Unfortunately, the cause of PCOS is still not fully understood. There are many different possible symptoms of PCOS, and the condition is likely caused by a combination of factors including environmental, genetic and our own hormonal make up. This can result in abnormally elevated levels of certain hormones.

Because PCOS effects many systems within our body, there is no one size fits all sadly when it comes to treatment. There are some great lifestyle changes, medication options and more that have been proven to benefit many women with PCOS though;

1. Lifestyle changes

Some people with PCOS are instructed to lose weight to help improve their symptoms. A 5% weight reduction can significantly improve symptoms, improve ovulation and increase the chances of pregnancy. But we know this is easier said than done. High levels of insulin that can be associated with PCOS can make weight loss difficult. We also want to avoid crash diets - we don't want to deplete your body of nutrients. Adding in nutritional foods rich in omega-3 (for example oily fish), flaxseeds, nuts and mint have been shown to be beneficial in PCOS by reducing the circulating inflammatory markers in the body. Studies have shown a link between ultra-processed foods and sedentary lifestyles as significant factors in PCOS progression so try to cut out the ultra-processed foods and move more.

2. Medication

The main aim here is to initiate ovulation. Ovulation is hindered by various factors including elevated glucose and subsequently insulin levels and elevated androgens (testosterone). The combined oral contraceptive pill or progesterone only pill may be recommended by your doctor to regulate your menstrual cycle. These cannot be used if you are trying to conceive, so you would need to speak to your doctor about coming off treatment before starting ICI.

3. Surgery

A minor surgical procedure called laparoscopic ovarian drilling (LOD) may be a treatment option for fertility problems associated with PCOS that do not respond to medicine. This can help correct the hormone imbalance and restore the function of your ovaries. The key is to make sure that you have healed fully from your surgery before considering getting pregnant and trying ICI. Talk to you doctor about your plans to conceive and get the green light to go ahead after your surgery.

If you've been diagnosed with PCOS

If you want to explore medication to restore ovulation, you should make an appointment with your GP. They can prescribe medication that might help:

• Metformin - Metformin can lower insulin and blood sugar levels in women with PCOS. This can help manage symptoms and it may improve ovulation.
• Medications to stimulate ovulation - Clomiphene citrate, letrozole or gonadotropins are medications that can be used in women with PCOS to stimulate ovulation. These are often used over multiple cycles and may require monitoring with ultrasound.

If you suspect you have PCOS

You should make an appointment with your GP and discuss the symptoms you have. It is really helpful if you can provide a symptom diary, allowing the GP to see if there is a correlation of symptoms with triggers and the pattern of symptoms you are experiencing. It can include details of your recent menstrual cycles, your cycle length, any information on ovulation testing and other PCOS related symptoms (oily skin and acne, excessive facial hair or body hair and hair loss from the head). This can be beneficial in understanding the type and severity of PCOS. Your GP will determine if you need blood tests to measure your hormone levels and an ultrasound scan to look at your ovaries. PCOS can increase your risk of some other conditions and it’s possible they may request additional tests such as glucose and lipid levels.

Getting a specialist referral

Often you're required to try to conceive for one year before being investigated for fertility issues. However, NICE (National Institute for Health and Care Excellence) guidelines state that if there is a known predisposing factor for infertility (like PCOS), then you should be offered an earlier referral.

Here's and excerpt from the NICE guidelines should you want show your GP:

"NICE Guidelines: Fertility problems: assessment and treatment

Clinical guideline [CG156]

1.2.13.7 Offer an earlier referral for specialist consultation to discuss the options for attempting conception, further assessment and appropriate treatment where:

• the woman is aged 36 years or over
• there is a known clinical cause of infertility or a history of predisposing factors for infertility. [new 2013]"