Last month, September, was recognised as PCOS Awareness Month, a time dedicated to increasing understanding of Polycystic Ovary Syndrome (PCOS). A diagnosis of PCOS can often be accompanied by advice from well-meaning friends, information from online sources and guidance from family elders, all of which can sometimes leave the person confused and full of questions. Here are answers to 20 of the most frequently asked questions about PCOS—questions that concern many other young women.
What is the correct term?
The accurate term is PCOS, which stands for Polycystic Ovary Syndrome. A syndrome refers to a collection of signs and symptoms. It is not correct to refer to this as PCOD, since calling it a “disease” or “disorder” can cause unnecessary mental distress. Occasionally, people pronounce PCOS as “PECOS,” but it means the same thing. The term “PCO” specifically describes a certain ultrasound appearance of the ovaries, which can also be seen in healthy women or in conditions other than PCOS. For clarity, it is best to use the term PCOS. There is also a growing movement to rename the condition Metabolic Reproductive Syndrome (MRS) to reflect its metabolic aspects more accurately. Updates may be forthcoming.
Who discovered PCOS and when?
PCOS was first identified as Stein-Leventhal Syndrome in 1935 by American gynaecologists Irving F. Stein, Sr. and Michael L. Leventhal, who made the connection between ovarian cysts, menstrual irregularities, and lack of ovulation. Notably, similar symptoms were described by an Italian scientist as early as 1721, suggesting that PCOS has existed for centuries.
How common is it?
PCOS is a common condition: it is the most common endocrine disorder among women of reproductive age (15–49 years), affecting approximately 10–15% of women, with higher rates in certain ethnic groups and families.
Symptoms and diagnosis
Diagnosing PCOS involves a careful review of your medical history, a physical exam, laboratory tests, and a pelvic ultrasound. You should consult your doctor if you experience any of the following symptoms: irregular menstrual cycles, excessive acne, facial or body hair, scalp hair loss, oily skin and obesity.
The presence of polycystic ovaries on an ultrasound examination is another feature of the syndrome. Diagnosis generally requires meeting two of the following three criteria: irregular cycles, clinical or laboratory signs of high androgens, and polycystic ovaries on an ultrasound. For adolescents, the diagnosis is challenging because irregular cycles and acne may be part of normal puberty. In such cases, an ultrasound is not recommended within eight years of menarche (the start of menstruation). Instead, doctors look at family history, weight, blood sugar, cholesterol levels, and male hormone levels. Physicians will also rule out other conditions that mimic PCOS, such as high prolactin levels, hypothyroidism, Cushing’s syndrome, ovarian or adrenal tumours that produce male hormones, congenital adrenal hyperplasia, and early ovarian insufficiency.
What are the tests for PCOS?
It is best not to order tests on your own. Testing should be tailored to your specific symptoms to avoid unnecessary expenses and misleading results. Commonly recommended tests include: fasting glucose, fasting lipid profile, liver enzymes (SGOT, SGPT), TSH, testosterone, prolactin, FSH and a pelvic ultrasound (in adults). Additional tests may be ordered based on individual clinical findings.
What are the causes of PCOS?
PCOS is a complex condition with several contributing factors. These include: genetics, with a higher risk if a first-degree relative, such as your mother or sister, has PCOS; hormonal imbalances, especially those involving the luteinizing hormone (LH) and adrenal hormones; insulin resistance, as defects at the cellular level can contribute to PCOS; medications, as certain drugs, such as Valproate (used for seizures), may trigger or worsen PCOS and obesity, which can amplify symptoms or reveal the syndrome.
Can PCOS be prevented?
PCOS is likely not preventable, but weight gain can unmask or worsen the condition. You can reduce your risk of complications by eating a healthy diet, exercising regularly, managing stress, ensuring adequate sleep, and avoiding triggers for obesity.
PCOS and weight gain
Weight gain can worsen PCOS symptoms. Approximately 50–70% of women with PCOS are overweight or obese, and some may also experience binge eating or have an eating disorder. Managing your weight helps lower insulin resistance, prevents diabetes and heart disease, and restores hormonal balance. Support for weight management may include dietary changes, exercise, counselling with a dietitian, sleep hygiene, medications, or, in select cases, bariatric surgery.
Whom should I consult?
It is best to begin with an obstetrician/gynaecologist (Ob/Gyn) or an endocrinologist. Depending on your symptoms, you may also be referred to a dermatologist (for acne or excessive body hair) or a nutritionist (for weight management, blood sugar, or cholesterol issues). Since PCOS affects multiple systems, long-term care from experienced professionals is essential.
