Polycystic ovary syndrome is the most common hormonal disorder in women of reproductive age, and studies in India suggest it affects between one in five and one in six. It is frequently reduced to a fertility problem, which underplays it considerably.
PCOS is a metabolic condition that happens to affect the ovaries, and understanding that changes how it should be treated.
What Is Actually Happening
At the centre of PCOS in most women is insulin resistance. The body produces insulin normally but the tissues respond poorly, so the pancreas produces more. High circulating insulin drives the ovaries to make excess androgens, the male type hormones that every woman produces in small amounts.
Those raised androgens interrupt the monthly maturation of an egg. Follicles start to develop but stall, which is what shows on ultrasound as multiple small follicles. Ovulation becomes irregular or stops, and periods follow suit.
This chain explains why treatments aimed at insulin often improve periods, skin and fertility together.
The Symptoms Beyond Irregular Periods
PCOS presents differently in different women, which is part of why diagnosis is often delayed for years.
- Periods more than thirty five days apart, or fewer than eight a year
- Excess hair on the face, chin, chest or abdomen
- Persistent acne beyond the teenage years, particularly along the jawline
- Thinning hair at the crown
- Weight gain concentrated around the abdomen, and difficulty losing it
- Darkened velvety skin at the neck, armpits or groin, which is a visible sign of insulin resistance
- Difficulty conceiving
Not every woman with PCOS is overweight. Lean PCOS is common in Indian women and often diagnosed later precisely because the classic picture is absent.
How It Is Diagnosed
Diagnosis requires two of three features, after excluding other conditions that mimic it.
- Irregular or absent ovulation
- Clinical or blood evidence of raised androgens
- Polycystic appearance of the ovaries on ultrasound
The third point causes confusion. Polycystic looking ovaries on a scan, on their own, are not PCOS. Many women with entirely normal cycles have them. A scan report alone should never be treated as a diagnosis.
Thyroid disease, raised prolactin and adrenal conditions all produce similar symptoms and must be ruled out first, which is why blood tests accompany the scan.
The Long Term Health Risks
This is the part that gets least attention in a short consultation, and it is why PCOS deserves lifelong follow up rather than treatment only when a pregnancy is wanted.
- Type 2 diabetes: substantially higher risk, appearing earlier than in the general population
- Gestational diabetes in future pregnancies
- High blood pressure and abnormal cholesterol
- Fatty liver disease
- Endometrial thickening: when periods are very infrequent, the uterine lining is not shed regularly, which raises long term risk
- Obstructive sleep apnoea
- Anxiety and depression, at rates well above the general population
Having fewer than four periods a year is the specific pattern that needs addressing for endometrial protection, even in a woman who is not trying to conceive.
What Actually Works: Lifestyle
Weight reduction of five to ten percent restores ovulation in a substantial proportion of women. That is a smaller change than most patients assume, and it is the single most effective intervention available.
- Reduce refined carbohydrate: white rice, maida, sugar and sweetened drinks
- Increase protein and fibre at every meal, which blunts the insulin response
- Resistance training twice a week alongside aerobic activity, since muscle improves insulin sensitivity
- Prioritise sleep, because sleep deprivation worsens insulin resistance directly
Extreme restriction backfires. Our dietetics team builds plans around South Indian meal patterns rather than replacing them, which is what makes them sustainable.
Medical Treatment Is Chosen by Your Goal
There is no single PCOS tablet. What you are prescribed depends on what is bothering you most.
- For cycle regulation and endometrial protection: combined hormonal contraception or cyclical progesterone
- For insulin resistance: metformin, which often improves cycles as a secondary effect
- For excess hair and acne: anti androgen treatment, which takes six months to show effect
- For fertility: ovulation induction, usually with letrozole as first line
Tell your gynaecologist which of these matters most to you. The answer genuinely changes the prescription.
PCOS and Fertility
PCOS is the most common cause of ovulation related infertility, and it is also one of the most treatable. Most women with PCOS who want a pregnancy achieve one.
Treatment is stepwise: weight optimisation, then ovulation induction tablets, then injectable stimulation with monitoring, then IUI, and IVF where those do not succeed or other factors coexist. Our fertility department works closely with the gynaecology team so this progression is coordinated rather than restarted.
Once pregnant, women with PCOS need screening for gestational diabetes, since the risk is meaningfully raised.
The Psychological Side Deserves Attention
Rates of anxiety and depression in PCOS are high, and this is not simply distress about symptoms. The hormonal and metabolic changes appear to contribute directly.
Hair growth, acne and weight are visible, which makes them socially difficult in a way that many conditions are not. This is worth raising with your doctor rather than treating as vanity. Support through our psychiatry department is available and appropriate.
PCOS is a lifelong condition, but it responds well to consistent management, and the earlier that starts the more it prevents. If your periods are irregular, do not wait until you want a pregnancy to have it assessed.
Our gynaecology department in T. Nagar offers assessment, and Dr. Asma Humayun sees PCOS referrals alongside the fertility team.
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