Polycystic Ovarian Syndrome (PCOS) Specialist Melbourne
| PMOS Melbourne
Polycystic ovarian syndrome, often abbreviated as PCOS (now known as Polyendocrine Metabolic Ovarian Syndrome: PMOS), is a complex hormonal condition. It can be associated with multiple medical issues including irregular periods and abnormal menses, infertility, and skin and hair problems. PCOS can be a challenging condition to manage, but there are treatments available to help those with PCOS to achieve their goals of starting a family and living a healthy life.
Here at Create Health, our doctors specialise in PCOS and have helped many with this condition manage this condition and achieve their goals.
PCOS is relatively common. It may affect 5 to 13% of women in the reproductive age group (between adolescence and menopause). A high percentage of cases unfortunately remain undiagnosed. PCOS is one of the most common causes of infertility.
What causes PCOS?
We still do not fully understand the cause of PCOS. However, family history and genetics play a significant role in the development of the condition.
Hormones and lifestyle are also significant. Higher insulin resistance is present in many, but not all, women with PCOS. Because the body does not respond well to insulin, the insulin levels are higher as the insulin does not work efficiently in metabolising blood sugar.
Women with PCOS also have a high level of androgen hormones. Both males and females naturally have androgen hormones in their bodies. In the female, ,the androgen hormones are used in the production of the female ovarian hormones, as well as in egg maturation for the ovulation process.
What are the symptoms of PCOS?
How is PCOS diagnosed?
Making the diagnosis of PCOS can be confusing and challenging to patients. In general, to be diagnosed with PCOS, women need to have at least two of the following criteria:
- Multi-follicular appearing ovaries on ultrasound. At least 25 follicles in at least one ovary, at one stage in her life. This does not mean the presence of cysts on the ovaries, rather it refers to the presence of multiple small follicles that can give the ovaries “a cystic appearance”.
- Abnormal menstruation which can be exhibited by irregular or absent periods.
- Excessive androgen levels exhibited by excessive acne or body hair and/or, indicated by a high level of androgen such as testosterone on a blood test.
You don’t need the ultrasound criteria as part of the diagnosis if you have 2 and 3. In fact using ultrasound for diagnosis is not recommended for women under 20 years of age as they commonly naturally will have multiple follicles in their ovaries.
It is very important to distinguish between polycystic ovarian syndrome (PCOS) and so-called “polycystic ovaries (PCO)”. Polycystic ovaries, now known as multi-follicular ovaries, refer to the presence of 25 or more follicles in at least one ovary on ultrasound scanning without displaying the symptoms and signs of the full syndrome. The number of follicles in an ovary is proportional to a person’s total egg count, as a female is born with all her eggs, stored in the ovaries.
It is therefore very common, and normal, to see multi-follicular ovaries on ultrasound, especially in younger women, without necessarily implicating the whole syndrome problem and the medical issues it entails.
It is very important to remember that PCOS is not a disease. It is a syndrome which means it is combination of symptoms or signs.
How Does PCOS / PMOS Affect the Body?
Understanding the mechanisms behind PCOS helps explain why such a wide range of seemingly unrelated symptoms can stem from the same underlying condition.
Insulin resistance develops:
Many women with PCOS have some insulin resistance, meaning the body’s cells do not respond effectively to insulin. To compensate, the body produces more insulin. These higher insulin levels can disrupt normal hormone balance.
Increased androgen levels
Elevated insulin levels can contribute to the ovaries producing higher levels of androgens (male-type hormones such as testosterone). These hormones are responsible for symptoms such as acne, excess facial or body hair, and thinning scalp hair.
Disrupted ovulation
Hormonal imbalances can interfere with the normal development and release of eggs from the ovaries. Ovulation may become irregular or may not occur at all.
Irregular menstrual cycles
Without regular ovulation, the menstrual cycle becomes unpredictable. Periods may be irregular, infrequent, or absent.
Longer-term health effects
Over time, PCOS can increase the risk of conditions such as Type 2 Diabetes and Cardiovascular Disease, particularly if not well managed. With appropriate care and support, these risks can often be reduced.
