PCOS Treatment in Knightsbridge: Symptoms, Diagnosis and Care

What is PCOS, and why has it been renamed PMOS?

PCOS is a long-term hormonal and metabolic condition that affects periods, ovulation, skin, hair, weight and mood. In May 2026 a global consensus published in The Lancet renamed it polyendocrine metabolic ovarian syndrome (PMOS), because the old name wrongly suggested cysts and hid its wider health effects.

Despite the name, people with PCOS do not have harmful cysts on their ovaries. What an ultrasound shows is a larger than usual number of small, developing follicles that have not matured to release an egg. The condition itself involves a combination of higher androgen activity (hormones such as testosterone), irregular ovulation and, very often, insulin resistance, where the body needs more insulin to keep blood sugar steady. These interact: high insulin levels can increase androgen production, and higher weight can amplify both.

The renaming followed a multistep global consensus process involving 56 academic, clinical and patient organisations and survey responses from 14,360 people with PCOS and health professionals across all world regions. The authors wrote that the term PCOS contributed to delayed diagnosis, fragmented care and stigma. The NHS website now uses PMOS, and NICE has a guideline on PMOS in development, with publication expected in December 2026. Because most people still search for "PCOS", this guide uses both names.

The NHS notes that symptoms usually begin around puberty and continue until the menopause, can be mild or severe, and that some people have no symptoms at all. You may be more likely to have PCOS if a close relative has it or if you are from an Asian background. At Levirgo in Knightsbridge, PCOS assessment and ongoing care sit within our private GP service.

What are the symptoms of PCOS?

The main symptoms listed by the NHS are irregular or infrequent periods, excess facial or body hair, hair thinning, weight gain or difficulty losing weight, difficulty getting pregnant, oily skin and acne, tiredness, depression or anxiety, and thick, dark patches of skin on the neck or armpits. Not everyone has every symptom.

Because these symptoms are common and can have other causes, having one or two of them does not mean you have PCOS. The NHS advises seeing a GP if you think you might have it, or if symptoms are affecting your everyday life, work or relationships. The table below links each symptom to the biology behind it, which helps explain why treatments target different pathways.

How is PCOS diagnosed? The Rotterdam criteria explained

In adults, PCOS is diagnosed when two of three features are present: ovulatory dysfunction, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound, or a raised anti-Müllerian hormone (AMH) level instead of ultrasound. Other conditions must be excluded first. If you have irregular cycles and high androgens, no scan is needed.

These criteria build on the 2003 Rotterdam consensus and were refined in the 2018 and 2023 international guidelines. The 2023 update simplified the diagnostic pathway and added AMH as an alternative to ultrasound, in adults only. It also warns against doing both an ultrasound and an AMH test, to limit over-diagnosis, and states that AMH should never be used as a single test for PCOS.

1. History

   Your cycle pattern, symptoms, family history, medicines, contraception and goals, including whether pregnancy is a consideration now or in future.

2. Examination

   Blood pressure, weight, waist, and a sensitive assessment of skin and hair, including hirsutism scoring where appropriate.

3. Blood tests to exclude other causes

   The guideline lists thyroid-stimulating hormone (TSH), prolactin, 17-hydroxyprogesterone and FSH, with further tests if clinically indicated.

4. Androgen tests

   Total and free testosterone first. The combined pill affects results, so the guideline suggests stopping it for at least 3 months, with other contraception, if testing is essential.

5. Metabolic checks

   A 75 g oral glucose tolerance test is the most accurate check of glucose status in PCOS; lipids and blood pressure are also assessed. Insulin blood tests are not recommended in routine care.

6. Ultrasound or AMH if needed

   Only when the first two features do not already confirm the diagnosis, and never in adolescents.

What are the long-term health risks of PCOS?

PCOS increases the risk of type 2 diabetes, high blood pressure, cardiovascular disease, fatty liver disease and womb cancer, according to the NHS. The international guideline adds higher rates of sleep apnoea, depression and anxiety, and higher odds of pregnancy complications. Regular checks allow early prevention.

