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Around one in eight Australian women live with PCOS. Clearer diagnosis and multidisciplinary care are key to supporting their reproductive, metabolic and psychological health across the lifespan.
Polycystic ovary syndrome (PCOS) is the most common hormonal condition in women of reproductive age, affecting about one in eight Australian women — close to half a million people. However, even with its high prevalence, recognition and management continue to be inconsistent, with adverse and sometimes traumatic consequences for women battling for clarity of diagnosis and optimal management.
Regardless of its name, PCOS is not simply an ovarian disorder, but a broader endocrine condition that affects reproductive, metabolic and psychological health across the lifespan. Women with PCOS can experience irregular periods, clinical hyperandrogenism, difficulties conceiving, increased risk of endometrial hyperplasia and metabolic complications including insulin resistance, higher risk of type 2 diabetes and cardiovascular disease. The psychological impact is significant too, with higher rates of anxiety, depression, and body image concerns.
Diagnosis can be delayed by years. Many women first present when trying to conceive, but by then symptoms have often affected their health and wellbeing for a long time. Understandings of PCOS vary widely, and women can receive mixed messages about its significance. Improving consistency in how the condition is explained and diagnosed could reduce uncertainty for patients.
PCOS care and challenges
Optimal management requires tertiary-level multidisciplinary services, a coordinated approach for patient care, as well as the opportunity for research and health care professional education. The coordination of care also involves engagement of primary care health professionals, hence communication between all service providers, including care plans, is of paramount importance.
This service integrates endocrinology, gynaecology, dietetics, exercise physiology, dermatology, psychology, and fertility expertise. Importantly, all interventions must be delivered in a way that avoids weight stigma and supports sustainable change.
Diagnosis has been refined in the International Evidence-based Guideline for the assessment and management of polycystic ovary syndrome 2023. In adults, PCOS is diagnosed when two of three features are present:
- ovulatory dysfunction;
- clinical or biochemical hyperandrogenism; and
- polycystic ovarian morphology on ultrasound (≥20 follicles per ovary or ovarian volume ≥10 mL) or elevated anti-Müllerian hormone (AMH).
If both irregular cycles and hyperandrogenism are present, ultrasound or AMH testing is not required. In adolescents, both hyperandrogenism and ovulatory dysfunction are required, and ultrasound/AMH are not recommended due to poor specificity. Unfortunately, there is still the risk of misdiagnosis as women with hypothalamic-pituitary-ovarian signalling disorders with associated hypogonadotrophic hypogonadism causing oligo-amenorrhoea often have a polycystic ovarian appearance, albeit without the characteristic thickened stroma typical of PCOS.
Other causes of hyperandrogenism such as congenital adrenal hyperplasia, Cushing’s syndrome, ovarian hyperthecosis and severe insulin resistance need to be considered. Additionally, diagnosis in adolescence may be difficult given the common occurrence of irregular menses, and the importance of avoiding mislabelling cannot be overstated.
The terminology remains problematic
The term “polycystic ovary syndrome” reflects early histological descriptions from the 1930s and is misleading in contemporary practice. The label contributes to diagnostic confusion, with some women assuming they have pathological cysts requiring surgical intervention. While a formal name change is under discussion, clear communication with patients and consistent application of diagnostic criteria are critical in the interim.
Implications and next steps
PCOS is common, complex, and lifelong. The updated 2023 international guideline provides an opportunity to strengthen care in Australia by aligning clinical practice with best available evidence. Several areas stand out:
Diagnosis: Clearer criteria reduce reliance on ultrasound, particularly in adolescents, and provide options such as anti-Müllerian hormone (AMH) for adults. Embedding these updates into daily practice will improve consistency and reduce uncertainty for both clinicians and patients.
Education: Ongoing professional development can help clinicians feel more confident discussing the full spectrum of PCOS — not just reproductive issues but also metabolic health, psychological wellbeing, and endometrial protection.
Models of care: Multidisciplinary approaches highlight the benefits of coordinated services. Broader access to similar models could allow more women to benefit from integrated care, whether in metropolitan or regional settings.
Mental health: Routine screening for depression and anxiety, and referral where needed are recommended. Incorporating this into standard practice would acknowledge the psychological impact of PCOS and ensure women receive timely support.
PCOS is highly prevalent and carries significant long-term health implications. Continued investment in research, service development, and education will help improve outcomes across the lifespan. With greater awareness, earlier recognition, and a focus on holistic management, Australian clinicians are well placed to lead improvements in care.
Associate Professor Catharyn Stern is a fertility specialist, gynaecologist and reproductive endocrinologist. She is Head of Reproductive Services at The Royal Women’s Hospital, a senior clinician at Melbourne IVF and Head of Fertility Preservation for both institutions. She is affiliated with the University of Melbourne Department of Obstetrics and Gynaecology (RWH).
Dr Michal Kirshenbaum is a Fertility Specialist, Obstetrician, and Gynaecologist. She currently holds a Clinical Fellowship at Melbourne IVF and works within the Reproductive Services Unit at The Royal Women’s Hospital, where she is also a member of the Fertility Preservation Board. Her clinical and research interests include fertility preservation, optimization of ovarian stimulation cycles, and reproductive endocrinology.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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