Comparing PCOS Management Approaches
Lifestyle modification vs. medication
- Lifestyle modification
Focuses on key metabolic aspects of Polycystic Ovary Syndrome, including insulin resistance, weight, and overall metabolic health. In some people, these changes can improve symptoms and help restore ovulation. - Medication
Different medications play different roles. Some primarily manage symptoms (such as irregular periods, acne, or excess hair), while others may help address hormonal or metabolic factors. - Best approach
Lifestyle measures are recommended as a core part of treatment for most patients, with medications added when needed based on symptoms and individual goals.
Combined oral contraceptive pill vs. progesterone therapy
- Combined oral contraceptive pill
Helps regulate menstrual cycles, reduces androgen-related symptoms (such as acne and excess hair growth), and protects the uterine lining. It is not suitable for those trying to conceive. - Cyclical progesterone therapy
Helps induce regular shedding of the uterine lining and reduces the risk of endometrial thickening. It does not prevent ovulation and is often used when oestrogen-containing treatments are not suitable. - Best approach
The combined pill is commonly used for symptom control, while progesterone therapy is useful for endometrial protection in those who cannot take oestrogen.
Letrozole vs. Clomid for ovulation induction
- Letrozole: Now considered the preferred first-line ovulation induction agent for PCOS; associated with higher ovulation and live birth rates than Clomid in women with PCOS.
- Clomid (clomiphene citrate): Established and effective, though with a slightly higher multiple pregnancy rate and lower efficacy in some PCOS patients.
- Best for: Letrozole is generally preferred; Clomid remains a valid option where Letrozole is not suitable.
Ovulation induction vs. IVF
- Ovulation induction (oral or injectable medications): Less invasive, lower cost, suitable as a first-line fertility intervention for most women with PCOS.
- IVF: Reserved for women who do not conceive with simpler measures, or where additional fertility factors are present. Success rates in women with PCOS undergoing IVF are generally high.
- Best for: Ovulation induction first; IVF if simpler approaches are unsuccessful.
What to Expect After Starting PCOS / PMOS Treatment
Management of Polycystic Ovary Syndrome is usually an ongoing process rather than a single treatment. Most people notice changes gradually, and the timeline can vary depending on symptoms and the type of treatment used.
Early changes
In the first few weeks to months, you may begin to notice subtle improvements such as:
- More regular menstrual cycles
- Gradual changes in skin or hair symptoms
- Improved energy or wellbeing
Hormonal and lifestyle-based treatments often take several months to show their full effect.
Fertility treatment
If you are undergoing treatment to support ovulation or conception, the timeline will depend on your individual response. Ovulation induction medications are typically monitored closely, and your specialist will adjust your treatment plan as needed to optimise results.
Ongoing care and follow-up
Regular follow-up appointments are an important part of PCOS management. These visits help to:
- Monitor your response to treatment
- Track hormonal and metabolic health markers
- Adjust your plan as your needs change over time
- Support long-term health and symptom control
With consistent care and monitoring, treatment can be tailored to both short-term goals and long-term health outcomes.
Frequently Asked Questions About PCOS in Melbourne
Can you have PCOS without polycystic ovaries on ultrasound?
Yes. Ultrasound findings are only one part of the diagnostic criteria. PCOS is diagnosed when at least two of three criteria are met (irregular ovulation, clinical or biochemical signs of androgen excess, and polycystic ovarian morphology).
Some people with PCOS have a normal ultrasound, while others may have polycystic-appearing ovaries without having the condition.
Is PCOS hereditary?
PCOS has a strong genetic component. If a close female relative has PCOS, your risk is higher. However, it is a multifactorial condition, meaning lifestyle and environmental factors also play a role. A family history combined with symptoms may warrant assessment.
Can PCOS cause weight gain even with a healthy diet?
Yes. Many people with PCOS have insulin resistance, which can affect how the body regulates blood sugar and stores energy. This may make weight management more difficult for some individuals, particularly around the abdomen. It is a physiological feature of the condition, not simply a lifestyle issue.
