absent ovulation, showing up as irregular or absent periods.

2. Clinical or biochemical evidence of excess androgens, whether that's symptoms like acne and excess hair growth, or elevated testosterone on a blood test.

3. Polycystic ovarian morphology on imaging, usually multiple small follicles arranged around the edge of the ovary.

PCOS is not solely a reproductive condition. At its core, it is a metabolic disorder with long-term implications for cardiovascular health, insulin sensitivity, and diabetes risk.

Symptoms of PCOS

PCOS symptoms vary considerably between individuals. Some women have predominantly hormonal symptoms, while others primarily have metabolic features. Many have both. Common signs include:

• Irregular, infrequent, or absent menstrual periods

• Heavy or prolonged periods when they do occur

• Excess hair growth on the face, chest, or abdomen (hirsutism)

• Acne, particularly on the jaw, chin, and chest

• Hair thinning or scalp hair loss

• Unexplained weight gain, particularly around the abdomen

• Difficulty losing weight despite dietary changes

• Fatigue and low energy

• Low mood, anxiety, or mood swings

• Difficulty conceiving from irregular or absent ovulation

• Skin darkening in body folds such as the neck, armpits, or groin (acanthosis nigricans), reflecting insulin resistance

What causes PCOS?

PCOS comes from a complex interplay between hormonal dysregulation, insulin resistance, and genetic predisposition. Contributing causes include:

• Insulin resistance: present in approximately 70% of women with PCOS regardless of body weight. Excess insulin stimulates the ovaries to produce more androgens, which disrupts follicle development and ovulation.

• Androgen excess: too much of these hormones disrupts the normal cycle and causes symptoms like acne or extra hair growth.

• Hormone imbalance (LH and FSH): your brain sends signals to your ovaries to manage your cycle. In PCOS, these signals get crossed, favoring hormone production over normal egg development.

• Genetics: first-degree relatives of women with PCOS have a significantly higher risk, pointing to a strong inherited component.

• Weight: while thin people can have PCOS, extra weight can make insulin resistance and hormone symptoms worse.

• Inflammation: long-term, low-level inflammation can push the ovaries to produce more androgens and make insulin less effective.

How is PCOS detected?

PCOS is diagnosed clinically using the Rotterdam criteria, combining hormonal blood testing with ovarian imaging.

Blood tests: Elfcare's panel includes the key hormonal and metabolic markers for PCOS assessment:

• Testosterone (total and free): measures the androgens that are the biochemical hallmark of PCOS.

• SHBG: a protein that is usually low in PCOS, which increases active testosterone and can signal insulin resistance.

• LH and FSH: checks the ratio of these signals. A high LH to FSH ratio suggests disrupted ovulation.

• Estradiol: provides context on overall hormone levels and where you are in your cycle.

• DHEAS: reflects how much the adrenal glands are contributing to androgen levels.

• Insulin and HOMA-IR: directly measures insulin resistance, the primary driver of PCOS and its long-term health risks.

• HbA1c and glucose: assesses your risk for type 2 diabetes, which is significantly higher for women with PCOS.

• Total cholesterol, LDL, HDL, and triglycerides: assesses cardiovascular risk. PCOS is associated with a characteristic pattern of high triglycerides and low HDL.

• CRP: a marker of inflammation that can worsen both hormone and insulin-related issues.

• Thyroid profile (TSH and T4): rules out thyroid issues, which can mimic PCOS symptoms like weight gain and irregular periods.

• Prolactin: another hormone check to ensure irregular cycles aren't caused by other pituitary issues.

Pelvic MRI: Elfcare's full body MRI covers the pelvis as standard, with the ovaries visualized. It can flag other pelvic findings relevant to the clinical picture, such as endometriomas or fibroids that may coexist with PCOS.

Pelvic ultrasound: Transvaginal ultrasound is the standard imaging tool for assessing polycystic ovarian morphology. Follicle count and ovarian volume, one of the three Rotterdam features used to confirm PCOS, are evaluated.

Why early detection matters

PCOS is not simply a reproductive condition that resolves after the fertile years. Left undiagnosed and unmanaged, the insulin resistance at its core progresses to type 2 diabetes in up to 40% of women by the age of 40. Cardiovascular risk is elevated throughout life. Endometrial cancer risk rises too, since regular ovulation normally offers some protection against it. Diagnosing PCOS early opens the door to lifestyle changes, insulin-sensitising treatment, and hormonal management, all of which can meaningfully reduce these long-term risks while also improving quality of life, fertility, and metabolic health in the years it matters most.

How Elfcare can help

Elfcare's blood panel covers the complete PCOS hormonal and metabolic profile including testosterone, SHBG, LH, FSH, estradiol, fasting insulin, HOMA-IR, HbA1c, lipids, CRP, thyroid function, and prolactin. That gives both the direct hormonal markers of PCOS and the metabolic assessment that shapes long-term cardiovascular and diabetes risk.

Our pelvic MRI images the ovaries directly, identifying polycystic morphology and any coexisting structural findings.

If our blood tests or MRI identify findings consistent with PCOS, we take care of further diagnostics such as a pelvic ultrasound or refer you to the appropriate specialist.