What are focus areas for management?
Managing PCOS requires a holistic approach, addressing all of the following: menstrual cycles, aiming for at least one period every two months to prevent endometrial thickening; optimal weight, as it is important for restoring ovulation and preventing metabolic issues; ensuring metabolic health through the monitoring of blood sugar, cholesterol, and liver function; addressing cosmetic issues such as acne and hair growth, after evaluating underlying causes.
Can women with PCOS get pregnant?
Most women with PCOS can become pregnant, although some may need medical assistance. Approaches often include weight loss, ovulation-inducing medications, and assisted reproduction. Preconception care is especially important for women with PCOS to reduce the risk of gestational diabetes and high blood pressure during pregnancy.
Is there a male equivalent?
There appears to be a male equivalent in men who have a family history of PCOS. These men may experience premature balding and metabolic issues such as diabetes, high cholesterol, and fatty liver. Healthy lifestyle choices and regular health screenings are recommended for men in this group.
Should I be on a special diet?
There is no need for complicated diets for PCOS. The best dietary approach is similar to the Mediterranean diet, which emphasizes: high-fibre foods including vegetables, fruits, legumes; low simple sugars and high complex carbohydrates; no trans fats and low saturated fats; lean proteins, whole grains, and portion control; healthy fats (nuts, seeds, olive oil). Home-cooked meals should be prioritised and it is best to avoid junk food and sugary drinks.
What are the medications?
Metformin, commonly used to treat diabetes, can improve insulin resistance in PCOS. It may be prescribed for prediabetes or diabetes and can help with weight loss and regulating menstrual cycles. The choice of medication depends on symptoms. For irregular cycles, oral contraceptives, progesterone, or Metformin may be prescribed. For excess androgens, anti-androgens such as spironolactone or cyproterone may be given. For obesity, lifestyle changes may be recommended. Metformin or GLP-1 analogues may also be prescribed. For infertility, ovulation-inducing medications such as Letrozole, Clomiphene, Gonadotropins or procedures may be recommended.
Are insulin checks necessary?
Routine testing of insulin levels or HOMA-IR is not recommended. Obesity itself can raise Insulin levels. Instead, monitoring should focus on fasting glucose, HbA1c, or using a 75g Oral Glucose Tolerance Test (OGTT).
How safe are oral contraceptives?
Oral contraceptives can help regulate menstrual cycles, reduce male hormone levels, and provide contraception. However, they should be used with caution if you are over 35 years old, are obese, or smoke.
Periods and exercise
Regular exercise improves the body’s insulin sensitivity by decreasing resistance. This improvement provides several benefits for people with PCOS. First, it aids in weight loss, which is often an important part of managing symptoms. Exercise also helps balance hormones, which is key to restoring normal ovulation and establishing more regular menstrual cycles.
Mood changes and PCOS
Mood changes, anxiety, and depression are common among individuals with PCOS. These mental health concerns can arise due to several factors, such as hormonal imbalances, challenges with weight or body image, stress related to fertility, and poor sleep quality. These are legitimate concerns, and it is important to seek support and assistance when needed to maintain overall well-being.
Will my PCOS go away?
Polycystic Ovary Syndrome (PCOS) is a chronic condition with a genetic basis. It does not resolve over time, and the ovarian cysts associated with PCOS do not appear and disappear frequently. Ultrasound imaging is intended for the initial diagnosis of PCOS, not for ongoing monitoring or repeated assessments. Instead of focusing on repeat ultrasounds, it is more important to monitor symptoms and key laboratory markers. Important factors to track include weight, blood sugar levels, cholesterol, sleep quality, and testosterone levels if symptoms persist.
Will cyst removals end PCOS?
The cysts found in PCOS are not dangerous and do not require surgical removal. These cysts result from a lack of ovulation and are not the root cause of the condition. Surgical interventions, such as removing cysts, do not address underlying issues such as insulin resistance or obesity. In rare situations, a procedure called laparoscopic ovarian drilling might be used to induce ovulation in women who are struggling to conceive. However, this treatment is highly specific and not routinely performed.
Take proactive action
PCOS is a common, chronic, and complex condition that can present in various ways. Effective management requires a personalized approach based on age, symptoms, reproductive goals, and metabolic health. Women with PCOS should feel empowered to ask questions, understand their bodies, and take proactive steps to maintain their physical, mental, and emotional health.
(Dr. Usha Sriram is head of diabetes and endocrinology at the Voluntary Health Services, Chennai. drushasriram@gmail.com)
