PCOS: Understanding Polycystic Ovary Syndrome
PCOS is one of the most common hormonal disorders in women of reproductive age. Early diagnosis and the right management plan can make a significant difference.
By Dr. Amrendra Prasad Kushwaha
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder affecting approximately 1 in 10 women of reproductive age. Despite being so common, it remains widely misunderstood and often goes undiagnosed for years. As a gynaecologist, I see this condition regularly and want to help women understand it clearly.
What Is PCOS?
PCOS is a condition in which the ovaries produce an excess of androgens (male hormones), which interferes with the development and release of eggs. The ovaries may develop many small follicles (cysts) that fail to mature and release an egg — leading to irregular or absent ovulation.
Common Symptoms
PCOS presents differently in every woman. The most frequent symptoms include:
- Irregular periods — cycles longer than 35 days, or fewer than 8 periods per year
- Excess hair growth (hirsutism) — on the face, chest, or back
- Acne — particularly on the jaw, chin, and chest
- Hair thinning or loss on the scalp
- Weight gain — especially around the abdomen
- Difficulty getting pregnant due to irregular ovulation
- Darkening of skin in neck creases, groin, or under the breasts
How Is PCOS Diagnosed?
There is no single test for PCOS. Diagnosis is based on the Rotterdam Criteria — at least 2 of the following 3 must be present:
- Irregular or absent ovulation
- Clinical or biochemical signs of excess androgens
- Polycystic ovaries on ultrasound (≥12 follicles in one ovary or ovarian volume >10 mL)
Blood tests to check hormone levels (LH, FSH, testosterone, insulin, thyroid) and a pelvic ultrasound are the main investigations.
Health Risks Associated with PCOS
PCOS is more than a reproductive issue. If left unmanaged, it increases the risk of:
- Type 2 diabetes — due to insulin resistance
- Cardiovascular disease
- Endometrial cancer — due to prolonged exposure of the uterine lining without regular shedding
- Obstructive sleep apnoea
- Depression and anxiety
Treatment Options
PCOS has no permanent cure, but symptoms can be effectively managed.
Lifestyle Changes (First-Line Treatment)
Even a 5–10% reduction in body weight can restore regular periods and improve fertility in overweight women with PCOS. A balanced diet low in refined carbohydrates, combined with regular exercise, significantly improves insulin sensitivity.
Medications
- Combined oral contraceptive pill — regulates periods and reduces androgen-related symptoms
- Metformin — improves insulin resistance and helps restore ovulation
- Anti-androgens (e.g., spironolactone) — reduces hair growth and acne
- Clomiphene or Letrozole — induces ovulation for women trying to conceive
Fertility Treatment
Women with PCOS who wish to conceive and do not respond to oral medications may benefit from:
- Ovulation induction with injectable gonadotropins
- Laparoscopic ovarian drilling
- IVF (in vitro fertilisation)
Living with PCOS
PCOS is a lifelong condition, but with the right support it is very manageable. Regular monitoring, a healthy lifestyle, and working closely with your gynaecologist allow most women with PCOS to live full, healthy lives — and many go on to have successful pregnancies.
If you suspect you may have PCOS, do not delay seeking evaluation. Early diagnosis and management can prevent long-term complications.
Contact: 984-3504431 | Hope Hospital, Kathmandu