Will I struggle to get pregnant with PCOS?
PCOS is one of the most common but also most treatable causes of infertility. The main challenge is irregular ovulation. With appropriate treatment—such as ovulation induction medications—many people conceive successfully. If needed, more advanced fertility treatments are also highly effective.
Does PCOS go away after menopause?
Menstrual and fertility-related symptoms resolve after menopause. However, the underlying metabolic tendencies—such as insulin resistance and increased cardiovascular risk—may persist. Ongoing health monitoring remains important.
What is the difference between PCOS and polycystic ovaries?
“Polycystic ovaries” refers to an ultrasound appearance with multiple small follicles. This can be a normal finding, especially in younger people, and does not by itself indicate PCOS.
PCOS is a broader hormonal and metabolic condition diagnosed based on clinical criteria, not ultrasound alone.
Can teenagers be diagnosed with PCOS?
Yes, but diagnosis in adolescents requires caution. Irregular cycles are common in the first few years after menstruation begins, so diagnosis should not rely on cycle irregularity alone. Ultrasound is generally not recommended for diagnosis in adolescents. Assessment is considered when persistent symptoms of androgen excess are present alongside ongoing cycle irregularity.
Is metformin used to treat PCOS?
Metformin is an insulin-sensitising medication that may be helpful for some people with PCOS, particularly those with insulin resistance, prediabetes, or type 2 diabetes. It is not used for everyone, but can play an important role in managing metabolic aspects of the condition when appropriate.
Can PCOS be cured?
PCOS cannot be cured, but it can be effectively managed. With a combination of lifestyle strategies, hormonal or metabolic treatments when needed, and ongoing medical support, most people achieve good symptom control and reduce long-term health risks.
How often should I be reviewed if I have PCOS?
Follow-up depends on individual symptoms, treatment, and metabolic risk. In general, an annual review of metabolic health (including blood glucose, lipids, and blood pressure) is recommended, even when symptoms are stable.
Treatment for PCOS
Treatment is usually directed at the symptoms, or the specific problems for each woman that may arise as a result of PCOS. The main lines of treatment options include:
- Lifestyle modification and weight reduction. Even a loss of 5-10% of body weight may alone convert the cycles from irregular, that occur without ovulation, to ovulatory, regular menses that can help fertility and resolve other symptoms.
- Medical treatment, for example, the contraceptive pill would be our first option to manage any irregular or absent menstrual cycles. This option would be obviously useful if fertility is not desired. Having regular cycles through the pill would stop the risk of the lining of the uterus becoming too thick. The pill would also help reduce other undesirable symptoms such as hair and skin changes.
For women who cannot take the contraceptive pill, regular cyclical use of a progesterone tablet can bring on regular menses, thinning out the uterine lining (endometrium).
Some women may benefit from Metformin if insulin resistance is an issue, or if there is underlying prediabetes or diabetes.
- For women wanting to fall pregnant there are several treatment options.
Ovulation stimulation medication including Letrozole or Clomid. These tablets can help induce ovulation in most women, also regulating menstrual cycles, allowing the couple to try timed intercourse to fall pregnant.
For women not responding to these tablets, hormonal injections (FSH) can induce ovulation and regular menstruation.Surgical options for ovulation are usually reserved for patients who do not have success with less invasive approaches and who have many follicles in their ovaries.
Assisted reproductive technologies including IUI and IVF. These are usually used if the above options do not result in a pregnancy. The success rate for women with PCOS is usually very high.
Women with PCOS are more prone to other fertility issues such as Endometriosis. Your Create Health gynaecologist can discuss this further with you. Managing PCOS may require a multidisciplinary team. We, here at Create Health, pride ourselves in working with several health professionals including dietitian, psychologist, psychiatrist, endocrinologist and physiotherapist.
Please get in touch with the Create Health team by calling us at (03) 9873 6767 or email if you have any queries or concerns, and we’ll be happy to schedule an appointment for you with one of our skilled specialists.