WTF is PCOS (And Can It Affect My Fertility?)

The other day I got a call from a male friend. He’s a 38-year-old bachelor, knows everything about AI (he’ll happily corner you at the pub to explain it - eye roll), and has a fancy economics PhD. But this time, he admitted there was something he didn’t understand:

“The girl I went out with last night said she can build muscle really fast because she’s like a boy. She has this thing… PCOS? What is it?”

Boy, oh boy.

I can’t tell you how often I hear friends bring up PCOS — quietly over drinks, squeezed between talk about the Glasto lineup, and the eternal moral question: “Should I really renew Soho House this year?” Even the ones who’ve been diagnosed often aren’t sure what it really means.

So, here’s the breakdown — no jargon, no condescension, just clear answers for anyone wondering what PCOS is, how it’s diagnosed, how it might affect fertility, and what you can actually do about it.

First off: What does PCOS stand for?

PCOS = Polycystic Ovarian Syndrome.

It sounds dramatic — and worse, it’s misleading.

Despite the name, women with PCOS don’t actually have ovarian cysts. Instead, they have underdeveloped follicles — small, fluid-filled sacs that fail to mature into eggs ready for ovulation. If you’ve ever heard a doctor say your ovaries look like a “pearl necklace,” that’s what they mean: a string of tiny follicles clustered around the edge of the ovary.

Honestly, whoever named this should’ve called it “pearl syndrome”, but no one asked us.

How is PCOS diagnosed?

Here’s where things get complicated.

PCOS isn’t diagnosed by one single test — there’s no “PCOS blood panel” you can order on Thriva or a magic app. (Womp.) Doctors follow something called the Rotterdam Criteria, which was set at a medical summit back in 2003 (no, unfortunately, it wasn’t a Berlin DJ festival, even if it sounds like it).

To be diagnosed, you need two out of these three:
1️⃣ Irregular or absent periods
2️⃣ Polycystic ovaries on ultrasound (remember: not cysts, but underdeveloped follicles)
3️⃣ Signs of excess androgens (like elevated testosterone)

Let’s break it down.

Irregular periods are the easiest to spot. If you’re going months without a period, or your cycle is wildly unpredictable, that’s a red flag.

Polycystic ovaries on ultrasound means that, regardless of where you are in your cycle, an ultrasound might show the classic “pearl string” look — clusters of small follicles lining up around the ovary. Some women have this pattern, some don’t, and you can still be diagnosed without it.

Elevated androgens are the tricky bit. Doctors might check your hormone levels through bloodwork, or look for outward signs like stubborn chin hairs, scalp hair thinning, or jawline acne that laughs in the face of your Dermalogica serum.

Importantly, you don’t need all three. The two-out-of-three approach helps ensure that women who don’t fit the textbook still get the diagnosis and support they need.

Other FAQs

Am I turning into a man?!

Let’s clear this up right now: absolutely not.

Androgens are sometimes called “male hormones,” but women naturally produce them, just at lower levels. Having elevated androgens doesn’t make you masculine, erase your femininity, or mean you’re about to bulk up like a Barry’s instructor (though our abs would love this).

For most women, PCOS symptoms are subtle. Maybe your periods are missing. Maybe you’ve got a few dark hairs on your chin you tweeze when no one’s looking (we' can’t be the only ones). Maybe you’ve got stubborn acne despite the full Space NK lineup in your bathroom cabinet.

This is not your fault. You didn’t cause this by skipping workouts, eating carbs, or texting your ex after two White Claws (though we are raising an eyebrow).

Plenty of high-profile women — Victoria Beckham, Daisy Ridley, Jools Oliver — have opened up about their PCOS journeys. You are not broken. You are not less feminine. You are not alone. In fact, you’re in a club with Victoria Beckham and that makes us all slightly jealous.

What causes PCOS?

Here’s the part that often makes people roll their eyes: we don’t fully know.

Science is still piecing it together, but theories include genetics, insulin resistance, inflammation, and environmental exposures (yes, some people even point fingers at microplastics).

The deeper issue? Women’s health research has been chronically underfunded for decades. Only 11% of the NIH’s 2020 budget went to women’s health. In the UK, Imperial reported in 2023 that just 2% of medical research funding targets women’s issues. Feel free to join us in a collective rage.

Does PCOS affect fertility?

This is where the panic button usually lights up.

The short answer: yes, but it’s not an automatic infertility sentence - we promise!