The guideline is clear that the increased risk of impaired glucose tolerance and type 2 diabetes applies regardless of age and BMI, which is why slim people with PCOS still need glucose checks. It also recognises PCOS as a cardiovascular risk factor and recommends prioritising prevention. On womb health, premenopausal women with PCOS have a markedly higher risk of endometrial hyperplasia and endometrial cancer; the overall chance remains low and routine screening is not recommended, but long-standing absent periods, higher weight and type 2 diabetes add to the risk.

• Mental health: the guideline recommends screening all adults and adolescents with PCOS for depression, and all adults for anxiety, using validated tools.
• Eating disorders: disordered eating should be considered regardless of weight, especially when weight management is discussed.
• Pregnancy: a 2024 meta-analysis of 104 studies found higher odds of miscarriage, gestational diabetes, gestational hypertension, pre-eclampsia and caesarean birth, even when age and BMI were matched.
• Sleep: snoring, daytime sleepiness or unrefreshing sleep are worth mentioning, given the higher rate of sleep apnoea.

How is PCOS treated? NHS and guideline-backed options

There is no cure, so treatment targets your priorities. Options include lifestyle support for everyone, the combined pill for irregular cycles and excess hair, metformin for metabolic features, anti-androgens when other options are not enough, targeted acne and hair treatments, and letrozole as first-line medicine for anovulatory infertility under specialist care.

The NHS lists the combined pill, progestogen-only pill or an intrauterine system for irregular periods; spironolactone or eflornithine for unwanted hair; weight loss medicines if you are overweight; metformin; skin creams or tablets for acne; and fertility treatments. The 2023 guideline gives more detail on when each is most appropriate, summarised below.

Inositol supplements are widely marketed for PCOS. The guideline says inositol could be considered based on personal preference, noting limited harm and possible metabolic benefits, but with limited clinical benefits for ovulation, hirsutism or weight, and that metformin is more effective. If you are thinking of trying a supplement, tell your doctor so it can be considered alongside everything else you take.

PCOS and weight: what actually helps?

Healthy eating and regular physical activity are recommended for everyone with PCOS, with benefits even without weight loss. For modest weight loss, the guideline suggests at least 250 minutes of moderate activity a week plus muscle strengthening on two non-consecutive days. Metformin or anti-obesity medicines may be considered alongside lifestyle support.

Many people with PCOS describe being told simply to "lose weight". The 2023 guideline recognises that weight stigma in healthcare is common and harmful, and recommends offering either weight-centred care or weight-inclusive care, focused on healthy behaviours rather than the scales, according to your goals. It also found no evidence that any single diet or type of exercise is better than another for PCOS, so the best plan is one you can sustain.

Medicines can help some people. The guideline says metformin should be considered in adults with PCOS and a BMI of 25 or above for weight and metabolic outcomes, and that anti-obesity medicines, including GLP-1 receptor agonists, could be considered alongside lifestyle support in line with general population guidance. Because pregnancy safety data are lacking, effective contraception is needed with GLP-1 medicines, and doses should be increased gradually. Our guide to medically supervised weight-loss medicines explains NICE eligibility and MHRA safety advice in detail.

How to treat PCOS acne and skin changes

For acne in PCOS, NICE recommends starting with a standard first-line acne treatment. If that is not effective, a combined oral contraceptive pill can be added, with a co-cyprindiol pill reviewed at 6 months. People with acne and other signs of high androgens may be referred to a specialist such as a reproductive endocrinologist.

Androgens increase oil production in the skin, which is why acne is one of the most common skin effects of PCOS. NICE guideline NG198 on acne was updated to include specific recommendations for people with PMOS. First-line treatments are topical or combined treatments chosen by severity, and NICE advises reviewing them at 12 weeks, which is a helpful reminder that skin treatment needs patience before judging whether it works.

