Private health insurance for PCOS

Average customer rating: 4.3/5
Written by Joshua Malin
Reviewed by Steven Spicer
Updated 19 March, 2024

What is PCOS?

PCOS is a common hormonal medical condition affecting 8-13% of women of reproductive age.1 This condition causes the development of multiple cysts on the ovarian follicles, preventing them from releasing eggs.

While the exact cause of PCOS is unknown, it has been linked to insulin resistance, low-grade inflammation, excess androgen (a reproductive hormone) and genetic factors.2 PCOS can also lead to an increased risk of health problems such as heart disease, endometrial cancer, type 2 diabetes and high cholesterol.3

How is PCOS diagnosed?

Getting a PCOS diagnosis can be quite difficult, as the syndrome has a wide range of symptoms, and you may not display them all.5 You’ll most likely need a blood test or an ultrasound before you can get a diagnosis from your healthcare provider.

The primary symptoms of PCOS include:

  • Hormonal imbalance. This may present as excess hair growth (hirsutism) or hair loss, acne or oily skin and more.
  • Irregular menstrual cycles. Such as absent or irregular periods.
  • Polycystic ovaries. Usually detected through an ultrasound, polycystic ovaries are typically larger than average-sized ovaries with small cysts around their edge.

If you or someone you know is concerned that they might have PCOS, it’s a good idea to talk to your GP. They can evaluate your family history, chart out menstruations and more. Following this consultation, PCOS can be diagnosed with a blood test to check hormone levels and an ultrasound to look for cysts.

Once you’ve got a diagnosis, the next step is management.

How does health insurance help with PCOS treatments?

When it comes to treating the symptoms and seeking help, your GP can guide you on what might best suit your particular situation. Private health insurance is just another tool that might present more options for managing your condition.

Extras policy cover

Hospital policy cover

Is PCOS considered a pre-existing condition?

Can you still get pregnant with PCOS?

Some women with PCOS worry that they’ll have trouble – or won’t be able to – conceive children. While PCOS can lead to infertility, in most cases women with PCOS can have healthy, successful pregnancies with the help of lifestyle changes and infertility treatment.5

If you’re struggling with PCOS, you should speak with a GP about possible conception options because these may vary depending on your health status (and that of your partner).

The following interventions may help some women fall pregnant:

  • Medication. A doctor may recommend tablets to help with ovulation.
  • Surgery. There’s also a range of surgical procedures available that can increase your chances of falling pregnant. Provided you’re treated as an inpatient for a medically necessary procedure with an MBS item number, a hospital insurance policy could pay towards your treatment provided you hold an adequate level of cover and have served any relevant waiting periods. These procedures are usually included on higher levels of cover (e.g. Gold or some Silver plus policies)
  • IVF. In-vitro fertilisations can be expensive, but many have success through this avenue. Hospital insurance policies that include cover for assisted reproductive services may pay a benefit towards IVF and other fertility treatments if you’re treated as an inpatient.

You will also need cover for pregnancy and birth related services if you want to take advantage of private hospital insurance benefits for the pregnancy and birth itself, such as choosing your own available doctor when you’re treated as an inpatient and having access to a private hospital room (subject to availability). Keep in mind the waiting periods for pregnancy and birth, though, as you may need to think about getting a private health insurance policy 12 months before giving birth.

Our guide to health insurance for pregnancies may help answer your questions about how to cut costs for these services.

Meet our health insurance expert, Steven Spicer

Steven Spicer
Executive General Manager – Health, Life & Energy

As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.

1 Better Health Victoria, Polycystic ovarian syndrome (PCOS). Accessed August 2023.
2 Mayo Clinic, Polycystic ovarian syndrome (PCOS). Accessed August 2023.
3, Polycystic ovarian syndrome (PCOS). Accessed August 2023.
4 US Office on Women’s Health, Polycystic ovarian syndrome (PCOS). Accessed August 2023.
5 Pregnancy Birth & Baby, Polycystic ovarian syndrome (PCOS). Accessed August 2023.