PCOS - Symptoms, Diagnosis and Treatment

PCOS or Polycystic Ovarian Disease is a common condition in women in the reproductive age group.

What is the main cause of PCOS?

The exact cause of PCOS isn’t fully understood, but research shows that several factors work together to trigger it.

• Hormonal Imbalance: PCOS is mainly driven by higher-than-normal levels of androgens (often called “male hormones,” but present in all women). Excess androgens are secreted by the ovaries and this can interfere with normal ovulation and cause physical symptoms like acne and excess hair growth.
• Insulin Resistance: Many women with PCOS have insulin resistance, which means their body doesn’t respond well to insulin. This makes the pancreas produce more insulin, which in turn stimulates the ovaries to make more androgens.
• Genetics: PCOS tends to run in families. If your mother, sister, or aunt has PCOS or irregular periods, your chances of having it are higher.
• Low-grade Inflammation: Some studies suggest women with PCOS have a type of low-grade inflammation that stimulates the ovaries to produce more androgens.

At what age does PCOS start?

PCOS can start at any time during the reproductive age of a woman . But it is most common in the twenties and thirties.

What are the Signs and Symptoms of PCOS?

Not every woman experiences all symptoms, and symptoms can vary in severity in different women. Some women notice symptoms early in their teens, while others find out only when they have trouble conceiving.

Common symptoms include:

• Irregular periods – Periods are often delayed but in some cases, the periods can occur earlier or later in different months.
• Heavy or scanty bleeding – The blood flow during the periods can vary. There may be heavy bleeding in some women. But most women complain of scanty bleeding with the periods lasting barely 1-2 days.
• Excess hair growth (hirsutism) – About 70% of women with PCOS may have increased hair growth on the face, usually along the chin or cheeks. Increased hair growth may also be seen on the lower abdomen and on the arms and legs. A typical male pattern hair growth is common.
• Acne and oily skin - PCOS can cause acne, especially on your back, chest and face. The skin may be oily. These PCOS symptoms are usually a result of high male hormones like testosterone and DHEAS.
• Hair thinning – Hair fall on the scalp is common.
• Obesity – Most women with PCOS complain of weight gain or difficulty in losing weight. This is more common in women who have been obese or have had a high weight in childhood. Diabetes and thyroid hormone issues are also common in this group of women.
• Dark, velvety skin patches (acanthosis nigricans).The skin may show dark, velvety patches along the back of the neck, upper back, arms, groins or thighs. Acanthosis Nigricans occurs due to stimulation of melanocytes (cells which produce the dark pigment called melanin) in the skin by the high insulin level common in PCOS.
• Skin tags – Skin tags are small, painless tags of skin commonly seen on the neck, back or arms. They occur due to stimulation of the skin by insulin.
• Infertility – Infertility is one of the most common complaints of women with PCOS. Difficulty in conceiving is usually due to lack of or delayed ovulation.
• Cysts in the ovary – On ultrasound, a number of small cysts may be seen on the periphery of the ovaries .

How does PCOS affect fertility?

One of the biggest concerns women have when they hear “PCOS” is “Will I be able to get pregnant?” The good news is that getting pregnant with PCOS is quite possible.

How PCOS affects fertility:

Irregular ovulation: Ovulation (release of an egg) occurs about 14 days after a period. PCOS causes irregular or delayed ovulation.Or sometimes no ovulation for a few months. This can cause difficulty in getting pregnant. However, medicines are available which can help control PCOS and also trigger ovulation form the varies.
Poor egg quality: The egg or ovum may not be of very good quality due to hormonal effects. The number of healthy ovums may be less in each menstrual cycle. Medicines to improve the egg count as well as the egg quality are needed to treat infertility due to PCOS
Hormonal imbalance: Hormonal imbalance occurs due to increased male hormones (androgens) like testosterone and DHEAS.

Fertility treatments that work:
- Lifestyle changes
- Ovulation-inducing medications
- Insulin-sensitizing drugs
- IVF (In Vitro Fertilization)

How is PCOS diagnosed?

