Polycystic ovary syndrome (PCOS) is one of the commonest hormonal conditions in women of reproductive age, affecting roughly one in ten. In India the terms PCOS and PCOD are used to mean the same thing. Medically it is one condition, in which the ovaries release eggs irregularly, male-type hormones (androgens) run a little high, and insulin works less efficiently than it should.
The name is misleading. The “cysts” are not true cysts but small, paused follicles, and a scan showing them is not enough to make the diagnosis on its own. A woman can also have PCOS with ovaries that look normal on ultrasound. That is why diagnosis follows a clear set of criteria, and why treatment is shaped around what matters most to you right now: your periods, your skin and hair, your weight, or a pregnancy.
Dr. Devang Patel, M.D. (Obstetrics & Gynecology, Gold Medalist), sees women with PCOS at Divine Women’s Hospital, Gota, from teenage years through to planning a family and beyond. Because PCOS affects pregnancy too, the same team can continue your care if you conceive.
What is going on in PCOS
In a typical cycle, one follicle in the ovary grows, releases an egg and the period follows about two weeks later. In PCOS, many follicles start to grow but stall at a small size, ovulation happens irregularly or not at all, and periods become infrequent or unpredictable.
Two drivers keep this going. The ovaries produce slightly more androgen, which causes acne, excess hair and further disrupts follicle growth. Insulin resistance, present in most women with PCOS whether slim or overweight, makes the body produce extra insulin, which in turn pushes the ovaries to make more androgen and encourages weight gain around the waist.
PCOS runs in families and is especially common in South Asian women, who tend to develop insulin resistance at a lower body weight. Sedentary routines, refined carbohydrates and weight gain do not cause PCOS, but they make it noticeably worse.
Signs and symptoms
- Irregular, infrequent or absent periods, or occasionally very heavy bleeding after a long gap
- Acne, oily skin, and excess hair on the face, chin, chest or abdomen (hirsutism)
- Thinning of scalp hair, especially along the parting
- Weight gain, particularly around the waist, and difficulty losing it
- Dark, velvety skin on the neck, underarms or groin (acanthosis nigricans), a sign of insulin resistance
- Difficulty conceiving because ovulation is irregular
- Low mood, anxiety and body-image concerns, which are more common with PCOS and deserve attention too
How PCOS is diagnosed
Following the Rotterdam criteria, as refined in the 2023 international evidence-based PCOS guideline, adults are diagnosed when at least two of these three features are present and other causes have been ruled out: irregular ovulation; clinical or blood-test signs of raised androgens; and polycystic ovaries on ultrasound, or a raised AMH level.
Irregular cycles in adults usually mean cycles shorter than 21 or longer than 35 days, or fewer than eight periods a year. On a transvaginal scan, polycystic ovaries are defined by 20 or more follicles in one ovary, or an ovarian volume of 10 ml or more. In girls within eight years of their first period, scans and AMH are not used, because many healthy adolescent ovaries look polycystic; diagnosis rests on persistent irregular cycles plus androgen signs.
Look-alike conditions are excluded first: thyroid disorders, a raised prolactin level, and where suspected, adrenal conditions such as non-classic congenital adrenal hyperplasia. A pregnancy test is done when periods have stopped.
Tests you can expect
- Pelvic ultrasound: transvaginal in married women, abdominal in girls and unmarried women, ideally in the first week of the cycle
- Hormones: testosterone (ideally free androgen index), TSH and prolactin; 17-hydroxyprogesterone if an adrenal cause is suspected
- Sugar: a 75 g oral glucose tolerance test, which picks up prediabetes that fasting sugar or HbA1c alone can miss
- Lipid profile and blood pressure, as a baseline for heart health
- Weight, BMI and waist measurement, using Asian cut-offs, where a BMI of 23 or above counts as overweight and a waist above 80 cm raises metabolic risk
- AMH, if useful for diagnosis in adults or for fertility planning
Treatment, matched to your goals
There is no single PCOS treatment. The table shows how the plan usually differs depending on what you want to achieve. Many women move between columns over the years, for example from cycle control to fertility treatment and back.
