PCOS basics: symptoms, diagnosis, and lifestyle steps that help

PCOS stands for polycystic ovary syndrome. It's a hormonal condition where your ovaries (the two small organs that store eggs) make more androgens (male-type hormones like testosterone that everyone has in small amounts) than they should.

Globally, PCOS affects about 10–13% of women of reproductive age (roughly 1 in 8). Indian community studies often show even higher numbers — up to 1 in 5 in some regions, depending on the diagnostic criteria used.

The name is a little misleading — you don't actually need cysts on your ovaries to have PCOS. What matters is the pattern of symptoms and hormone levels.

Common symptoms

• Irregular or missed periods — often the first sign
• Acne that keeps coming back, especially along the jaw
• Hair growth on the face, chest, or belly (called hirsutism)
• Hair thinning on the scalp
• Weight gain, especially around the middle, that's hard to shift
• Trouble getting pregnant
• Darker patches of skin (called acanthosis nigricans) on the neck or under the arms — often a sign of insulin resistance (when your body doesn't use insulin well)

How doctors diagnose it — the Rotterdam criteria

Doctors use what's called the Rotterdam criteria. You need at least two of the three:

1. Irregular or missed periods
2. Signs of high androgens (either visible — acne, hirsutism — or on a blood test)
3. Many small follicles on an ovary ultrasound (or a raised AMH — anti-Müllerian hormone — blood test, which the 2023 international guideline accepts as an alternative in adults)

Your gynaecologist will usually:

• Ask about your cycle history and symptoms
• Do blood tests for hormones (testosterone, LH, FSH, thyroid, prolactin, AMH)
• Order an ultrasound of the ovaries if needed
• Check fasting glucose and HbA1c (a blood-sugar average over 3 months) — PCOS raises diabetes risk, and this risk is higher in South Asian women, so screening thresholds are lower

Lifestyle steps that genuinely help

PCOS has no cure — but it responds strongly to lifestyle changes. These aren't "just diet advice"; they're treatment.

• Move most days. Any movement — walking, dancing, yoga, gym — improves how your body handles insulin, which is often the root problem in PCOS. Aim for 30–45 minutes, 4–5 days a week.
• Eat protein and fibre first. Start meals with dal, paneer, egg, chicken, or fish — plus a vegetable — before the rice or roti. This keeps blood sugar steady.
• Cut back on ultra-processed carbs. White bread, sugary drinks, and packaged snacks spike insulin and worsen symptoms. You don't need to give them up entirely — just less often.
• Sleep 7–8 hours. Poor sleep worsens insulin resistance.
• Reduce stress. Chronic stress raises cortisol, which raises androgens.

Even a 5–10% loss in body weight (if you're overweight) often brings periods back and improves fertility.

Medical and supplement treatments your doctor may suggest

• Combined birth control pills — to regulate cycles and reduce acne/hair symptoms
• Metformin — a diabetes medicine that helps insulin resistance
• Letrozole (now first-line, ahead of clomiphene) — for women trying to get pregnant
• Spironolactone — for stubborn hair growth and acne
• Inositol (usually myo-inositol, sometimes combined with D-chiro-inositol) — a supplement recognised in the 2023 international PCOS guideline. Evidence is still emerging, but many women report better cycles and fewer symptoms. Talk to your doctor before starting.

When to see a doctor

• You go 3+ months without a period
• You have acne or hair growth that upsets you
• You've been trying to get pregnant for 12 months without luck (or 6 months if you're over 35)

PCOS is manageable. It's not a life sentence — thousands of women live full lives, get pregnant, and feel well with the right support.