• Active acne first: treat inflammation before marks and scars, because treating scars while breakouts continue is less effective.
• Acanthosis nigricans: dark, velvety patches in skin folds are a sign of insulin resistance and a reason to check glucose, not just a cosmetic concern.
• Post-acne marks and scarring: once skin is stable, options such as scar treatment can be discussed.
• Persistent or severe acne: may need specialist dermatology input, including consideration of isotretinoin, which has strict safety and pregnancy prevention requirements.

Excess hair and hair thinning with PCOS

For unwanted facial hair, the guideline recommends laser and light therapies, noting that more sessions are usually needed in PCOS and laser works poorly on blond, grey or white hair. The combined pill, with or without anti-androgens, may improve results. For scalp thinning, anti-androgens with the pill could be trialled, although evidence is limited.

Hirsutism means coarse, dark hair growing in a male-type pattern, such as on the upper lip, chin, chest or lower abdomen. The guideline notes that its prevalence appears similar across ethnicities, although severity can vary, and that laser treatment for facial hirsutism can also improve related depression, anxiety and quality of life. Wavelength and settings need to match skin and hair colour, and low-fluence lasers appear similarly effective with less pain.

Scalp thinning can have more than one cause, so iron levels and thyroid function are usually checked too. Some people also ask about in-clinic treatments such as platelet-rich plasma (PRP) for thinning hair. PRP is not part of the PCOS guideline recommendations, so it should be seen as an optional addition discussed after medical assessment, not a substitute for treating the hormonal driver.

How can a private GP help with PCOS?

A private GP can offer a longer, unhurried consultation, arrange blood tests and scans quickly, confirm or review a diagnosis using guideline criteria, start first-line treatment where appropriate, coordinate skin, hair and weight care, and refer you to a gynaecologist, endocrinologist or fertility specialist when needed.

PCOS care often feels fragmented, with periods, skin, hair, weight and mood handled separately. The 2023 guideline calls for better models of care and shared decision-making. A private GP appointment does not replace your NHS GP, but it can give you time to talk through the whole picture and leave with a written plan. At Levirgo, consultations typically last up to 30 minutes, same-day and next-day appointments are available, and no referral is needed.

1. Book an unhurried consultation and bring your symptom diary, current medicines and any previous results.
2. Agree your priorities, for example cycles, skin, hair, weight, mood or future fertility.
3. Arrange tests to confirm the diagnosis and exclude other causes, plus metabolic checks.
4. Start a plan that may include lifestyle support, first-line medicines where clinically appropriate and skin or hair treatment.
5. Refer when needed to gynaecology, endocrinology, fertility, dermatology or mental health services, privately or via your NHS GP.
6. Review regularly, including blood pressure, weight, glucose and mood, with your NHS GP kept informed if you consent.

Our guide to private GP appointments and private prescriptions explains costs, how private prescriptions are dispensed, and how private and NHS care can run side by side.

How much does private PCOS care cost in London?

Costs depend on what you need. A standard private GP consultation in London typically costs about £95 to £250, with blood test panels ranging from about £60 to £300 depending on the tests. Ultrasound, medicines, specialist referrals and skin or hair treatments are priced separately and confirmed before you proceed.

Using private care does not affect your right to NHS care. Some people choose a private assessment for speed and time, then continue long-term prescriptions or specialist care through the NHS. To discuss what you need, book a private GP appointment or contact the clinic.

Why choose Levirgo for PCOS support in Knightsbridge?

Levirgo is a doctor-led aesthetics, skin and private GP clinic at 6 Beauchamp Place, Knightsbridge, a few minutes from Harrods and Knightsbridge Underground station on the Piccadilly line. We offer unhurried GP assessment, fast tests, guideline-based plans and coordinated skin, hair and weight support under one roof.

• Time to talk: consultations of up to 30 minutes, with same-day and next-day appointments.
• Guideline-based assessment: diagnosis and reviews aligned with the 2023 international guideline and relevant NICE guidance.
• Joined-up care: private GP, dermatology consultations, weight management and skin treatments in one clinic.
• Honest referrals to gynaecology, endocrinology or fertility specialists when that is the right step.
• Discreet and convenient for patients from Kensington, Chelsea and Belgravia.