Overview#
Polycystic Ovarian Disease (PCOD) or Polycystic Ovary Syndrome (PCOS) is a hormonal disorder affecting 1 in 5 Indian women of reproductive age (ICMR estimate). It is characterised by irregular ovulation, elevated androgens (male hormones), and multiple small follicles in the ovaries on ultrasound. PCOS is the leading cause of infertility due to anovulation and is strongly linked to insulin resistance, obesity, and metabolic syndrome.
Causes & Risk Factors#
- Insulin resistance – present in up to 70 % of PCOS patients; drives androgen overproduction by the ovaries.
- Hormonal imbalance – elevated LH (luteinizing hormone) relative to FSH, and excess androgens (testosterone, DHEAS).
- Genetic predisposition – strong familial clustering; having a mother or sister with PCOS increases risk significantly.
- Obesity – especially central adiposity; worsens insulin resistance and hormonal imbalance.
- Sedentary lifestyle and high-glycaemic diet – refined carbohydrates and sugary foods exacerbate insulin resistance.
Signs & Symptoms#
- Irregular, infrequent, or absent menstrual periods
- Heavy bleeding during periods when they occur
- Acne (especially along jawline and chin), oily skin
- Excessive facial and body hair (hirsutism) – upper lip, chin, chest, abdomen
- Hair thinning or male-pattern hair loss on the scalp
- Weight gain, particularly around the abdomen
- Darkening of skin in folds (neck, armpits, groin) – acanthosis nigricans
- Difficulty conceiving (infertility due to anovulation)
Diagnosis#
PCOS is diagnosed using the Rotterdam Criteria (2 of 3 features):
- Irregular or absent ovulation (menstrual irregularity)
- Clinical or biochemical signs of excess androgens
- Polycystic ovaries on ultrasound (≥ 12 follicles per ovary or ovarian volume > 10 mL)
Recommended tests:
- Hormonal Panel – LH, FSH, testosterone, DHEAS, prolactin. Book Hormone Panel
- Thyroid Profile – to rule out thyroid disorders that mimic PCOS. Book Thyroid Profile
- Fasting insulin and glucose – to assess insulin resistance. Book Fasting Blood Sugar
- Lipid Profile and HbA1c – to screen for metabolic complications. Book HbA1c
- Pelvic ultrasound – to visualize ovarian morphology.
Treatment Options#
Lifestyle modification (first-line):
- Weight loss of even 5-10 % can restore ovulation and improve symptoms.
- Low-glycaemic Indian diet: replace white rice with millets (ragi, jowar), increase protein (dal, chana, eggs), and add fibre-rich vegetables.
- 45-60 minutes of exercise most days – a combination of cardio and strength training is ideal.
Medications:
- Metformin – addresses insulin resistance; often used alongside lifestyle changes.
- Oral contraceptive pills (OCPs) – regulate periods and reduce androgen levels.
- Anti-androgens (spironolactone) – for severe acne and hirsutism.
- Letrozole or clomiphene – for ovulation induction in women trying to conceive.
- Inositol (myo-inositol + D-chiro-inositol) – emerging evidence supports its role in improving insulin sensitivity and ovulation.
Prevention#
- Maintain a healthy BMI through regular exercise and a balanced, low-glycaemic diet.
- Adolescent girls with irregular periods should be evaluated early rather than assuming it will "settle with age."
- Limit processed foods, sugary drinks, and refined carbohydrates.
- Manage stress, as cortisol elevation can worsen hormonal imbalance.
- Regular screening for metabolic complications (blood sugar, lipids) every 6-12 months.
When to See a Doctor#
Consult a gynaecologist if your periods are absent for more than 3 months, you notice unusual facial hair growth or severe acne, or you have been trying to conceive for over 6 months without success. Women with PCOS should also see an endocrinologist if they develop signs of diabetes or prediabetes.