| Your main goal | Usual first steps | Other options |
|---|---|---|
| Regular periods and protecting the womb lining | Lifestyle change; combined oral contraceptive pill | Cyclical progesterone tablets every 1–3 months; metformin |
| Acne and excess hair | Combined pill for at least 6 months; skin care and laser or threading for hair | Anti-androgen tablets such as spironolactone, only with reliable contraception |
| Weight and insulin resistance | Diet and activity plan; target 5–10% weight loss if overweight | Metformin; newer weight-loss medicines in selected women |
| Pregnancy | Optimise weight, sugar and folic acid; letrozole to induce ovulation with follicle scans | Gonadotropin injections, laparoscopic ovarian drilling, or IVF |
Food, activity and sleep: the Indian kitchen and PCOS
Lifestyle change is the foundation of PCOS care, but it has to fit real life. The aim is not to give up home food but to change its balance: more protein and fibre at each meal, fewer refined carbohydrates and sugary drinks, and regular meal times.
Practical swaps include bajra, jowar or multigrain rotli instead of maida-based foods; a bowl of dal, sprouts, curd, paneer, eggs or chicken with each meal; vegetables filling half the plate; and keeping sweets, farsan, fried snacks, packaged juices and bakery items for occasional treats rather than daily habits.
Aim for at least 150 minutes a week of moderate activity such as brisk walking, cycling or dance, plus muscle-strengthening exercise twice a week; more is needed for weight loss. Regular sleep matters too, as poor sleep worsens insulin resistance and cravings. Supplements such as inositol are widely sold, but the evidence for them remains limited, and they are not a replacement for these basics.
In women who are overweight, losing even 5–10% of body weight often brings back regular ovulation, which is why small, sustainable changes are worth more than a crash diet.
PCOS, fertility and pregnancy
Most women with PCOS can conceive. Letrozole, taken for five days early in the cycle, is now the first-line tablet to bring on ovulation, and follicle-tracking scans confirm the response and time intercourse. If tablets do not work after several cycles, low-dose gonadotropin injections or laparoscopic ovarian drilling are options, and IVF is considered for some women.
Women with PCOS are more likely to over-respond to fertility drugs, so careful monitoring is important to avoid twins or ovarian hyperstimulation. Before pregnancy, folic acid should be started at least three months ahead, and weight, blood pressure and sugar optimised.
In pregnancy, PCOS raises the risk of gestational diabetes, high blood pressure and pre-eclampsia, and of preterm birth. Early sugar testing, often in the first trimester rather than waiting for 24–28 weeks, and closer monitoring are therefore advised. As a high-risk pregnancy specialist, Dr. Devang Patel can continue care through pregnancy at the same hospital.
Long-term health with PCOS
- Womb lining: going many months without a period can thicken the lining and, over years, raise the risk of endometrial hyperplasia and cancer, so a bleed at least every three to four months is advised
- Blood sugar: PCOS significantly raises the risk of prediabetes and type 2 diabetes, so sugar is rechecked every one to three years depending on your risk
- Heart health: blood pressure is checked yearly and cholesterol periodically
- Sleep apnoea: loud snoring and daytime tiredness should be mentioned, as they are more common with PCOS
- Emotional health: anxiety, depression and eating concerns are screened for and taken seriously
- After 40: cycles often become more regular, but metabolic risks continue, so checks should not stop
How PCOS care is organised at Divine Women’s Hospital
At the first visit Dr. Devang Patel takes a full history, examines skin, hair and weight, and arranges the scan and blood tests needed to confirm or rule out PCOS. Results are discussed in plain language, with time to ask questions, in Gujarati, Hindi or English.
You then agree a plan around your goal, with a review after three to six months. If pregnancy is the aim, follicle scans are done at the hospital in Gota, and if you conceive, antenatal care continues with the same doctor, which is useful given the higher pregnancy risks that come with PCOS.
Your care, step by step
- History and examinationYour cycle pattern, skin and hair changes, weight trend, family history and goals are reviewed together.
- TestsA pelvic ultrasound and blood tests for androgens, thyroid, prolactin and a glucose tolerance test confirm the diagnosis and rule out look-alikes.
- A plan around your goalTreatment is chosen for what matters most to you now: regular periods, skin and hair, weight or pregnancy.
- Follow-upResponse is reviewed after three to six months, and the plan adjusted.
