“Why can’t I lose weight and why am I so hairy?”

Oligomenorrhoea with clinical hyperandrogenism (hirsutism, acne) and weight difficulty fits PCOS — and the first task is to NAME it kindly, as a common, manageable hormonal condition and not a personal failing, explicitly noting that the weight difficulty is partly the condition (reducing self-blame). Management is not cosmetic: address the metabolic dimension (insulin resistance, type 2 diabetes/CVD risk — HbA1c/lipids/BP, weight/lifestyle) and ensure regular endometrial shedding to reduce endometrial hyperplasia risk; treat symptoms (cycle regulation/COCP, anti-androgen and cosmetic options for hirsutism, acne treatment) with realistic timeframes. The examinable hidden agenda is a recently-engaged woman’s terror that she is "broken" and cannot conceive, plus significant body-image distress and low mood ("I feel disgusting"). Surface the fertility fear and deliver the honest, largely-reassuring message (PCOS is a common, very treatable cause of subfertility; weight loss improves ovulation; ovulation-induction exists), screen and support mood, counter the self-blame with compassion, and make a collaborative plan with a pre-conception/fertility pathway and follow-up that holds the whole person.