The main issue is ovulation. Without regular ovulation, there’s no egg release. No egg release = No baby. Some women with PCOS don’t ovulate at all; others ovulate unpredictably, making it hard to time things if you’re trying to conceive. It’s a sliding scale.

There’s also some discussion about whether PCOS affects egg quality. Early research suggests that insulin resistance or hormonal imbalances might impact egg health, potentially raising miscarriage risk. But the evidence is still emerging. Did we mention that women’s health is underfunded?

✨ Silver lining? Women with PCOS who pursue IVF or egg freezing often produce more eggs than average, thanks to their highly responsive ovaries. While the path to pregnancy might be more complex, it’s absolutely possible! Women with PCOS shouldn’t be concerned, just aware!

Is the pill the only solution?

Ah, the go-to GP response.

The combined birth control pill is often prescribed because it regulates cycles, reduces androgen levels, and helps with acne and getting tickets to Bad Bunny. (Okay, maybe not the latter, but you get the idea.)  But here’s the issue: it creates fake, non-ovulatory cycles. You’re not solving the root hormonal imbalance — you’re just managing symptoms. You’re bandaging it.

If you’re trying to conceive, you’ll need to come off the pill, and your doctor might recommend medications to help induce ovulation if it doesn’t resume naturally. Luckily, this can be relatively straightforward, safe, and effective. So really, don’t panic!

What can I do?

Here’s where things get both empowering and frustrating.

There’s no one-size-fits-all cure, but lifestyle changes can have an impact.

Let’s break it down:

✔ Balance blood sugar: Stable insulin helps regulate hormones. This doesn’t mean cutting all carbs and living like a Notting Hill wellness influencer — it means eating balanced meals regularly, with protein, fibre, and healthy fats. If you feel you’re in the dark on this whole thing - Check out the Glucose Goddess. Our girl Jesse will break it down for you.

✔ Move your body: Exercise improves insulin sensitivity, but you don’t need to kill yourself at Third Space five days a week. Find what you enjoy — yoga, strength training, swimming, or even dancing under the lights at Glastonbury. Here at Klia, we love a hot girl walk.

✔ Manage stress: Chronic stress impacts your hormonal balance. Yes, easier said than done when the cost of living keeps rising and your landlord’s just hiked the rent, but small steps (better sleep, mindfulness, boundaries) can help.

✔ Prioritize recovery: Your body isn’t just a machine — it needs rest, sleep, and downtime to rebalance.

✔ Get support: You don’t need to navigate this solo. A great GP, endocrinologist, or women’s health dietitian can help tailor a plan to you.

What about supplements?

Ah, the Reddit rabbit hole.

You’ve probably seen people raving about inositol, spearmint tea, zinc, or magnesium. Some of these have promising early research, especially inositol (which may help regulate insulin and ovulation). They may definitely help, but as with anything, they’re not magic fixes. The good news is that most of these supplements are safe, so feel free to drink a spearmint tea or add some magnesium if budget allows.

Supplements can play a supportive role, but they work best on top of, not instead of, a balanced foundation of food, movement, sleep, and stress care. Always check with a professional before adding a new one.

What about body image?

Let’s get real: PCOS doesn’t just affect labs and scans — it hits your self-esteem.

Weight gain, hair changes, acne — they’re not just medical symptoms; they touch deeply on identity and body image. And they can leave you feeling isolated, especially in a culture obsessed with perfection.

If you’re struggling, remember you’re not alone. There are brilliant online communities, support groups, and spaces (both in London and globally) where women share experiences, advice, and solidarity. The good news is that there are so many women to look up to and turn to in times of frustration. Cool girl podcaster Arielle Lorre has extensively discussed her struggle, especially with acne, via her podcast, Well.

Please take note: Your worth is not defined by a number on the scale, the state of your skin, or whether your cycle is behaving. 

The bottom line

PCOS is soooo common. It’s complex. And it’s something you can absolutely manage.

You’re not broken. You’re not less feminine. You’re part of a generation navigating hormonal health with more knowledge, more community, and more resources than ever before — even if you’re figuring it out between festival plans, freelance deadlines, and the occasional existential crisis about your matcha budget.

Here’s the real takeaway: you’re allowed to take your time, ask the hard questions, and advocate for your care.

And if anyone — whether it’s a clueless date, a dismissive doctor, or that nagging inner critic — tries to tell you you’re “too complicated” or “overreacting,” you have full permission to ignore them. You deserve answers, support, and the freedom to feel good in your body.