PCOS is diagnosed based on three main symptoms – at least two of the following three symptoms must be present to make a diagnosis of PCOS

1. You must have irregular or missed periods for more than 3 months
2. The ultrasound should show a number of small follicles along the edge of the ovary, a sign known as the necklace pattern.
3. The blood levels of testosterone and DHEAS (male hormones) must be high. Signs of high male hormones include growth of hair along the chin or excessive acne.

How is PCOS Treated?

There’s no one-size-fits-all treatment for PCOS because symptoms differ from woman to woman. The goal is to manage symptoms, regulate periods, reduce long-term risks, and improve fertility if desired.

How PCOS is treated also depends on whether you want to become pregnant early or whether you are not interested in getting pregnant at that moment.

Lifestyle Modifications: You will be encouraged to lose weightby eating a healthy, nutritious diet and exercising. Regular exercise will not only help to improve weight but also regularise insulin levels. Weight management is vitally important in treatment of PCOS.
Common Medications:
1. Birth control pills – If you are not planning to get pregnant soon, birth control pills will be prescribed to regularise your periods. It will also help control acne.
2. Metformin – Metformin is a medicine which helps to control and normalize insulin levels. A normal insulin level will help improve PCOS and cause regular periods.
3. Inositol – Inositols like myoinositol and d-chiro inositol are substances which reduce insulin resistance and improves ovulation. They are also naturally found in many foods like fresh fruits (especially citrus fruits), beans, legumes, brown rice, and wheat bran..

4. Anti-androgens – Certain medicines like Spirinolactone can block androgens . These are prescribed to help decrease male pattern hair growth.

5. Fertility medicines – Medicines like Clomiphene Citrate or Letrozole can cause ovulation by stimulating the ovaries, They are usually prescribed for women planning a pregnancy.

Does PCOS ever get cured?

I am very sorry to say that there is no permanent cure for PCOS. But lifestyle changes combined with medicines can help decrease the symptoms and improve the symptoms to a great extent.

Frequently Asked Questions (FAQs) on PCOS

What are the most common symptoms of PCOS?

Common symptoms of PCOS include:

• Irregular or missed periods
• Weight gain (especially around the abdomen)
• Acne or oily skin
• Excess facial or body hair
• Difficulty getting pregnant

Not all women will have every symptom.

Does weight loss help in PCOS?

Yes, even a 5–10% reduction in body weight can help improve insulin resistance, regulate periods, and support ovulation in women with PCOS.

What foods should be avoided in PCOS?

Women with PCOS should limit foods that increase blood sugar quickly, such as:

• Sugary foods and drinks
• Refined carbohydrates (white bread, pastries)
• Processed and packaged foods

These can worsen insulin resistance and hormonal imbalance.

Is exercise really helpful for PCOS?

Yes, exercise is one of the most effective ways to manage PCOS. It helps improve insulin sensitivity, supports weight management, and can regulate menstrual cycles. A mix of strength training, walking, and moderate cardio works best.

Can PCOS cause weight gain?

Yes, PCOS can lead to weight gain, especially around the abdomen, due to insulin resistance and hormonal imbalance. It can also make losing weight more difficult, but not impossible with the right approach.

Are irregular periods always a sign of PCOS?

Not always. Irregular periods can have many causes, including stress, thyroid issues, or hormonal changes. However, if irregular cycles are frequent or long-term, PCOS is a common cause that should be evaluated.

Is PCOS genetic?

Researchers are learning more about the causes of PCOS. However, some evidence shows PCOS has a genetic or hereditary component. This means if your biological parent has PCOS, you may be more likely to have it, too.

Can PCOS lead to other health problems?

Yes, if not managed properly, PCOS can increase the risk of:

• Type 2 diabetes
• High blood pressure
• Cholesterol issues
• Endometrial problems

Early treatment and lifestyle changes can help reduce these risks.

When should I see a doctor for PCOS?

You should consult a doctor if you have:

• Irregular or absent periods
• Difficulty conceiving
• Excess hair growth or acne
• Unexplained weight gain

Early diagnosis and treatment can prevent long-term complications.

Final Words

PCOS can feel overwhelming at first—but with the right care, it’s entirely manageable. By understanding the causes, symptoms, fertility challenges, and treatment options, you can take charge of your health.

Click here to consult our gynecologist now.