PCOS: Symptoms, Diagnosis, Diet and Treatment

Polycystic ovary syndrome (PCOS) affects an estimated 1 in 10 women of reproductive age worldwide, and Indian studies report similar or higher rates. Many don't know they have it. Despite the name, PCOS isn't really about cysts: it's a hormonal and metabolic condition that affects the whole body.

Symptoms

Symptoms usually appear in the late teens or early twenties and vary widely:

• irregular, infrequent or absent periods
• excess hair growth on the face, chest, belly or back (hirsutism)
• acne and oily skin
• thinning hair on the scalp
• weight gain, especially around the waist, and difficulty losing weight
• dark, velvety patches of skin on the neck, armpits or groin (acanthosis nigricans): a sign of insulin resistance
• difficulty getting pregnant due to irregular ovulation
• mood changes, anxiety or low mood

What causes PCOS?

The exact cause isn't known, but two factors play key roles:

• Insulin resistance: the body produces extra insulin, which stimulates the ovaries to make more androgens (male type hormones).
• High androgen levels, which disrupt ovulation and cause skin and hair symptoms.

PCOS runs in families, and South Asian women appear to be at higher risk of the metabolic features.

Diagnosis

Doctors commonly use the Rotterdam criteria: PCOS is diagnosed when you have at least two of these three, and other conditions (such as thyroid disorders or high prolactin) have been ruled out:

1. irregular or absent ovulation (irregular periods)
2. signs of high androgens, on blood tests or as symptoms like excess hair or acne
3. polycystic ovaries on ultrasound, or a raised AMH blood level in adults

Ultrasound isn't recommended for diagnosis in teenagers within 8 years of their first period, because multifollicular ovaries are normal at that age.

Your doctor may also check blood sugar, cholesterol and blood pressure, since PCOS raises the risk of type 2 diabetes and heart disease.

Lifestyle: the foundation of treatment

• Weight: if you're above a healthy weight, losing 5 to 10% can restore regular periods, improve ovulation and reduce androgen levels.
• Diet: there's no single "PCOS diet". Focus on whole grains and millets instead of refined flour, plenty of vegetables, enough protein (dal, paneer, eggs, fish), and fewer sugary drinks, sweets and fried snacks. See our vegetarian protein guide.
• Exercise: aim for at least 150 minutes of moderate activity a week, plus strength training: it improves insulin sensitivity even without weight loss.
• Sleep and stress: both affect hormones and appetite.

Medical treatment

Treatment depends on your symptoms and goals:

• Regulating periods: combined oral contraceptive pills or cyclical progesterone protect the womb lining and regulate bleeding.
• Acne and excess hair: the pill, anti androgen medicines, topical treatments and hair removal methods such as laser.
• Insulin resistance and weight: metformin may be prescribed; newer weight management medicines may be considered in some cases.
• Fertility: letrozole is now the first choice medicine to trigger ovulation; other options include gonadotropins and IVF.

Long term health

PCOS is lifelong, but symptoms can be managed well. Regular checkups for blood sugar, blood pressure and cholesterol help prevent complications. Track your cycles with our ovulation and period calculator.