What Is PCOS?
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects approximately 8–13% of women of reproductive age globally. In India, the prevalence is estimated to be even higher, with studies suggesting up to 20% of Indian women may be affected. Despite its prevalence, PCOS remains underdiagnosed, with many women attributing symptoms to stress, lifestyle or normal variation.
PCOS is characterised by a combination of hormonal imbalances — primarily elevated androgens (male hormones) — irregular or absent ovulation, and the presence of multiple small follicles (not true cysts) on the ovaries. The condition is diagnosed using the Rotterdam criteria, which require at least two of three features: irregular periods, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound.
Common Symptoms
PCOS manifests differently in different women. Some experience primarily menstrual irregularity, while others present with skin and hair changes or weight-related concerns. Common symptoms include irregular or absent menstrual periods, excess facial and body hair (hirsutism), persistent acne beyond the teenage years, thinning hair on the scalp, weight gain particularly around the abdomen, difficulty conceiving and mood changes including anxiety and low mood.
It is important to note that not all women with PCOS will experience every symptom, and severity varies widely.
Causes and Risk Factors
The exact cause of PCOS is not fully understood, but several factors contribute. Insulin resistance plays a central role — elevated insulin levels stimulate the ovaries to produce excess androgens. Genetic predisposition is significant, with PCOS frequently running in families. Chronic low-grade inflammation has also been identified as a contributing factor, and lifestyle factors including diet, physical inactivity and stress can exacerbate the condition.
Diagnostic Approach
Diagnosis begins with a detailed menstrual and medical history, followed by hormonal blood tests including LH, FSH, testosterone, DHEAS, anti-Müllerian hormone (AMH), fasting insulin, glucose and thyroid function. A pelvic ultrasound assesses ovarian morphology. It is important to rule out other conditions that mimic PCOS, such as thyroid disorders, congenital adrenal hyperplasia and hyperprolactinaemia.
Treatment and Management
PCOS management is multimodal and tailored to the individual patient's symptoms and reproductive goals. Lifestyle modification forms the foundation — even a 5–10% reduction in body weight can significantly improve hormonal profiles and restore ovulation. Dietary changes emphasising low glycaemic index foods, regular physical activity and stress management are recommended as first-line interventions.
Medical treatment may include combined oral contraceptives to regulate cycles and reduce androgens, metformin for insulin resistance, spironolactone for hirsutism and acne, and ovulation induction agents such as letrozole or clomiphene citrate for patients planning pregnancy. For women with PCOS-related infertility who do not respond to first-line treatment, assisted reproductive technologies including IUI and IVF may be considered.
Long-Term Health Considerations
PCOS is not merely a reproductive condition. Women with PCOS face increased long-term risks of type 2 diabetes, cardiovascular disease, endometrial hyperplasia and metabolic syndrome. Regular monitoring of glucose tolerance, lipid profiles and blood pressure is therefore an important component of ongoing care.
When to Seek Help
If you are experiencing irregular periods, difficulty conceiving, persistent acne or unexplained weight gain, a structured evaluation by a gynaecologist can provide clarity and a clear treatment path. Early diagnosis and management significantly improve outcomes, both for symptom control and long-term health.