Understanding PCOS

Polycystic ovary syndrome — PCOS — is one of the most common hormonal conditions in women of reproductive age, and one of the most misunderstood. Studies in India suggest it affects somewhere between one in five and one in ten women. Many go years without a diagnosis, because the symptoms are easy to dismiss individually.

What PCOS actually is

Despite the name, PCOS is not really about cysts. The "cysts" seen on an ultrasound are actually small immature follicles — eggs that started to develop but never released. The real problem is hormonal: the ovaries produce slightly more androgens (male-type hormones) than usual, and ovulation becomes irregular or stops.

That single disruption explains almost every symptom that follows. If you don't ovulate regularly, periods become unpredictable. Higher androgens cause acne and unwanted hair. And many women with PCOS also have insulin resistance, which makes weight harder to manage and drives the hormonal imbalance further.

Signs worth noticing

No two women present identically. You do not need all of these to have PCOS:

• Irregular or missing periods — cycles longer than 35 days, or fewer than eight periods a year
• Acne that persists past the teenage years, especially along the jawline
• Excess hair growth on the face, chest or abdomen (hirsutism)
• Hair thinning on the scalp
• Weight gain, particularly around the middle, or difficulty losing weight
• Difficulty conceiving — often the reason women first come in
• Darkened skin patches on the neck or underarms, a sign of insulin resistance

Why it happens

There is no single cause. PCOS tends to run in families, so genetics play a real part. Insulin resistance is central for many women: when the body's cells respond poorly to insulin, the pancreas produces more of it, and high insulin levels push the ovaries to make more androgens. Low-grade inflammation and lifestyle factors interact with all of this.

What matters practically is this — PCOS is not caused by anything you did, and it is manageable.

How it's diagnosed

Diagnosis uses the Rotterdam criteria: you need two of the following three.

1. Irregular or absent ovulation
2. Clinical or blood-test evidence of raised androgens
3. Polycystic-appearing ovaries on ultrasound

In practice a consultation usually involves a detailed history of your cycles, an examination, a pelvic ultrasound, and blood tests — typically hormone levels, thyroid function, prolactin, and a check of blood sugar and insulin. Other conditions that mimic PCOS, particularly thyroid disorders, must be ruled out first.

Treatment options

Treatment depends entirely on what is troubling you and whether you are trying to conceive. There is no one prescription.

Lifestyle changes

This is genuinely the first-line treatment, not a consolation. Even a 5–10% reduction in body weight can restore regular ovulation in many women. Resistance training and reducing refined carbohydrates help insulin resistance more than crash dieting does.

Medication for cycles and symptoms

Combined hormonal contraceptives regulate periods, reduce acne and control excess hair growth. They protect the uterine lining too — important, because long gaps between periods raise the long-term risk of endometrial problems.

Insulin-sensitising treatment

Metformin is often used where insulin resistance is prominent, and can help restore cycles alongside lifestyle change.

If you're trying to conceive

Ovulation-induction medication is usually the starting point, with follicular tracking by ultrasound to time things properly. Most women with PCOS conceive with relatively simple treatment; a minority need to progress to IUI or IVF.

PCOS is a long-term condition, but it is not a life sentence, and it does not mean you cannot have children. Most women who want to conceive, do.

When to see a doctor

Book a consultation if your cycles are consistently longer than 35 days, if you've had fewer than eight periods in a year, if acne or hair growth is worsening, or if you've been trying to conceive for a year without success (six months if you're over 35).

Beyond fertility, PCOS carries a raised long-term risk of type 2 diabetes and cardiovascular disease. That's a strong reason to get it identified and monitored early, even if you're not planning a pregnancy.