PCOS: long-term health and emotional wellbeing

A PCOS review can include blood pressure, sleep and emotional wellbeing even when periods are not your main concern. The international guideline treats PCOS as a lifelong condition and recommends care across these areas.

PCOS is now called polyendocrine metabolic ovarian syndrome, or PMOS. Both names refer to the same condition; this article uses PCOS to match the name you may already know.

Blood glucose and heart-health checks

PCOS is associated with an increased risk of type 2 diabetes, regardless of age or body size. The guideline recommends assessment of blood glucose status at diagnosis for adults and adolescents, followed by reassessment every one to three years according to additional risk factors.

The guideline describes the oral glucose tolerance test as the most accurate way to assess blood glucose in PCOS. This is different from measuring insulin levels: the guideline does not recommend routine insulin tests because they have limited use in guiding care.

A cholesterol and triglyceride blood test, called a lipid profile, is recommended at diagnosis regardless of age or body size. When the test is repeated depends on the results and your wider cardiovascular risk. Blood pressure measurement is recommended annually and when planning pregnancy or fertility treatment.

The guideline identifies increased cardiovascular risk while noting that the overall risk of cardiovascular disease before menopause is low. These checks help your clinician discuss prevention with you. Heart disease is not inevitable. Ask when your next checks are due and who will arrange them.

The womb lining and infrequent periods

PCOS increases the risk of endometrial hyperplasia, or thickening of the womb lining, and endometrial cancer. The overall chance of that cancer remains low, so the guideline does not recommend routine screening for everyone with PCOS.

Long-standing untreated absence of periods adds to that risk. A clinician can discuss cycle regulation and progestogen treatment to help protect the lining. Ask about this if periods are very infrequent, even if you are not planning pregnancy.

The advice against routine screening does not replace assessment of new bleeding symptoms. Contact your GP (UK), or your doctor (US or elsewhere), promptly for bleeding or spotting after menopause, bleeding between periods, or periods that have become unusually heavy for you. Do not wait for your next scheduled PCOS review.

Snoring and tiredness deserve attention

Sleep apnoea causes repeated interruptions to breathing during sleep. It is more common in PCOS independently of body size. The guideline recommends assessment when snoring occurs alongside waking unrefreshed, daytime sleepiness or fatigue.

Book a GP appointment in the UK, or see your doctor in the US or elsewhere, for that combination of symptoms. Describe what you notice during the day and anything someone else has noticed about your sleep. Ask whether a sleep assessment is appropriate.

Mood, eating and body image are part of care

The guideline recommends screening for depression in adults and adolescents with PCOS, and for anxiety in adults. There is no agreed best interval for repeating these checks; follow-up depends on symptoms, risk factors and life events.

Clinicians need to consider eating disorders and disordered eating at any weight, especially when discussing lifestyle changes. Body-image distress and the social effects of symptoms can also affect wellbeing. These concerns deserve assessment. They do not mean you are putting too little effort into PCOS care.

Psychological therapy is recommended when depression, anxiety or eating disorders are diagnosed, with treatment guided by your preferences and local guidance. Evidence-based therapy can also help address body-image distress. In the US, a primary care provider can begin a mental health assessment and arrange referral; in the UK, ask your GP about treatment and access to services. Elsewhere, speak with your usual doctor.

For an appointment, a simple sentence is enough: “Worry about my symptoms is affecting my day,” or “Food and weight advice have become difficult for me.” Ask for help with these concerns as part of your care plan.

Getting urgent support

Call 999 now in the UK, 911 in the US, or your local emergency number if your life is in danger or you cannot keep yourself safe.

For urgent mental health help, contact an urgent GP service in the UK. In England, call NHS 111 and select the mental health option. In the US, call or text 988. Elsewhere, contact your local urgent mental health service.

In the UK, Samaritans offers free listening support on 116 123 at any time. This is a listening service; use emergency services for immediate danger.