- Long-term checksPeriodic sugar, blood pressure and cholesterol checks continue, and care carries on into pregnancy if you conceive.
When to book a visit
- Your periods come more than 35 days apart, or you have fewer than eight a year
- You have not had a period for three months or more and are not pregnant
- Acne, facial hair or scalp hair thinning is new or worsening
- Your teenage daughter’s cycles are still very irregular two or three years after her first period
- You have been trying to conceive for a year (or six months if over 35), or sooner if your periods are irregular
- You have PCOS and are planning a pregnancy
Warning signs - get same-day care
- Very heavy bleeding after a long gap without periods, soaking a pad every hour or causing faintness
- Severe lower abdominal pain, bloating, vomiting or breathlessness while taking fertility medicines, which may mean ovarian hyperstimulation
- Sudden one-sided pelvic pain with vomiting
- Pain or bleeding with a positive pregnancy test
- Excess thirst, frequent urination and weight loss, which may signal high blood sugar
Labour and emergency care are available 24 × 7. Call the hospital and come in directly.
Myths and facts
Myth: PCOS means you cannot have children.
Most women with PCOS conceive, naturally or with tablets to help ovulation. PCOS is one of the most treatable causes of subfertility.
Myth: Only overweight women get PCOS.
A significant proportion of women with PCOS are at a normal weight. They can still have insulin resistance and need the same long-term checks.
Myth: A scan showing polycystic ovaries means you have PCOS.
Polycystic-looking ovaries are common in healthy women, especially teenagers. PCOS needs at least two of the three features, with other causes ruled out.
Myth: Missing periods is harmless as long as you feel well.
Long gaps without a period can thicken the womb lining over time. A regular bleed, natural or medically induced, protects it.
Frequently asked questions
Can PCOS be cured permanently?
PCOS is a long-term tendency rather than an infection or growth that can be removed, so there is no one-time cure. The symptoms can, however, be controlled very well, and many women have regular cycles once weight and insulin resistance improve. Symptoms often ease further with age.
Is PCOD different from PCOS?
In everyday use in India, PCOD and PCOS mean the same condition. Guidelines use the term PCOS, polycystic ovary syndrome, because it affects hormones and metabolism, not just the ovaries.
Can I get pregnant naturally with PCOS?
Yes, many women do, particularly if they ovulate some months or after modest weight loss. If periods are irregular, it is reasonable to seek help sooner rather than wait a full year, because letrozole and follicle scans can shorten the time to pregnancy.
Do I need to take birth control pills for life?
No. The pill is one option for regulating periods and treating acne or hair growth, and it can be stopped whenever you wish to conceive or try another approach. Some women manage well with lifestyle change alone or with periodic progesterone tablets to bring on a bleed.
Is metformin necessary for PCOS?
Not for everyone. Metformin helps insulin resistance, weight and sometimes cycles, especially alongside lifestyle change. It can cause stomach upset, which is reduced by starting low and taking it with meals. Whether it suits you depends on your weight, sugar levels and goals.
Will losing weight make PCOS go away?
Weight loss does not remove the underlying tendency, but in women who are overweight, losing 5–10% of body weight often restores regular ovulation, improves skin and lowers diabetes risk. Women with PCOS at a healthy weight need a plan focused on cycles and symptoms instead.
Is PCOS a reason for hair fall and facial hair?
Yes, raised androgens can thin scalp hair and increase facial and body hair. The combined pill, and sometimes anti-androgen tablets, slow new growth over six months or more, and cosmetic methods remove existing hair.
Does PCOS cause cancer?
Long gaps between periods can, over years, raise the risk of abnormal changes in the womb lining. Making sure you have a regular bleed, naturally, with the pill or with progesterone, protects against this. Bleeding between periods or a very long gap should be checked.
What should I eat if I have PCOS?
Focus on regular meals with protein at each one, millets or whole grains instead of maida, plenty of vegetables, and fewer sweets, fried snacks and sugary drinks. There is no single “PCOS diet”; the plan that works is the one you can keep up.
Can teenagers have PCOS?
Yes, but it is diagnosed carefully. Irregular cycles are normal for the first couple of years after periods start, and scans are not used for diagnosis in this age group. If cycles stay irregular with acne or excess hair, a teenager may be labelled “at risk” and reassessed later.